32 results on '"Anita Asiimwe"'
Search Results
2. Detectable Viral Load in Late Pregnancy among Women in the Rwanda Option B+ PMTCT Program: Enrollment Results from the Kabeho Study.
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Michelle M Gill, Heather J Hoffman, Emily A Bobrow, Placidie Mugwaneza, Dieudonne Ndatimana, Gilles F Ndayisaba, Cyprien Baribwira, Laura Guay, and Anita Asiimwe
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Medicine ,Science - Abstract
There are limited viral load (VL) data available from programs implementing "Option B+," lifelong antiretroviral treatment (ART) to all HIV-positive pregnant and postpartum women, in resource-limited settings. Extent of viral suppression from a prevention of mother-to-child transmission of HIV program in Rwanda was assessed among women enrolled in the Kigali Antiretroviral and Breastfeeding Assessment for the Elimination of HIV (Kabeho) Study. ARV drug resistance testing was conducted on women with VL>2000 copies/ml. In April 2013-January 2014, 608 pregnant or early postpartum HIV-positive women were enrolled in 14 facilities. Factors associated with detectable enrollment VL (>20 copies/ml) were examined using generalized estimating equations. The most common antiretroviral regimen (56.7%, 344/607) was tenofovir/lamivudine/efavirenz. Median ART duration was 13.5 months (IQR 3.0-48.8); 76.1% of women were on ART at first antenatal visit. Half of women (315/603) had undetectable RNA-PCR VL and 84.6% (510) had 36 months compared to those on ART 4-36 months (72/191, 37.7% versus 56/187, 29.9%), though the difference was not significant. The odds of having detectable enrollment VL decreased significantly as duration on ART at enrollment increased (AOR = 0.99, 95% CI: 0.9857, 0.9998, p = 0.043). There was a higher likelihood of detectable VL for women with lower gravidity (AOR = 0.90, 95% CI: 0.84, 0.97, p = 0.0039), no education (AOR = 2.25, (95% CI: 1.37, 3.70, p = 0.0004), nondisclosure to partner (AOR = 1.97, 95% CI: 1.21, 3.21, p = 0.0063) and side effects (AOR = 2.63, 95% CI: 1.72, 4.03, p 36 months with genotyping available. Most women were receiving ART at first antenatal visit, with relatively high viral suppression rates. Shorter ART duration was associated with higher VL, with a concerning increasing trend for higher viremia and drug resistance among women on ART for >3 years.
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- 2016
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3. Combination Antiretroviral Therapy for HIV in Rwandan Adults: Clinical Outcomes and Impact on Reproductive Health up to 24 Months
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Brenda Asiimwe-Kateera, Nienke Veldhuijzen, Jean Paul Balinda, John Rusine, Sally Eagle, Joseph Vyankandondera, Julie Mugabekazi, Pascale Ondoa, Kimberly Boer, Anita Asiimwe, Joep Lange, Peter Reiss, and Janneke van de Wijgert
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Immunologic diseases. Allergy ,RC581-607 - Abstract
Adult women (n=113) and men (n=100) initiating combination antiretroviral therapy (cART) and women not yet eligible for cART (n=199) in Kigali, Rwanda, were followed for 6–24 months between 2007 and 2010. In the cART groups, 21% of patients required a drug change due to side effects and 11% of patients had virological failure (defined as >1,000 HIV RNA copies/mL) after 12 months of cART. About a third of the pregnancies since HIV diagnosis were unintended. The proportion of women in the pre-cART group using modern contraception other than condoms (50%) was similar to women in the general population, but this proportion was only 25% in women initiating cART. Of the women who carried at least one pregnancy to term since having been diagnosed HIV-positive, a third reported to have participated in a prevention-of-mother-to-child-transmission (PMTCT, option A) intervention. Many patients were coinfected with herpes simplex virus type 2 (79–92%), human papillomavirus (38–53%), and bacterial sexually transmitted infections (STIs) with no differences between groups. We applaud the Rwandan government for having strengthened family planning and PMTCT services and for having introduced HPV vaccination in recent years, but additional work is needed to strengthen STI and HPV-related cancer screening and management in the HIV-positive population.
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- 2015
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- View/download PDF
4. Provider-initiated HIV testing and counselling in Rwanda: acceptability among clinic attendees and workers, reasons for testing and predictors of testing.
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Felix R Kayigamba, Mirjam I Bakker, Judith Lammers, Veronicah Mugisha, Emmanuel Bagiruwigize, Anita Asiimwe, and Maarten F Schim van der Loeff
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Medicine ,Science - Abstract
INTRODUCTION: Routine provider-initiated HIV testing and counselling (PITC) may increase HIV testing rates, but whether PITC is acceptable to health facility (HF) attendees is unclear. In the course of a PITC intervention study in Rwanda, we assessed the acceptability of PITC, reasons for being or not being tested and factors associated with HIV testing. METHODS: Attendees were systematically interviewed in March 2009 as they left the HF, regarding knowledge and acceptability of PITC, history of testing and reasons for being tested or not. Subsequently, PITC was introduced in 6 of the 8 HFs and a second round of interviews was conducted. Independent factors associated with testing were analysed using logistic regression. Randomly selected health care workers (HCWs) were also interviewed. RESULTS: 1772 attendees were interviewed. Over 95% agreed with the PITC policy, both prior to and after implementation of PITC policy. The most common reasons for testing were the desire to know one's HIV status and having been offered an HIV test by an HCW. The most frequent reasons for not being tested were known HIV status and test not being offered. In multivariable analysis, PITC, age ≥15 years, and not having been previously tested were factors significantly associated with testing. Although workload was increased by PITC, HIV testing rates increased and HCWs overwhelmingly supported the policy. CONCLUSION: Among attendees and HCWs in Rwandan clinics, the acceptability of PITC was very high. PITC appeared to increase testing rates and may be helpful in prevention and early access to treatment.
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- 2014
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5. Safety and effectiveness of combination antiretroviral therapy during the first year of treatment in HIV-1 infected Rwandan children: a prospective study.
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Philippe R Mutwa, Kimberly R Boer, Brenda Asiimwe-Kateera, Diane Tuyishimire, Narcisse Muganga, Joep M A Lange, Janneke van de Wijgert, Anita Asiimwe, Peter Reiss, and Sibyl P M Geelen
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Medicine ,Science - Abstract
With increased availability of paediatric combination antiretroviral therapy (cART) in resource limited settings, cART outcomes and factors associated with outcomes should be assessed.HIV-infected children -2, immunological success as CD4 cells ≥500/mm3 and ≥25% for respectively children over 5 years and under 5 years, and virological success as a plasma HIV-1 RNA concentration 1000 c/mL). Older age at cART initiation, poor adherence, and exposure to antiretrovirals around birth were associated with virological failure. A third (33%) of children had side effects (by self-report or clinical assessment), but only 9% experienced a severe side effect requiring a cART regimen change.cART in Rwandan HIV-infected children was successful but success might be improved further by initiating cART as early as possible, optimizing adherence and optimizing management of side effects.
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- 2014
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6. High levels of adherence and viral suppression in a nationally representative sample of HIV-infected adults on antiretroviral therapy for 6, 12 and 18 months in Rwanda.
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Batya Elul, Paulin Basinga, Harriet Nuwagaba-Biribonwoha, Suzue Saito, Deborah Horowitz, Denis Nash, Jules Mugabo, Veronicah Mugisha, Etienne Rugigana, Richard Nkunda, and Anita Asiimwe
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Medicine ,Science - Abstract
BACKGROUND: Generalizable data are needed on the magnitude and determinants of adherence and virological suppression among patients on antiretroviral therapy (ART) in Africa. METHODS: We conducted a cross-sectional survey with chart abstraction, patient interviews and site assessments in a nationally representative sample of adults on ART for 6, 12 and 18 months at 20 sites in Rwanda. Adherence was assessed using 3- and 30-day patient recall. A systematically selected sub-sample had viral load (VL) measurements. Multivariable logistic regression examined predictors of non-perfect (40 copies/ml). RESULTS: Overall, 1,417 adults were interviewed and 837 had VL measures. Ninety-four percent and 78% reported perfect adherence for the last 3 and 30 days, respectively. Eighty-three percent had undetectable VL. In adjusted models, characteristics independently associated with higher odds of non-perfect 30-day adherence were: being on ART for 18 months (vs. 6 months); younger age; reporting severe (vs. no or few) side effects in the prior 30 days; having no documentation of CD4 cell count at ART initiation (vs. having a CD4 cell count of
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- 2013
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7. Patient enrolment into HIV care and treatment within 90 days of HIV diagnosis in eight Rwandan health facilities: a review of facility-based registers.
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Felix R Kayigamba, Mirjam I Bakker, Hadassa Fikse, Veronicah Mugisha, Anita Asiimwe, and Maarten F Schim van der Loeff
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Medicine ,Science - Abstract
INTRODUCTION: Access to antiretroviral therapy (ART) has increased greatly in sub-Saharan Africa. However many patients do not enrol timely into HIV care and treatment after HIV diagnosis. We studied enrolment into care and treatment and determinants of non-enrolment in Rwanda. METHODS: Data were obtained from routine clinic registers from eight health facilities in Rwanda on patients who were diagnosed with HIV at the antenatal care, voluntary counselling-and-testing, outpatient or tuberculosis departments between March and May 2009. The proportion of patients enrolled into HIV care and treatment was calculated as the number of HIV infected patients registered in ART clinics for follow-up care and treatment within 90 days of HIV diagnosis divided by the total number of persons diagnosed with HIV in the study period. RESULTS: Out of 482 patients diagnosed with HIV in the study period, 339 (70%) were females, and the median age was 29 years (interquartile range [IQR] 24-37). 201 (42%) enrolled into care and treatment within 90 days of HIV diagnosis. The median time between testing and enrolment was six days (IQR 2-14). Enrolment in care and treatment was not significantly associated with age, sex, or department of testing, but was associated with study site. None of those enrolled were in WHO stage 4. The median CD4 cell count among adult patients was 387 cells/mm(3) (IQR: 242-533 cells/mm(3)); 81 of 170 adult patients (48%) were eligible to start ART (CD4 count
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- 2012
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8. Understanding Antiretroviral Treatment Adherence Among HIV-Positive Women at Four Postpartum Time Intervals: Qualitative Results from the Kabeho Study in Rwanda
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Emily A. Bobrow, Dieudonne Ndatimana, Michelle M. Gill, Gilles F. Ndayisaba, Solange Kibitenga, Anita Asiimwe, Aline Umutoni, Placidie Mugwaneza, and Heather J. Hoffman
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Adult ,0301 basic medicine ,medicine.medical_specialty ,Social stigma ,Social Stigma ,Population ,HIV Infections ,Medication Adherence ,Interviews as Topic ,03 medical and health sciences ,Theory of reasoned action ,0302 clinical medicine ,Pregnancy ,medicine ,Humans ,Prospective Studies ,030212 general & internal medicine ,Pregnancy Complications, Infectious ,education ,Prospective cohort study ,Qualitative Research ,education.field_of_study ,business.industry ,Postpartum Period ,Rwanda ,Public Health, Environmental and Occupational Health ,Infant ,Fear ,030112 virology ,Infectious Disease Transmission, Vertical ,CD4 Lymphocyte Count ,Breast Feeding ,Cross-Sectional Studies ,Infectious Diseases ,Health promotion ,Family medicine ,Female ,Observational study ,Pregnant Women ,business ,Breast feeding ,Postpartum period ,Clinical psychology - Abstract
As lifelong antiretroviral therapy (ART) for pregnant women is implemented, it is important to understand the attitudes and norms affecting women's postpartum ART adherence. This is a qualitative cross-sectional study of HIV-positive postpartum women (n = 112) enrolled in a 2-year observational prospective cohort in Rwanda. Informed by the Theory of Reasoned Action (TRA), we conducted in-depth interviews with women whose children were 0-6, 7-12, 13-18, or 21-24 months of age to describe factors contributing to adherence and changes over time. Positive ART attitudes reported by women included mothers' health promotion, prevention of infant HIV infection, higher CD4 count, and improved physical appearance. Negative attitudes were few, but included side effects and the lifelong nature of treatment. Learning from people living with HIV (PLHIV) was identified as a norm facilitating adherence; ART adherence was inhibited by fear of disclosure or stigmatization in communities and clinics. Poor adherence behaviors were common immediately after HIV diagnosis, not necessarily during prevention of mother-to-child transmission (PMTCT). Women with older children, most of whom stopped breastfeeding by 13-18 months, reported more barriers and missed doses than women with younger children. The TRA was useful in identifying the collective influence of attitudes, norms, and intentions on behavior. Findings suggest that HIV-positive women are vulnerable to poor adherence following HIV diagnosis and around the time of breastfeeding cessation. Lifelong treatment adherence can be supported through PLHIV exemplifying long-term ART use, fewer and less stigmatizing clinic visits, and counseling messages highlighting the benefits of drugs on appearance and illness prevention and incorporating biological feedback.
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- 2017
9. Longitudinal interrelationship between HIV viral suppression, maternal weight change, breastfeeding, and length in HIV-exposed and uninfected infants participating in the Kabeho study in Kigali, Rwanda
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Linda S. Adair, Anita Asiimwe, Emily A. Bobrow, Placidie Mugwaneza, Charlotte Lane, and Gilles F. Ndayisaba
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Adult ,Chronic condition ,medicine.medical_specialty ,Epidemiology ,Breastfeeding ,Human immunodeficiency virus (HIV) ,HIV Infections ,Context (language use) ,medicine.disease_cause ,01 natural sciences ,Article ,03 medical and health sciences ,0302 clinical medicine ,Pregnancy ,medicine ,Humans ,Longitudinal Studies ,030212 general & internal medicine ,Viral suppression ,Pregnancy Complications, Infectious ,0101 mathematics ,Obstetrics ,business.industry ,Public health ,010102 general mathematics ,Weight change ,Infant, Newborn ,Rwanda ,Viral Load ,Body Height ,Gestational Weight Gain ,Infectious Disease Transmission, Vertical ,Breast Feeding ,Prenatal Exposure Delayed Effects ,Female ,business ,Breast feeding - Abstract
Purpose The health of infants that are HIV-exposed and -uninfected (HEU) is a major public health concern as HIV becomes a chronic condition. We investigate the interrelationship between maternal viral suppression, maternal weight status, breastfeeding, and infants that are HEU. Methods The Kabeho study followed 502 HEU infants in Kigali, Rwanda, for 24 months from 2013 to 2014. We use a structural equation modeling approach to investigate the dynamic relationships between viral suppression, maternal weight change, breastfeeding, and infant length-for-age z-score (LAZ) as defined by the WHO. Results Older mothers are more likely to be virally suppressed and to breastfeed. Viral suppression and the mother being on antiretroviral treatment for longer were related to lower infant LAZ at three months. A more positive maternal weight change was related to higher infant LAZ at the end of each period. At 12 months, a higher infant LAZ was related to increased probability of continued breastfeeding. At 18 months, continued breastfeeding was related to lower LAZ, and food shortages were related to higher LAZ. Conclusion There is a complex interrelationship between viral suppression, maternal weight change, breastfeeding, and infant LAZ. These relationships demonstrate the link between maternal and infant health in the context of HIV.
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- 2021
10. Is increasing complexity of algorithms the price for higher accuracy? virtual comparison of three algorithms for tertiary level management of chronic cough in people living with HIV in a low-income country.
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Constance Mukabatsinda, Jasmine Nguyen, Bettina Bisig, Lutgarde Lynen, Yerma D. Coppens, Anita Asiimwe, and Jef Van den Ende
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- 2012
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11. Linkage to HIV care before and after the introduction of provider-initiated testing and counselling in six Rwandan health facilities
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Anita Asiimwe, Veronicah Mugisha, Felix R. Kayigamba, Mirjam I. Bakker, Kirstin R Mitchell, Maarten F. Schim van der Loeff, Carmen B. Franse, Emmanuel Bagiruwigize, KIT: Biomedical Research, and Infectious diseases
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Adult ,Counseling ,Male ,medicine.medical_specialty ,Disease status ,Health (social science) ,Social Psychology ,030231 tropical medicine ,Hiv epidemic ,HIV diagnosis ,Human immunodeficiency virus (HIV) ,HIV Infections ,medicine.disease_cause ,Ambulatory Care Facilities ,World health ,03 medical and health sciences ,0302 clinical medicine ,Surveys and Questionnaires ,Health care ,Outcome Assessment, Health Care ,Odds Ratio ,Medicine ,Humans ,030212 general & internal medicine ,Psychiatry ,Referral and Consultation ,Hiv stigma ,business.industry ,Public Health, Environmental and Occupational Health ,Rwanda ,Odds ratio ,Continuity of Patient Care ,Female ,business - Abstract
HIV testing and counselling forms the gateway to the HIV care and treatment continuum. Therefore, the World Health Organization recommends provider-initiated testing and counselling (PITC) in countries with a generalized HIV epidemic. Few studies have investigated linkage-to-HIV-care among out-patients after PITC. Our objective was to study timely linkage-to-HIV-care in six Rwandan health facilities (HFs) before and after the introduction of PITC in the out-patient departments (OPDs). Information from patients diagnosed with HIV was abstracted from voluntary counselling and testing, OPD and laboratory registers of six Rwandan HFs during three-month periods before (March-May 2009) and after (December 2009-February 2010) the introduction of PITC in the OPDs of these facilities. Information on patients' subsequent linkage-to-pre-antiretroviral therapy (ART) care and ART was abstracted from ART clinic registers of each HF. To triangulate the findings from HF routine, a survey was held among patients to assess reasons for non-enrolment. Of 635 patients with an HIV diagnosis, 232 (36.5%) enrolled at the ART clinic within 90 days of diagnosis. Enrolment among out-patients decreased after the introduction of PITC (adjusted odds ratio, 2.0; 95% confidence interval, 1.0-4.2; p = .051). Survey findings showed that retesting for HIV among patients already diagnosed and enrolled into care was not uncommon. Patients reported non-acceptance of disease status, stigma and problems with healthcare services as main barriers for enrolment. Timely linkage-to-HIV-care was suboptimal in this Rwandan study before and after the introduction of PITC; the introduction of PITC in the OPD may have had a negative impact on linkage-to-HIV-care. Healthier patients tested through PITC might be less ready to engage in HIV care. Fear of HIV stigma and mistrust of test results appear to be at the root of these problems.
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- 2017
12. The Human Resources for Health Program in Rwanda — A New Partnership
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Agnes Binagwaho, Patrick Kyamanywa, Paul E. Farmer, Tej Nuthulaganti, Benoite Umubyeyi, Jean Pierre Nyemazi, Soline Dusabeyesu Mugeni, Anita Asiimwe, Uzziel Ndagijimana, Helen Lamphere McPherson, Jean de Dieu Ngirabega, Anne Sliney, Agnes Uwayezu, Vincent Rusanganwa, Claire M. Wagner, Cameron T. Nutt, Mark Eldon-Edington, Corrado Cancedda, Ira C. Magaziner, and Eric Goosby
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medicine.medical_specialty ,Medical education ,business.industry ,Public health ,education ,General Medicine ,Health promotion ,Nursing ,General partnership ,Health care ,Global health ,Medicine ,Health education ,business ,Human resources ,Health policy - Abstract
The authors discuss the Human Resources for Health Program, which is working to improve the quality and quantity of health professionals in Rwanda by means of sustained collaborations with U.S. schools of medicine, nursing, dentistry, and public health.
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- 2013
13. Detectable Viral Load in Late Pregnancy among Women in the Rwanda Option B+ PMTCT Program: Enrollment Results from the Kabeho Study
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Dieudonne Ndatimana, Michelle M. Gill, Laura Guay, Cyprien Baribwira, Gilles F. Ndayisaba, Anita Asiimwe, Emily A. Bobrow, Placidie Mugwaneza, and Heather J. Hoffman
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0301 basic medicine ,RNA viruses ,Maternal Health ,Breastfeeding ,Gene Identification and Analysis ,lcsh:Medicine ,HIV Infections ,Pathology and Laboratory Medicine ,chemistry.chemical_compound ,0302 clinical medicine ,Immunodeficiency Viruses ,Pregnancy ,Medicine and Health Sciences ,Prevalence ,Public and Occupational Health ,030212 general & internal medicine ,Prospective Studies ,Young adult ,Prospective cohort study ,lcsh:Science ,Multidisciplinary ,Obstetrics ,Lamivudine ,Obstetrics and Gynecology ,HIV diagnosis and management ,Viral Load ,Vaccination and Immunization ,Medical Microbiology ,Viral Pathogens ,Viruses ,Female ,Pathogens ,Viral load ,medicine.drug ,Research Article ,Adult ,medicine.medical_specialty ,Efavirenz ,Anti-HIV Agents ,Immunology ,HIV prevention ,Antiretroviral Therapy ,Microbiology ,03 medical and health sciences ,Young Adult ,Antiviral Therapy ,Antenatal Care ,Virology ,Retroviruses ,medicine ,Genetics ,Humans ,Viremia ,Microbial Pathogens ,Mutation Detection ,business.industry ,Lentivirus ,lcsh:R ,Organisms ,Rwanda ,Biology and Life Sciences ,HIV ,medicine.disease ,030112 virology ,Diagnostic medicine ,Infectious Disease Transmission, Vertical ,Surgery ,Regimen ,chemistry ,HIV-1 ,Women's Health ,lcsh:Q ,Preventive Medicine ,business ,Viral Transmission and Infection - Abstract
There are limited viral load (VL) data available from programs implementing “Option B+,” lifelong antiretroviral treatment (ART) to all HIV-positive pregnant and postpartum women, in resource-limited settings. Extent of viral suppression from a prevention of mother-to-child transmission of HIV program in Rwanda was assessed among women enrolled in the Kigali Antiretroviral and Breastfeeding Assessment for the Elimination of HIV (Kabeho) Study. ARV drug resistance testing was conducted on women with VL>2000 copies/ml. In April 2013-January 2014, 608 pregnant or early postpartum HIV-positive women were enrolled in 14 facilities. Factors associated with detectable enrollment VL (>20 copies/ml) were examined using generalized estimating equations. The most common antiretroviral regimen (56.7%, 344/607) was tenofovir/lamivudine/efavirenz. Median ART duration was 13.5 months (IQR 3.0–48.8); 76.1% of women were on ART at first antenatal visit. Half of women (315/603) had undetectable RNA-PCR VL and 84.6% (510) had 36 months compared to those on ART 4–36 months (72/191, 37.7% versus 56/187, 29.9%), though the difference was not significant. The odds of having detectable enrollment VL decreased significantly as duration on ART at enrollment increased (AOR = 0.99, 95% CI: 0.9857, 0.9998, p = 0.043). There was a higher likelihood of detectable VL for women with lower gravidity (AOR = 0.90, 95% CI: 0.84, 0.97, p = 0.0039), no education (AOR = 2.25, (95% CI: 1.37, 3.70, p = 0.0004), nondisclosure to partner (AOR = 1.97, 95% CI: 1.21, 3.21, p = 0.0063) and side effects (AOR = 2.63, 95% CI: 1.72, 4.03, p 36 months with genotyping available. Most women were receiving ART at first antenatal visit, with relatively high viral suppression rates. Shorter ART duration was associated with higher VL, with a concerning increasing trend for higher viremia and drug resistance among women on ART for >3 years.
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- 2016
14. Does provider-initiated HIV testing and counselling lead to higher HIV testing rate and HIV case finding in Rwandan clinics?
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Ludwig De Naeyer, Mirjam I. Bakker, Felix R. Kayigamba, Veronicah Mugisha, Daniela K van Santen, Anita Asiimwe, Judith Lammers, Maarten F. Schim van der Loeff, Emmanuel Bagiruwigize, KIT: Biomedical Research, and Infectious diseases
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Adult ,Counseling ,Male ,medicine.medical_specialty ,Health services administration ,Voluntary Programs ,HIV (Viruses)--Testing ,PITC ,030231 tropical medicine ,Human immunodeficiency virus (HIV) ,HIV Infections ,HIV testing rate ,Hiv testing ,medicine.disease_cause ,03 medical and health sciences ,0302 clinical medicine ,Ambulatory care ,Ambulatory Care ,Humans ,Mass Screening ,Medicine ,030212 general & internal medicine ,Hospitals--Outpatient services--Evaluation ,Lead (electronics) ,HIV case finding ,Mass screening ,Voluntary Program ,Medical care ,business.industry ,Obstetrics ,Rwanda ,AIDS serodiagnosis ,AIDS Serodiagnosis ,virus diseases ,Health Services ,Infectious Diseases ,Immunology ,Case finding ,Female ,HIV (Viruses)--Psychological aspects ,business ,Research Article - Abstract
Background Provider-initiated HIV testing and counselling (PITC) is promoted as a means to increase HIV case finding. We assessed the effectiveness of PITC to increase HIV testing rate and HIV case finding among outpatients in Rwandan health facilities (HF). Methods PITC was introduced in six HFs in 2009-2010. HIV testing rate and case finding were compared between phase 1 (pre-PITC) and phase 3 (PITC period) for outpatient-department (OPD) attendees only, and for OPD and voluntary counseling & testing (VCT) departments combined. Results Out of 26,367 adult OPD attendees in phase 1, 4.7 % were tested and out of 29,864 attendees in phase 3, 17.0 % were tested (p
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- 2016
15. Safety and Efficacy of the PrePex Device for Rapid Scale-Up of Male Circumcision for HIV Prevention in Resource-Limited Settings
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Agnes Binagwaho, Theobald Hategekimana, Jean Paul Bitega, Anita Asiimwe, and Muyenzi Leon Ngeruka
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Adult ,Male ,medicine.medical_specialty ,Adolescent ,Adult male ,Human immunodeficiency virus (HIV) ,HIV Infections ,medicine.disease_cause ,Sterile environment ,Young Adult ,Foreskin ,Device removal ,medicine ,Humans ,Pharmacology (medical) ,Adverse effect ,business.industry ,Rwanda ,Surgical Instruments ,Surgery ,Infectious Diseases ,medicine.anatomical_structure ,Circumcision, Male ,Male circumcision ,Feasibility Studies ,business ,Limited resources - Abstract
OBJECTIVE: To assess the safety and efficacy of the PrePex device for nonsurgical circumcision in adult males as part of a comprehensive HIV prevention program in Rwanda. METHODS: Single-center 6-week noncontrolled study in which healthy men underwent circumcision using the PrePex device which employs fitted rings to clamp the foreskin leading to distal necrosis. In the first phase of the study the feasibility of the procedure was tested on 5 subjects in a sterile environment; in the main phase an additional 50 subjects were circumcised in a nonsterile setting by physicians or a nurse. Outcome measures included the rate of successful circumcision time to complete healing pain and adverse events. RESULTS: In the feasibility phase all 5 subjects achieved complete circumcision without adverse events. In the main phase all 50 subjects achieved circumcision with 1 case of diffuse edema after device removal which resolved with minimal intervention. Pain was minimal except briefly during device removal (day 7 after placement in most cases). The entire procedure was bloodless requiring no anesthesia no suturing and no sterile settings. Subjects had no sick/absent days associated with the procedure. Median time for complete healing was 21 days after device removal. There were no instances of erroneous placement and no mechanical problems with the device. CONCLUSION: The PrePex device was safe and effective for nonsurgical adult male circumcision without anesthesia or sterile settings and may be useful in mass circumcision programs to reduce the risk of HIV infection particularly in resource-limited settings.
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- 2011
16. Combination Antiretroviral Therapy for HIV in Rwandan Adults: Clinical Outcomes and Impact on Reproductive Health up to 24 Months
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Janneke van de Wijgert, Kimberly R. Boer, Pascale Ondoa, Anita Asiimwe, John Rusine, Joseph Vyankandondera, Jean Paul Balinda, Sally Eagle, Brenda Asiimwe-Kateera, Nienke J. Veldhuijzen, Peter Reiss, Joep M. A. Lange, Julie Mugabekazi, Global Health, Infectious diseases, Amsterdam institute for Infection and Immunity, Amsterdam Public Health, Epidemiology and Data Science, and CCA - Innovative therapy
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Cart ,lcsh:Immunologic diseases. Allergy ,Pediatrics ,medicine.medical_specialty ,Article Subject ,Population ,Dermatology ,Intervention (counseling) ,mental disorders ,Cancer screening ,medicine ,Immunology and Allergy ,education ,Reproductive health ,Pregnancy ,education.field_of_study ,business.industry ,Public Health, Environmental and Occupational Health ,virus diseases ,medicine.disease ,Antiretroviral therapy ,Infectious Diseases ,Family planning ,Clinical Study ,business ,lcsh:RC581-607 - Abstract
Adult women (n=113) and men (n=100) initiating combination antiretroviral therapy (cART) and women not yet eligible for cART (n=199) in Kigali, Rwanda, were followed for 6–24 months between 2007 and 2010. In the cART groups, 21% of patients required a drug change due to side effects and 11% of patients had virological failure (defined as >1,000 HIV RNA copies/mL) after 12 months of cART. About a third of the pregnancies since HIV diagnosis were unintended. The proportion of women in the pre-cART group using modern contraception other than condoms (50%) was similar to women in the general population, but this proportion was only 25% in women initiating cART. Of the women who carried at least one pregnancy to term since having been diagnosed HIV-positive, a third reported to have participated in a prevention-of-mother-to-child-transmission (PMTCT, option A) intervention. Many patients were coinfected with herpes simplex virus type 2 (79–92%), human papillomavirus (38–53%), and bacterial sexually transmitted infections (STIs) with no differences between groups. We applaud the Rwandan government for having strengthened family planning and PMTCT services and for having introduced HPV vaccination in recent years, but additional work is needed to strengthen STI and HPV-related cancer screening and management in the HIV-positive population.
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- 2015
17. Safety and effectiveness of combination antiretroviral therapy during the first year of treatment in HIV-1 infected Rwandan children: a prospective study
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Narcisse Muganga, Kimberly R. Boer, Anita Asiimwe, Philippe R. Mutwa, Peter Reiss, Brenda Asiimwe-Kateera, Janneke van de Wijgert, Sibyl P. M. Geelen, Joep M. A. Lange, Diane Tuyishimire, AII - Amsterdam institute for Infection and Immunity, Global Health, Infectious diseases, and APH - Amsterdam Public Health
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Cart ,Male ,Pediatrics ,medicine.medical_specialty ,Side effect ,Clinical Research Design ,Population ,lcsh:Medicine ,HIV Infections ,Research and Analysis Methods ,Medication Adherence ,immune system diseases ,medicine ,Medicine and Health Sciences ,Humans ,Prospective Studies ,Adverse effect ,Prospective cohort study ,education ,lcsh:Science ,Child ,education.field_of_study ,Multidisciplinary ,business.industry ,lcsh:R ,Rwanda ,virus diseases ,Antiretroviral therapy ,CD4 Lymphocyte Count ,Regimen ,Infectious Diseases ,Anti-Retroviral Agents ,Research Design ,HIV-1 ,RNA, Viral ,lcsh:Q ,Drug Therapy, Combination ,Female ,business ,Viral load ,Follow-Up Studies ,Research Article - Abstract
Background With increased availability of paediatric combination antiretroviral therapy (cART) in resource limited settings, cART outcomes and factors associated with outcomes should be assessed. Methods HIV-infected children −2, immunological success as CD4 cells ≥500/mm3 and ≥25% for respectively children over 5 years and under 5 years, and virological success as a plasma HIV-1 RNA concentration 1000 c/mL). Older age at cART initiation, poor adherence, and exposure to antiretrovirals around birth were associated with virological failure. A third (33%) of children had side effects (by self-report or clinical assessment), but only 9% experienced a severe side effect requiring a cART regimen change. Conclusions cART in Rwandan HIV-infected children was successful but success might be improved further by initiating cART as early as possible, optimizing adherence and optimizing management of side effects.
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- 2014
18. Developing cancer control plans in Africa: examples from five countries
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Fabien Ntaganda, Daniela Cristina Stefan, Hussein M. Khaled, Anita Asiimwe, Ahmed Elzawawy, Seth Wiafe, Beatrice Wiafe Addai, and Isaac F. Adewole
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Economic growth ,business.industry ,media_common.quotation_subject ,Environmental resource management ,Rwanda ,Nigeria ,Ghana ,Politics ,South Africa ,Oncology ,Cancer control ,State (polity) ,Neoplasms ,Medicine ,Humans ,Egypt ,business ,Delivery of Health Care ,media_common - Abstract
The creation and implementation of national cancer control plans is becoming increasingly necessary for countries in Africa, with the number of new cancer cases per year in the continent expected to reach up to 1·5 million by 2020. Examples from South Africa, Egypt, Nigeria, Ghana, and Rwanda describe the state of national cancer control plans and their implementation. Whereas in Rwanda the emphasis is on development of basic facilities needed for cancer care, in those countries with more developed economies, such as South Africa and Nigeria, the political will to fund national cancer control plans is limited, even though the plans exist and are otherwise well conceived. Improved awareness of the increasing burden of cancer and increased advocacy are needed to put pressure on governments to develop, fund, and implement national cancer control plans across the continent.
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- 2013
19. High levels of adherence and viral suppression in a nationally representative sample of HIV-infected adults on antiretroviral therapy for 6, 12 and 18 months in Rwanda
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Denis Nash, Jules Mugabo, Batya Elul, Paulin Basinga, Etienne Rugigana, Richard Nkunda, Anita Asiimwe, Harriet Nuwagaba-Biribonwoha, Suzue Saito, Deborah Horowitz, and Veronicah Mugisha
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Gerontology ,Male ,Multivariate analysis ,Time Factors ,Epidemiology ,lcsh:Medicine ,HIV Infections ,Global Health ,0302 clinical medicine ,Hiv infected ,Antiretroviral Therapy, Highly Active ,Clinical Epidemiology ,030212 general & internal medicine ,Viral suppression ,Young adult ,lcsh:Science ,Multidisciplinary ,Obstetrics and Gynecology ,HIV diagnosis and management ,Middle Aged ,Viral Load ,3. Good health ,HIV epidemiology ,Medicine ,Infectious diseases ,Female ,0305 other medical science ,Viral load ,Research Article ,Adult ,medicine.medical_specialty ,Adolescent ,Urology ,Viral diseases ,Infectious Disease Epidemiology ,03 medical and health sciences ,Young Adult ,Internal medicine ,medicine ,Humans ,Biology ,030505 public health ,Population Biology ,business.industry ,Genitourinary Infections ,Public health ,Patient Selection ,lcsh:R ,Rwanda ,HIV ,Antiretroviral therapy ,Multivariate Analysis ,Patient Compliance ,lcsh:Q ,Self Report ,business - Abstract
BACKGROUND: Generalizable data are needed on the magnitude and determinants of adherence and virological suppression among patients on antiretroviral therapy (ART) in Africa. METHODS: We conducted a cross-sectional survey with chart abstraction, patient interviews and site assessments in a nationally representative sample of adults on ART for 6, 12 and 18 months at 20 sites in Rwanda. Adherence was assessed using 3- and 30-day patient recall. A systematically selected sub-sample had viral load (VL) measurements. Multivariable logistic regression examined predictors of non-perfect (40 copies/ml). RESULTS: Overall, 1,417 adults were interviewed and 837 had VL measures. Ninety-four percent and 78% reported perfect adherence for the last 3 and 30 days, respectively. Eighty-three percent had undetectable VL. In adjusted models, characteristics independently associated with higher odds of non-perfect 30-day adherence were: being on ART for 18 months (vs. 6 months); younger age; reporting severe (vs. no or few) side effects in the prior 30 days; having no documentation of CD4 cell count at ART initiation (vs. having a CD4 cell count of
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- 2012
20. Scale-up of HIV Treatment Through PEPFAR: A Historic Public Health Achievement
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Peter Mugyenyi, Alan Whiteside, Wafaa El-Sadr, Charles B. Holmes, Ian Sanne, Isaac Zulu, Robert Ferris, Rejoice Nkambule, Chloe A. Teasdale, Lara Stabinski, Megan Affrunti, Gottfried Hirnschall, Harsha Thirumurthy, Tedd V. Ellerbrock, and Anita Asiimwe
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Male ,medicine.medical_specialty ,Economic growth ,National Health Programs ,Anti-HIV Agents ,media_common.quotation_subject ,Universal design ,International Cooperation ,Alternative medicine ,HIV Infections ,Global Health ,Public-Private Sector Partnerships ,Article ,Acquired immunodeficiency syndrome (AIDS) ,Environmental health ,Antiretroviral Therapy, Highly Active ,medicine ,Disease Transmission, Infectious ,Humans ,Pharmacology (medical) ,Quality (business) ,Hiv treatment ,media_common ,business.industry ,Public health ,Emergency plan ,medicine.disease ,Drug Utilization ,United States ,Infectious Diseases ,General partnership ,Communicable Disease Control ,business - Abstract
Since its inception in 2003, the US President’s Emergency Plan for AIDS Relief (PEPFAR) has been an important driving force behind the global scale-up of HIV care and treatment services, particularly in expansion of access to antiretroviral therapy. Despite initial concerns about cost and feasibility, PEPFAR overcame challenges by leveraging and coordinating with other funders, by working in partnership with the most affected countries, by supporting local ownership, by using a public health approach, by supporting task-shifting strategies, and by paying attention to health systems strengthening. As of September 2011, PEPFAR directly supported initiation of antiretroviral therapy for 3.9 million people and provided care and support for nearly 13 million people. Benefits in terms of prevention of morbidity and mortality have been reaped by those receiving the services, with evidence of societal benefits beyond the anticipated clinical benefits. However, much remains to be accomplished to achieve universal access, to enhance the quality of programs, to ensure retention of patients in care, and to continue to strengthen health systems.
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- 2012
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21. Patient Enrolment into HIV Care and Treatment within 90 Days of HIV Diagnosis in Eight Rwandan Health Facilities: A Review of Facility-Based Registers
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Veronicah Mugisha, Anita Asiimwe, Mirjam I. Bakker, Hadassa Fikse, Felix R. Kayigamba, Maarten F. Schim van der Loeff, KIT: Biomedical Research, and Infectious diseases
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Male ,Health Screening ,Pediatrics ,Time Factors ,National Health Programs ,Epidemiology ,Human immunodeficiency virus (HIV) ,lcsh:Medicine ,HIV Infections ,medicine.disease_cause ,Health Services Accessibility ,Interquartile range ,Ambulatory Care ,Stage (cooking) ,Young adult ,Child ,lcsh:Science ,education.field_of_study ,Multidisciplinary ,virus diseases ,Middle Aged ,Socioeconomic Aspects of Health ,HIV epidemiology ,Child, Preschool ,Medicine ,Infectious diseases ,Female ,Public Health ,Behavioral and Social Aspects of Health ,Research Article ,Adult ,medicine.medical_specialty ,Tuberculosis ,Adolescent ,Infectious Disease Control ,Anti-HIV Agents ,Population ,MEDLINE ,Viral diseases ,Infectious Disease Epidemiology ,Young Adult ,Ambulatory care ,medicine ,Humans ,education ,business.industry ,lcsh:R ,Rwanda ,Infant ,HIV ,medicine.disease ,CD4 Lymphocyte Count ,lcsh:Q ,Health Facilities ,business - Abstract
INTRODUCTION: Access to antiretroviral therapy (ART) has increased greatly in sub-Saharan Africa. However many patients do not enrol timely into HIV care and treatment after HIV diagnosis. We studied enrolment into care and treatment and determinants of non-enrolment in Rwanda. METHODS: Data were obtained from routine clinic registers from eight health facilities in Rwanda on patients who were diagnosed with HIV at the antenatal care, voluntary counselling-and-testing, outpatient or tuberculosis departments between March and May 2009. The proportion of patients enrolled into HIV care and treatment was calculated as the number of HIV infected patients registered in ART clinics for follow-up care and treatment within 90 days of HIV diagnosis divided by the total number of persons diagnosed with HIV in the study period. RESULTS: Out of 482 patients diagnosed with HIV in the study period, 339 (70%) were females, and the median age was 29 years (interquartile range [IQR] 24-37). 201 (42%) enrolled into care and treatment within 90 days of HIV diagnosis. The median time between testing and enrolment was six days (IQR 2-14). Enrolment in care and treatment was not significantly associated with age, sex, or department of testing, but was associated with study site. None of those enrolled were in WHO stage 4. The median CD4 cell count among adult patients was 387 cells/mm(3) (IQR: 242-533 cells/mm(3)); 81 of 170 adult patients (48%) were eligible to start ART (CD4 count
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- 2012
22. 598 NATIONAL SAFETY AND EFFICACY STUDY OF PREPEX, A NEW DEVICE FACILITATING NON-SURGICAL, BLOODLESS CIRCUMCISION WITH NO ANESTHESIA AND NO SUTURES, FOR RESOURCE LIMITED SETTINGS
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Muyenzi Leon Ngeruka, Agnes Binagwaho, Anita Asiimwe, Jean Paul Bitega, and Theobald Hategekimana
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medicine.medical_specialty ,business.industry ,Urology ,Anesthesia ,Medicine ,New device ,business ,Intensive care medicine ,Limited resources ,Efficacy Study - Published
- 2011
23. Determinants of nonadherence to a single-dose nevirapine regimen for the prevention of mother-to-child HIV transmission in Rwanda
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Thérèse Delvaux, Dominique Roberfroid, Felix Ndagije, Elevanie Munyana, Batya Elul, and Anita Asiimwe
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Adult ,medicine.medical_specialty ,Nevirapine ,Single dose ,Anti-HIV Agents ,Population ,HIV Infections ,Viral diseases ,Disease transmission, vertical ,Women in development ,Interviews as Topic ,Social support ,Acquired immunodeficiency syndrome (AIDS) ,immune system diseases ,Pregnancy ,medicine ,Humans ,Africa, Central ,Pharmacology (medical) ,Pregnancy Complications, Infectious ,education ,GeneralLiterature_REFERENCE(e.g.,dictionaries,encyclopedias,glossaries) ,Determinants ,education.field_of_study ,business.industry ,Transmission prevention ,Infant, Newborn ,Rwanda ,HIV ,virus diseases ,medicine.disease ,Infectious Disease Transmission, Vertical ,Mother-to-child ,AIDS ,Regimen ,Infectious Diseases ,Family medicine ,Case-Control Studies ,Immunology ,Chemoprophylaxis ,HIV-1 ,Patient Compliance ,Reverse Transcriptase Inhibitors ,Female ,business ,Compliance ,medicine.drug - Abstract
Not the final published version, Objectives: To describe experiences, and identify factors associated with nonadherence to a single-dose nevirapine (SD-NVP) regimen for the prevention of mother-to-child transmission (PMTCT) of HIV in Rwanda. Methods: In April to May 2006, using a case-control design at 12 PMTCT sites, we interviewed HIV-infected women who did not adhere (n = 111) and who adhered (n = 125) to the PMTCT prophylaxis regimen. Nonadherence was defined as mother and/or infant not ingesting SD-NVP at the recommended time or not at all and adherence as mother-infant pairs who ingested it as recommended. Results: Only 61% of nonadherent women had received SD-NVP during pregnancy or delivery. Among nonadherent women who received SD-NVP, 80% ingested it at the recommended time, representing 49% of all nonadherent women. Only 7% of their newborns ingested SD-NVP. Multivariate logistic regression showed that unmarried women, less educated women, women who made 2 or less antenatal care visits, and those offered HIV testing after their first antenatal care visit were more likely to be nonadherent to PMTCT prophylaxis. Not disclosing one's HIV status to someone aside from a partner was also associated with nonadherence in mother-infant pairs. Conclusions: Sociodemographic factors, health services delivery factors, and a lack of communication and social support contributed to nonadherence to PMTCT prophylaxis in Rwanda.
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- 2009
24. Pregnancy desires, and contraceptive knowledge and use among prevention of mother-to-child transmission clients in Rwanda
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Elevanie Munyana, Anita Asiimwe, Thérèse Delvaux, Denis Nash, Deborah Horowitz, Felix Ndagije, Batya Elul, Dominique Roberfroid, Maria Lahuerta, and Veronicah Mugisha
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Adult ,medicine.medical_specialty ,Health Knowledge, Attitudes, Practice ,Multivariate analysis ,media_common.quotation_subject ,Immunology ,Population ,Developing country ,Fertility ,HIV Infections ,Intentions ,Young Adult ,Acquired immunodeficiency syndrome (AIDS) ,Pregnancy ,medicine ,Immunology and Allergy ,Humans ,Africa, Central ,Use ,Family planning ,education ,Contraception Behavior ,media_common ,Gynecology ,education.field_of_study ,business.industry ,Rwanda ,Prevention of mother to child transmission ,virus diseases ,Patient Acceptance of Health Care ,medicine.disease ,Infectious Disease Transmission, Vertical ,Infectious Diseases ,Contraception ,Knowledge ,Family medicine ,Family Planning Services ,Female ,business - Abstract
Objective: To understand pregnancy intentions and contraception knowledge and use among HIV-positive and negative women in the national prevention of mother-to-child transmission (PMTCT) program in Rwanda. Design: A cross-sectional survey of 236 HIV-positive and 162 HIV-negative postpartum women interviewed within 12 months of their expected delivery date in 12 randomly selected public-sector health facilities providing PMTCT services. Methods: Bivariate analyses explored fertility intentions, and family planning knowledge and use by HIV status. Multivariate analysis identified socio-demographic and service delivery-related predictors of reporting a desire for additional children and modern family planning use. Results: HIV-positive women were less likely to report wanting additional children than HIV-negative women (8 vs. 49%, P < 0.001), and although a majority of women reported discussing family planning with a health worker during their last pregnancy (HIV-positive 79% vs. HIV-negative 69%, P = 0.057), modern family planning use remained low in both groups (HIV-positive 43% vs. HIV-negative 12%, P < 0.001). Condoms were the most commonly used method among HIV-positive women (31%), whereas withdrawal was most frequently reported among HIV-negative women (19%). In multivariate analysis, HIV-negative women were 16 times more likely to report wanting additional children and nearly 85% less likely to use modern family planning. Women who reported making two or less antenatal care visits were 77% less likely to use modern family planning. Conclusion: Our results highlight success in provision of family planning counseling in PMTCT services in Rwanda. As family planning use was low among HIV-positive and negative women, further efforts are needed to improve uptake of modern methods, including dual protection, in Rwandan PMTCT settings.
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- 2009
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25. Success with antiretroviral treatment for children in Kigali, Rwanda: Experience with health center/nurse-based care
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Anita Asiimwe, Johan van Griensven, Tony Reid, Jeanine Uwera, Ludwig De Naeyer, and Claire Gazille
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Male ,Program evaluation ,Pediatrics ,medicine.medical_specialty ,Nevirapine ,Adolescent ,Population ,MEDLINE ,HIV Infections ,Nursing care ,Nursing ,Interquartile range ,medicine ,Humans ,Pediatrics, Perinatology, and Child Health ,Community Health Services ,Child ,education ,education.field_of_study ,business.industry ,Rwanda ,lcsh:RJ1-570 ,Infant ,lcsh:Pediatrics ,Viral Load ,Survival Analysis ,CD4 Lymphocyte Count ,Government Programs ,Regimen ,Treatment Outcome ,Anti-Retroviral Agents ,Caregivers ,Child, Preschool ,Pediatrics, Perinatology and Child Health ,Patient Compliance ,Female ,Nursing Care ,business ,Psychosocial ,Research Article ,Follow-Up Studies ,medicine.drug - Abstract
Background Although a number of studies have shown good results in treating children with antiretroviral drugs (ARVs) in hospital settings, there is limited published information on results in pediatric programs that are nurse-centered and based in health centers, in particular on the psychosocial aspects of care. Methods Program treatment and outcome data were reported from two government-run health centers that were supported by Médecins Sans Frontières (MSF) in Kigali, Rwanda between October 2003 and June 2007. Interviews were held with health center staff and MSF program records were reviewed to describe the organization of the program. Important aspects included adequate training and supervision of nurses to manage ARV treatment. The program also emphasized family-centered care addressing the psychosocial needs of both caregivers and children to encourage early diagnosis, good adherence and follow-up. Results A total of 315 children (< 15 years) were started on ARVs, at a median age of 7.2 years (range: 0.7–14.9). Sixty percent were in WHO clinical stage I/II, with a median CD4% of 14%. Eighty-nine percent (n = 281) started a stavudine-containing regimen, mainly using the adult fixed-dose combination. The median follow-up time after ARV initiation was 2 years (interquartile range 1.2–2.6). Eighty-four percent (n = 265) of children were still on treatment in the program. Thirty (9.5%) were transferred out, eight (2.6%) died and 12 (3.8%) were lost to follow-up. An important feature of the study was that viral loads were done at a median time period of 18 months after starting ARVs and were available for 87% of the children. Of the 174 samples, VL was < 400 copies/ml in 82.8% (n = 144). Two children were started on second-line ARVs. Treatment was changed due to toxicity for 26 children (8.3%), mainly related to nevirapine. Conclusion This report suggests that providing ARVs to children in a health center/nurse-based program is both feasible and very effective. Adequate numbers and training of nursing staff and an emphasis on the psychosocial needs of caregivers and children have been key elements for the successful scaling-up of ARVs at this level of the health system.
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- 2008
26. A National Electronic System for Disease Surveillance in Rwanda (eIDSR): Lessons Learned from a Successful Implementation
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Thierry, Nyatanyi, primary, Adeline, Kabeja, additional, Anita, Asiimwe, additional, Agnes, Binagwaho, additional, Jean Baptiste, Koama, additional, Pamela, Johnson, additional, and Kizito, Kayumba, additional
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- 2014
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27. Provider-Initiated HIV Testing and Counselling in Rwanda: Acceptability among Clinic Attendees and Workers, Reasons for Testing and Predictors of Testing
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Judith Lammers, Felix R. Kayigamba, Emmanuel Bagiruwigize, Maarten F. Schim van der Loeff, Veronicah Mugisha, Mirjam I. Bakker, Anita Asiimwe, KIT: Biomedical Research, and Infectious diseases
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Counseling ,Male ,Program evaluation ,Viral Diseases ,Health Screening ,HIV (Viruses)--Testing ,Epidemiology ,lcsh:Medicine ,HIV (Viruses)--Diagnosis ,HIV Infections ,AIDS (Disease)--Testing ,Global Health ,Immunodeficiency Viruses ,Health facility ,Health care ,Mass Screening ,Young adult ,lcsh:Science ,Public health ,Multidisciplinary ,virus diseases ,HIV diagnosis and management ,Test (assessment) ,Infectious Diseases ,Medical Microbiology ,HIV epidemiology ,Research Design ,Viral Pathogens ,Medicine ,HIV infections--Epidemiology ,Female ,Research Article ,Adult ,medicine.medical_specialty ,Infectious Disease Control ,Clinical Research Design ,Health Personnel ,HIV prevention ,Research and Analysis Methods ,Microbiology ,AIDS (Disease)--Epidemiology ,Young Adult ,Nursing ,Virology ,Retroviruses ,AIDS (Disease)--Diagnosis ,medicine ,Humans ,Microbial Pathogens ,Mass screening ,Medicine and health sciences ,Preventive medicine ,business.industry ,lcsh:R ,Rwanda ,Biology and Life Sciences ,HIV ,Diagnostic medicine ,Viral Disease Diagnosis ,Viral Classification ,Public and occupational health ,Family medicine ,lcsh:Q ,business - Abstract
Introduction: Routine provider-initiated HIV testing and counselling (PITC) may increase HIV testing rates, but whether PITC is acceptable to health facility (HF) attendees is unclear. In the course of a PITC intervention study in Rwanda, we assessed the acceptability of PITC, reasons for being or not being tested and factors associated with HIV testing. Methods: Attendees were systematically interviewed in March 2009 as they left the HF, regarding knowledge and acceptability of PITC, history of testing and reasons for being tested or not. Subsequently, PITC was introduced in 6 of the 8 HFs and a second round of interviews was conducted. Independent factors associated with testing were analysed using logistic regression. Randomly selected health care workers (HCWs) were also interviewed. Results: 1772 attendees were interviewed. Over 95% agreed with the PITC policy, both prior to and after implementation of PITC policy. The most common reasons for testing were the desire to know one’s HIV status and having been offered an HIV test by an HCW. The most frequent reasons for not being tested were known HIV status and test not being offered. In multivariable analysis, PITC, age ≥15 years, and not having been previously tested were factors significantly associated with testing. Although workload was increased by PITC, HIV testing rates increased and HCWs overwhelmingly supported the policy. Conclusion: Among attendees and HCWs in Rwandan clinics, the acceptability of PITC was very high. PITC appeared to increase testing rates and may be helpful in prevention and early access to treatment.
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- 2014
28. TRACnet: A National Phone-based and Web-based Tool for the Timely Integrated Disease Surveillance and Response in Rwanda
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Kizito, Kayumba, primary, Adeline, Kabeja, additional, Jean Baptiste, Koama, additional, Anita, Asiimwe, additional, Agnes, Binagwaho, additional, Johnson, Pamela, additional, and Thierry, Nyatanyi, additional
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- 2013
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29. Determinants of circumcision and willingness to be circumcised by Rwandan men, 2010
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Placidie Mugwaneza, Sabin Nsanzimana, Rwego A Gasasira, Anita Asiimwe, Malabika Sarker, Corine Karema, Landry Tsague, Aimée Gwiza, and Jennifer Mbabazi
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Adult ,Male ,medicine.medical_specialty ,Adolescent ,Cross-sectional study ,Male Circumcision ,World health ,Interviews as Topic ,Young Adult ,Acquired immunodeficiency syndrome (AIDS) ,Epidemiology ,medicine ,Humans ,Young adult ,Gynecology ,business.industry ,Public health ,lcsh:Public aspects of medicine ,Public Health, Environmental and Occupational Health ,Rwanda ,lcsh:RA1-1270 ,Middle Aged ,Patient Acceptance of Health Care ,medicine.disease ,HIV Prevention ,Cross-Sectional Studies ,Logistic Models ,Circumcision, Male ,Male circumcision ,Family medicine ,HIV/AIDS ,Biostatistics ,business ,Research Article - Abstract
Background Male Circumcision (MC) has been recommended as one of the preventive measures against sexual HIV transmission by the World Health Organization (WHO). Rwanda has adopted MC as recommended but the country is a non-traditionally circumcising society. The objective was to explore knowledge and perception of Rwandan men on Male Circumcision (MC) and to determine the factors associated with the willingness to be circumcised and to circumcise their sons. Methods This cross sectional study was conducted in 29 districts of Rwanda between January and March 2010. Data were collected using a structured questionnaire among men aged 15-59 years. The rate of MC was measured and its perception from respondents, and then the factors associated with the willingness to go for MC were analysed using multiple logistic regressions. Results A total of 1098 men were interviewed. Among respondents 17% (95% CI 14-19%) reported being circumcised. About three-quarter (72%) could define MC, but 37% of adolescent could not. Half of the participants were willing to get circumcised and 79% of men would accept circumcision for their sons. The main motivators for MC were its benefits in HIV/STI prevention (69%) and improving hygiene (49%). Being too old was the main reason (32%) reported by men reluctant to undergo MC and younger men were afraid of pain in particular those less than 19 years old (42%). The willingness to circumcise was significantly associated with younger age, living in the Eastern Province, marital status, and the knowledge of the preventive role of circumcision. Conclusions Adolescents and young adults were more willing to be circumcised. It is critical to ensure the availability of pain free services in order to satisfy the increasing demand for the scale up of MC in Rwanda.
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- 2012
30. AIDS Funds: Rwanda
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Joan Kaufman, Donald S. Shepard, Angelique K. Rwiyereka, and Anita Asiimwe
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education.field_of_study ,Multidisciplinary ,business.industry ,Cost effectiveness ,Environmental resource management ,Population ,Developing country ,Prenatal care ,medicine.disease ,Acquired immunodeficiency syndrome (AIDS) ,Family planning ,Global health ,Medicine ,business ,education ,Reproductive health ,Demography - Abstract
In their Policy Forum “Global HIV/AIDS policy in transition” (11 June, p. [1359][1]), J. Bongaarts and M. Over conclude that antiretroviral therapy for AIDS is not a cost-effective use of donor funding for global health. We believe that Bongaarts and Over omitted key aspects of a complete cost-effectiveness assessment: numerous positive spinoffs to other services, the effect on increased attention on global health, and the ability to mobilize resources that would not otherwise have been available for global health. The situation in Rwanda serves as an example. Rwanda's total health expenditure declined from 1998 through 2002, but because of advocacy for HIV resources, total health expenditure doubled between 2002 and 2003 ([ 1 ][2]). HIV funding, even before the current focus on integration, provided resources for the renovation of health facilities, equipment, training, and management, as well as a culture of openness for best practices. With integration of HIV services into other health services, resources have had an even wider benefit, especially for maternal health services. Integration is still in progress, but successful steps have been made ([ 2 ][3], [ 3 ][4]). Rwanda's 2006 National Health Accounts reported that although reproductive health spending did not grow as rapidly as overall spending, it increased by 15% between 2002 and 2006 ([ 4 ][5]), and maternal mortality rate decreased from 1071 (in 2000) to 750 per 100,000 births (in 2005) and is expected to fall to about 350 in 2010. Rates of assisted deliveries, use of family planning, and receipt of four standard prenatal care services have seen a marked increase ([ 4 ][5]–[ 6 ][6]). Consistent with the results in Rwanda, a recent Lancet article correlated maternal mortality with HIV mortality in women ([ 7 ][7]). These improvements cannot be attributed to reproductive health spending alone; major health initiatives made possible by HIV funding are largely responsible. HIV resources also paid for the community-based health insurance premiums of many of the poorest segments of the population; the funding thus contributed to the increase in community-based health insurance enrollment rate from 7% in 2003 to 85% in 2008. The literature cited by Bongaarts and Over failed to consider all benefits gained beyond direct HIV services, including the value of saving a mother and its contribution to quality of life for her children and family and societal productivity. In doing so, Bongaarts and Over have greatly underestimated the impact of HIV funding on both HIV and non-HIV health results. 1. [↵][8] Rwanda Ministry of Health, “National health accounts 2006” (2008). 2. [↵][9] National AIDS Commission, “National strategic plan 2009–2012” (2009). 3. [↵][10] UNAIDS, “Rwanda country progress report 2008–2009” (UNAIDS, Geneva, 2010). 4. [↵][11] Rwanda Ministry of Health, “Rwanda demographic and health survey 2000” (2001). 5. Rwanda Ministry of Health, “Rwanda demographic and health survey 2005” (2006). 6. [↵][12] Rwanda Ministry of Health, “Rwanda demographic and health survey 2007–2008” (2009). 7. [↵][13] 1. M. C. Hogan 2. et al ., Lancet 375, 1967 (2010). [OpenUrl][14][CrossRef][15][PubMed][16][Web of Science][17] [1]: /lookup/doi/10.1126/science.1191804 [2]: #ref-1 [3]: #ref-2 [4]: #ref-3 [5]: #ref-4 [6]: #ref-6 [7]: #ref-7 [8]: #xref-ref-1-1 "View reference 1 in text" [9]: #xref-ref-2-1 "View reference 2 in text" [10]: #xref-ref-3-1 "View reference 3 in text" [11]: #xref-ref-4-1 "View reference 4 in text" [12]: #xref-ref-6-1 "View reference 6 in text" [13]: #xref-ref-7-1 "View reference 7 in text" [14]: {openurl}?query=rft.jtitle%253DLancet%26rft.stitle%253DLancet%26rft.aulast%253DMcCaw-Binns%26rft.auinit1%253DA.%26rft.volume%253D375%26rft.issue%253D9730%26rft.spage%253D1967%26rft.epage%253D1968%26rft.atitle%253DNew%2Bmodelled%2Bestimates%2Bof%2Bmaternal%2Bmortality.%26rft_id%253Dinfo%253Adoi%252F10.1016%252FS0140-6736%252810%252960924-5%26rft_id%253Dinfo%253Apmid%252F20569839%26rft.genre%253Darticle%26rft_val_fmt%253Dinfo%253Aofi%252Ffmt%253Akev%253Amtx%253Ajournal%26ctx_ver%253DZ39.88-2004%26url_ver%253DZ39.88-2004%26url_ctx_fmt%253Dinfo%253Aofi%252Ffmt%253Akev%253Amtx%253Actx [15]: /lookup/external-ref?access_num=10.1016/S0140-6736(10)60924-5&link_type=DOI [16]: /lookup/external-ref?access_num=20569839&link_type=MED&atom=%2Fsci%2F330%2F6001%2F176.1.atom [17]: /lookup/external-ref?access_num=000278689600024&link_type=ISI
- Published
- 2010
31. Low risk of attrition among adults on antiretroviral therapy in the Rwandan national program: a retrospective cohort analysis of 6, 12, and 18 month outcomes
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Batya Elul, Veronicah Mugisha, Anita Asiimwe, Harriet Nuwagaba-Biribonwoha, Aleksandra Jakubowski, Paulin Basinga, and Denis Nash
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Adult ,Male ,Rural Population ,Gerontology ,medicine.medical_specialty ,Adolescent ,Urban Population ,Anti-HIV Agents ,Population ,HIV Infections ,Loss to follow-up ,Health Services Accessibility ,Young Adult ,Attrition ,Epidemiology ,Humans ,Medicine ,Mortality ,Lost to follow-up ,education ,Proportional Hazards Models ,Retrospective Studies ,education.field_of_study ,business.industry ,Proportional hazards model ,Antiretroviral therapy [ART] ,Public health ,Hazard ratio ,Rwanda ,Public Health, Environmental and Occupational Health ,Retrospective cohort study ,Middle Aged ,medicine.disease ,CD4 Lymphocyte Count ,Retention ,Africa ,Female ,Lost to Follow-Up ,Health Facilities ,business ,Research Article ,Demography - Abstract
Background We report levels and determinants of attrition in Rwanda, one of the few African countries with universal ART access. Methods We analyzed data abstracted from health facility records of a nationally representative sample of adults [≥18 years] who initiated ART 6, 12, and 18 months prior to data collection; and collected facility characteristics with a health facility assessment questionnaire. Weighted proportions and rates of attrition [loss to follow-up or death] were calculated, and patient- and health facility-level factors associated with attrition examined using Cox proportional hazard models. Results 1678 adults initiated ART 6, 12 and 18 months prior to data collection, with 1508 person-years [PY] on ART. Attrition was 6.8% [95% confidence interval [CI] 6.0-7.8]: 2.9% [2.4-3.5] recorded deaths and 3.9% [3.4-4.5] lost to follow-up. Population attrition rate was 7.5/100PY [6.1-9.3]. Adjusted hazard ratio [aHR] for attrition was 4.2 [3.0-5.7] among adults enrolled from in-patient wards [vs 2.2 [1.6-3.0] from PMTCT, ref: VCT]. Compared to adults who initiated ART 18 months earlier, aHR for adults who initiated ART 12 and 6 months earlier was 1.8 [1.3-2.5] and 1.3 [0.9-1.9] respectively. Male aHR was 1.4 [1.0-1.8]. AHR of adults enrolled at urban health facilities was 1.4 [1.1-1.8, ref: rural health facilities]. AHR for adults with CD4+ ≥200 cells/μL vs
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32. Shared learning in an interconnected world: innovations to advance global health equity
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Jean de Dieu Ngirabega, Parfait Uwaliraye, Anita Asiimwe, Agnes Binagwaho, Vincent Mutabazi, Fidele Ngabo, Cathy Mugeni, Peter Drobac, Cameron T Nutt, Gita N. Mody, Danielle R. Zurovcik, Hinda Ruton, Jonathan A. Niconchuk, Corine Karema, Andrew Makaka, Claire M. Wagner, Jean Pierre Nyemazi, Paul Farmer, Michael Rich, Sabin Nsanzimana, Michael R. Murphy, Michel Gasana, Massachusetts Institute of Technology. Department of Mechanical Engineering, and Zurovcik, Danielle R.
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Economic growth ,medicine.medical_specialty ,Shared learning ,Global Health ,Health outcomes ,medicine ,Global health ,Humans ,Cooperative Behavior ,Developing Countries ,Social policy ,Equity (economics) ,Information Dissemination ,business.industry ,Developed Countries ,Public health ,Health Policy ,Rwanda ,Health services research ,Public Health, Environmental and Occupational Health ,Public relations ,Commentary ,Strategic management ,Diffusion of Innovation ,business ,Delivery of Health Care - Abstract
The notion of "reverse innovation";--that some insights from low-income countries might offer transferable lessons for wealthier contexts--is increasingly common in the global health and business strategy literature. Yet the perspectives of researchers and policymakers in settings where these innovations are developed have been largely absent from the discussion to date. In this Commentary, we present examples of programmatic, technological, and research-based innovations from Rwanda, and offer reflections on how the global health community might leverage innovative partnerships for shared learning and improved health outcomes in all countries.
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