The future of children of female sex workers in Rwanda : a call to address their risk and vulnerability to HIV infection

Female sex workers (FSWs) are one of the populations most at risk for becoming infected with HIV in sub-Saharan Africa, a region with the worst disease burden globally. In Rwanda, there are an estimated 15,000 FSWs. The HIV prevalence among FSWs in Rwanda was estimated to be approximately 46% in 2015. The 2015 Behavioral and Biological Surveillance Survey among female sex workers enrolled 1978 FSWs. In this study, 4% and 10,4% of the FSWs in Kigali city and other provinces respectively were aged 15–19. Nearly a quarter (22%) reported conducting their business from home as opposed to other hotspots [2]. Participants largely (70%) reported that they had sexual intercourse for their first time at the age of 15–19. Among them, 43% were engaged in the sex work for the first time within the same age range with 5.5% reporting engaging in their first commercial sex under the age of 15 years. Despite the progress made in HIV interventions amongst FSWs as evident by the decreased prevalence, little work has been done on their children, an equally vulnerable population.https://www.sciencedirect.com/journal/public-health-in-practiceam2022School of Health Systems and Public Health (SHSPH

COVID-19 : comparison of the response in Rwanda, South Africa and Zimbabwe

The COVID-19 pandemic has had an impact worldwide with regions experiencing varying degrees of severity. African countries have mounted different response strategies eliciting varied outcomes. Here, we compare these response strategies in Rwanda, South Africa and Zimbabwe and discuss lessons that could be shared. In particular, Rwanda has a robust and coordinated national health system that has effectively contained the epidemic. South Africa has considerable testing capacity, which has been used productively in a national response largely funded by local resources but affected negatively by corruption. Zimbabwe has an effective point-of-entry approach that utilizes an innovative strategic information system. All three countries would benefi t having routine meetings to share experiences and lessons learned during the COVD-19 pandemic.http://mediccreview.orgam2022School of Health Systems and Public Health (SHSPH

Factors associated with retention on pre-exposure prophylaxis among female sex workers in Kigali, Rwanda.

Pre-Exposure Prophylaxis (PrEP) is recommended as an additional HIV prevention measure for persons at substantial risk of HIV acquisition. Although uptake of PrEP among female sex workers (FSW) has increased, retention remains low, resulting in suboptimal benefits. This study aimed at determining PrEP retention rates and associated factors among FSW in Kigali, Rwanda. We retrospectively studied records of 309 FSW abstracted from five (5) health centers for the period between April-June 2020 and April-June 2021. PrEP retention was defined as presenting for a scheduled follow-up visit. We used Kaplan-Meier survival analysis to estimate survival probabilities at months 1,3,6,9, and 12 post-PrEP initiation and Cox regression to determine factors associated with 12-month PrEP retention. Data was analyzed using STATA (version 14.0). Out of 309 FSW whose records were reviewed, data for 268 (87%) were complete. One half (50%, n = 133) of the respondents were aged 25-34 years; slightly more than half (52%, n = 136) were single; nearly three-quarters (73%, n = 196) had completed primary school; majority (88%, n = 236) lived alone; while 69% (n = 184) had no formal employment besides sex work. PrEP dropout rates were 228, 65, 29, 49, and 36 per 100-persons years at months 1, 3, 6, 9 and 12 respectively, with 81%, 72%, 67%, 59% and 53% of FSW that started PrEP retained at these time periods. Multivariable Cox regression revealed that compared to FSW opposed to additional children, the desire to have two or more children (adjusted Hazard Ratio [aHR] = 1.654; 95% Confidential Interval [95%CI]: 1.008, 2.713); and using hormonal (aHR = 2.091, 95%CI: 1.181, 3.702) or no method of contraception other than condoms (aHR = 2.036, 95%CI: 1.006, 4.119) were factors positively associated with PrEP retention. Conversely, compared to consistent condom-use, not using (aHR = 0.329; 95%CI: 0.149, 0.726) or inconsistently using condoms (aHR = 0.413; 95%CI: 0.228, 0.749), and accessing PrEP from ultra-urban clinics (aHR = 0.290; 95%CI: 0.183, 0.458) compared to clinics in the outskirts of the city, were factors negatively associated with PrEP retention. The study found a continuous decline in PrEP retention among FSW with slightly more than half retained at 12 months. To improve outcomes, PrEP retention monitoring should target FSW enrolled in ultra-urban clinics and those not or inconsistently using condoms

Epidemiology of sexually transmitted infections: trends among patients screened for sexually transmitted infections in rwandan health facilities 2014–2020

Background Sexually Transmitted Infections (STIs) are of great global health concern. Currently, there are limited epidemiological data characterizing STIs in the general population in Rwanda. We assessed the national and regional epidemiology of STIs in Rwanda from 2014–2020 among patients syndromically screened for STIs in all health facilities in Rwanda. Methods This is a retrospective analysis of the trend of STIs epidemiology among screened patients at all health facilities in Rwanda using data from the Health Management Information System (HMIS) reporting. Adult patients (15 years and over) screened for STIs between July 2014 and June 2020 were included in the analysis. Outcomes of interest were the number of individuals screened for STIs and individuals diagnosed with at least one STI with a syndromic approach only or plus a test together. Results Overall, the number of individuals screened for STIs over the study period was 5.3 million (M) in 2014–2015, 6.6 M in 2015–2016, 6.3 M in 2016–2017, 6.7 M in 2017–2018, 6.2 M in 2018–2019, and 4.9 M in 2019–2020. There was a modest increase in the number of individuals diagnosed and treated for STIs from 139,357 in 2014–15 to 202,294 (45% increase) in 2019–2020. At the national level, the prevalence of STI syndromes amongst individuals screened at health facilities in Rwanda varied between 2.37% to 4.16% during the study period. Among the provinces, Kigali city had the highest prevalence for the whole 6 years ranging from 3.46% (95%CI: 3.41, 3.51) in 2014–2015 to 8.23% (95%CI: 8.15, 8.31) in 2019–2020. Conclusion From 2014 to 2020, the number of patients screened for STI syndromes in Rwanda varied between 4.9 M and 6.7 M. However, the prevalence of STIs among screened patients increased considerably over time, which could be associated with public awareness and improved data recording. The highest prevalence of all STIs was observed in urban areas and near borders, and private clinics reported more cases, suggesting the need to improve awareness in these settings and increase confidentiality and trust in public health clinics.Medicine, Faculty ofNon UBCPopulation and Public Health (SPPH), School ofReviewedFacultyResearche

Additional file 1 of Reducing time to differentiated service delivery for newly-diagnosed people living with HIV in Kigali, Rwanda: a pilot, unblinded, randomized controlled trial

Supplementary Material

Estimated proportion of PLHIV and transmission proportion attributable to PLHIV subgroups in Nigeria, Ethiopia, Rwanda, Lesotho, 2010–2020.

Countries chosen as illustrative examples as their transmission proportion patterns are similar to other countries in their regions. See S12 Fig for all countries in analysis.</p

Predicted prevalence ratios of self-reporting condomless last sex (with any partner) for each of the 14 survey countries by sex.

Predicted prevalence ratios of self-reporting condomless last sex (with any partner) for each of the 14 survey countries by sex.</p

Predicted prevalence ratios of self-reporting condomless casual partnership for each of the 14 survey countries by sex.

Predicted prevalence ratios of self-reporting condomless casual partnership for each of the 14 survey countries by sex.</p

Proportion of transmission attributed to PLHIV sub-group by sex across all 14 PHIA surveys (sensitivity analysis using linear function of transmission and viremia relationship, and adjusted prevalence ratio of self-reporting HIV high-risk behaviour in transmission equation.

Proportion of transmission attributed to PLHIV sub-group by sex across all 14 PHIA surveys (sensitivity analysis using linear function of transmission and viremia relationship, and adjusted prevalence ratio of self-reporting HIV high-risk behaviour in transmission equation.</p

Forest plots showing the adjusted prevalence ratios of self-reporting high HIV high-risk behaviour by sub-groups (including normalized survey weight in regression mode).

Forest plots showing the adjusted prevalence ratios of self-reporting high HIV high-risk behaviour by sub-groups (including normalized survey weight in regression mode).</p