Search

Pre-Exposure Prophylaxis (PrEP) is recommended as an HIV prevention measure for men who have sex with men (MSM). We assessed factors associated with PrEP retention and adherence among MSM in Kigali, Rwanda. We undertook a retrospective cross-sectional study and used a questionnaire to obtain PrEP retention and adherence history from MSM enrolled in the key population (KP) program that attended scheduled follow-up clinics from four (4) health facilities between April 2021 to June 2021. Retention was defined as attending scheduled PrEP follow-up appointments and adherence as taking PrEP medication 95% or more of the time. We used multivariable cox proportion hazard regression to determine factors associated with 3-month retention and principal component analysis (PCA) to determine factors associated with self-reported adherence. Data were analyzed using STATA (version 16.0). We interviewed 439 MSM aged 18 years and above that were initiated on PrEP. Majority were employed (57%, n = 251), between ages 25-34 years (49%, n = 217), close to half completed primary level education (47%, n = 206), were involved in sex work (42%, n = 184), and over a half lived in household of 1-2 members (55%, n = 241). Ninety percent of the MSM respondents (n = 393) were retained on PrEP at 3 months and among those retained, 287 (73%) had good adherence. Multivariable cox regression revealed that MSM more likely to be retained on PrEP, were those that are sex workers (adjusted Hazard Ratio (aHR) = 4.139; 95% Confidence Interval (95%CI): 1.569, 10.921), had more than one (1) regular sexual partners (aHR = 3.949; 95%CI: 2.221, 7.022), lived in households of 3-5 members (aHR = 3.755; 95%CI: 1.706, 8.261), completed secondary school education (aHR = 2.154; 95%CI: 1.130, 4.108), and were circumcised (aHR = 2.218, 95%CI: 1.232, 3.993). Employed MSM had a 66% decreased likelihood to be retained on PrEP (aHR = 0.345; 95%CI: 0.168, 0.707). Similarly, MSM that used condoms consistently had an 85% decreased likelihood to be retained on PrEP (aHR = 0.149; 95%CI: 0.035, 0.632). Principal component regression analysis showed that the component with MSM with higher numbers of regular sexual partners had increased odds of adhering to PrEP (Crude Odds Ratio (cOR) = 1.32; 95%CI: 1.144, 1.530). The study highlighted that MSM using PrEP as the main method of HIV prevention were more likely to be retained and adherent to PrEP. There is need to emphasize PrEP use alongside other HIV prevention methods and targeted STI testing and treatment among PrEP users.

Background We examined the epidemiology and transmission potential of HIV population viral load (VL) in 12 sub-Saharan African countries. Methods We analyzed data from Population-based HIV Impact Assessments (PHIAs), large national household-based surveys conducted between 2015 and 2019 in Cameroon, Cote d’Ivoire, Eswatini, Kenya, Lesotho, Malawi, Namibia, Rwanda, Tanzania, Uganda, Zambia, and Zimbabwe. Blood-based biomarkers included HIV serology, recency of HIV infection, and VL. We estimated the number of people living with HIV (PLHIV) with suppressed viral load (Results The proportion of female PLHIV with viral suppression was higher than that among males in all countries, however, the number of unsuppressed females outnumbered that of unsuppressed males in all countries due to higher overall female HIV prevalence, with ratios ranging from 1.08 to 2.10 (median: 1.43). The spatial distribution of HIV seroprevalence, viremia prevalence, and number of unsuppressed adults often differed substantially within the same countries. The 1% and 5% of PLHIV with the highest VL on average accounted for 34% and 66%, respectively, of countries’ total VL. HIV transmission ratios varied widely across countries and were higher for male-to-female (range: 2.3–28.3/100 PY) than for female-to-male transmission (range: 1.5–10.6/100 PY). In all countries mean log10 VL among unsuppressed males was higher than that among females. Correlations between VL measures and incident HIV varied, were weaker for VL metrics among females compared to males and were strongest for the number of unsuppressed PLHIV per 100 HIV-negative adults (R2 = 0.92). Conclusions Despite higher proportions of viral suppression, female unsuppressed PLHIV outnumbered males in all countries examined. Unsuppressed male PLHIV have consistently higher VL and a higher risk of transmitting HIV than females. Just 5% of PLHIV account for almost two-thirds of countries’ total VL. Population-level VL metrics help monitor the epidemic and highlight key programmatic gaps in these African countries.

Voluntary medical male circumcision (VMMC) has primarily been promoted for HIV prevention. Evidence also supports that male circumcision offers protection against other sexually transmitted infections. This analysis assessed the effect of circumcision on syphilis, hepatitis B virus (HBV) infection and HIV. Data from the 2015 to 2019 Population-based HIV Impact Assessments (PHIAs) surveys from Rwanda, Tanzania, Uganda, Zambia, and Zimbabwe were used for the analysis. The PHIA surveys are cross-sectional, nationally representative household surveys that include biomarking testing for HIV, syphilis and HBV infection. This is a secondary data analysis using publicly available PHIA data. Univariate and multivariable logistic regression models were created using pooled PHIA data across the five countries to assess the effect of male circumcision on HIV, active and ever syphilis, and HBV infection among sexually active males aged 15-59 years. Circumcised men had lower odds of syphilis infection, ever or active infection, and HIV, compared to uncircumcised men, after adjusting for covariates (active syphilis infection = 0.67 adjusted odds ratio (aOR), 95% confidence interval (CI), 0.52-0.87, ever having had a syphilis infection = 0.85 aOR, 95% CI, 0.73-0.98, and HIV = 0.53 aOR, 95% CI, 0.47-0.61). No difference between circumcised and uncircumcised men was identified for HBV infection (P = 0.75). Circumcised men have a reduced likelihood for syphilis and HIV compared to uncircumcised men. However, we found no statistically significant difference between circumcised and uncircumcised men for HBV infection.

BackgroundDespite Rwanda's progress toward HIV epidemic control, 16.2% of HIV-positive individuals are unaware of their HIV positive status. Tailoring the public health strategy could help reach these individuals with new HIV infection and achieve epidemic control. Recency testing is primarily for surveillance, monitoring, and evaluation but it's not for diagnostic purposes. However, it's important to know what proportion of the newly diagnosed are recent infections so that HIV prevention can be tailored to the profile of people who are recently infected. We therefore used available national data to characterize individuals with recent HIV infection in Rwanda to inform the epidemic response.MethodsWe included all national-level data for recency testing reported from October 2018 to June 2020. Eligible participants were adults (aged ≥15 years) who had a new HIV diagnosis, who self-reported being antiretroviral therapy (ART) naïve, and who had consented to recency testing. Numbers and proportions of recent HIV infections were estimated, and precision around these estimates was calculated with 95% confidence intervals (CI). Logistic regression was used to assess factors associated with being recently (within 12 months) infected with HIV.ResultsOf 7,785 eligible individuals with a new HIV-positive diagnosis, 475 (6.1%) met the criteria for RITA recent infection. The proportion of RITA recent infections among individuals with newly identified HIV was high among those aged 15-24 years (9.6%) and in men aged ≥65 years (10.3%) compared to other age groups; and were higher among women (6.7%) than men (5.1%). Of all recent cases, 68.8% were women, and 72.2% were aged 15-34 years. The Northern province had the fewest individuals with newly diagnosed HIV but had the highest proportion of recent infections (10.0%) compared to other provinces. Recent infections decreased by 19.6% per unit change in time (measured in months). Patients aged ≥25 years were less likely to have recent infection than those aged 15-24 years with those aged 35-49 years being the least likely to have recent infection compared to those aged 15-24 years (adjusted odds ratio [aOR], 0.415 [95% CI: 0.316-0.544]).ConclusionPublic health surveillance targeting the areas and the identified groups with high risk of recent infection could help improve outcomes.

Background Despite Rwanda’s progress toward HIV epidemic control, 16.2% of HIV-positive individuals are unaware of their HIV positive status. Tailoring the public health strategy could help reach these individuals with new HIV infection and achieve epidemic control. Recency testing is primarily for surveillance, monitoring, and evaluation but it’s not for diagnostic purposes. However, it’s important to know what proportion of the newly diagnosed are recent infections so that HIV prevention can be tailored to the profile of people who are recently infected. We therefore used available national data to characterize individuals with recent HIV infection in Rwanda to inform the epidemic response. Methods We included all national-level data for recency testing reported from October 2018 to June 2020. Eligible participants were adults (aged ≥15 years) who had a new HIV diagnosis, who self-reported being antiretroviral therapy (ART) naïve, and who had consented to recency testing. Numbers and proportions of recent HIV infections were estimated, and precision around these estimates was calculated with 95% confidence intervals (CI). Logistic regression was used to assess factors associated with being recently (within 12 months) infected with HIV. Results Of 7,785 eligible individuals with a new HIV-positive diagnosis, 475 (6.1%) met the criteria for RITA recent infection. The proportion of RITA recent infections among individuals with newly identified HIV was high among those aged 15–24 years (9.6%) and in men aged ≥65 years (10.3%) compared to other age groups; and were higher among women (6.7%) than men (5.1%). Of all recent cases, 68.8% were women, and 72.2% were aged 15–34 years. The Northern province had the fewest individuals with newly diagnosed HIV but had the highest proportion of recent infections (10.0%) compared to other provinces. Recent infections decreased by 19.6% per unit change in time (measured in months). Patients aged ≥25 years were less likely to have recent infection than those aged 15–24 years with those aged 35–49 years being the least likely to have recent infection compared to those aged 15–24 years (adjusted odds ratio [aOR], 0.415 [95% CI: 0.316–0.544]). Conclusion Public health surveillance targeting the areas and the identified groups with high risk of recent infection could help improve outcomes.

Agnes Binagwaho and colleagues describe how Rwanda achieved country ownership of its HIV programs.