At a glance
CDC Rwanda, established in 2002, works closely with the government of Rwanda to strengthen health systems and prevent communicable diseases. Key initiatives include the Global Health Security Agenda (GHSA), U.S. President’s Emergency Plan for AIDS Relief (PEPFAR), and the U.S. President's Malaria Initiative (PMI).
Overview
CDC established an office in Rwanda in 2002. CDC Rwanda works with the government of Rwanda through the Ministry of Health (MOH) to address the following issues:
- HIV
- Tuberculosis (TB)
- Global health security
- Malaria
HIV and TB
Strategic focus
Through the PEPFAR, CDC works with Rwanda's MOH to strengthen clinical HIV prevention and treatment services. CDC supports counseling and testing at government-run facilities, distribution of self-test kits, index testing, voluntary medical male circumcision, and prevention of mother-to-child transmission. In addition, the agency supports pre-exposure prophylaxis among key populations, including female sex workers, men who have sex with men, and adolescent girls and young women ages 15-24.
CDC also assists with:
- Scaling up antiretroviral treatment (ART).
- Integrating TB and HIV services at MOH testing and treatment facilities.
- Improving TB and HIV informatics, surveillance, and monitoring and evaluation.
- Improving population-based impact assessment surveys.
Public health systems
CDC supports the MOH to establish innovative and robust electronic health information systems to prevent, detect, treat, and report cases of HIV, TB, and other diseases. Rwanda used case-based surveillance system (CBS) to identify patients during clinic visits and link health records from multiple visits and across health facilities. A digital platform for CBS has been deployed at 150 sites as of December 2023. Investments in electronic health information systems contribute to:
- Enhanced quality and availability of timely data for clinical decisions and evidence-based programs and policies.
- Enhanced data analysis and use of strategic information.
- Mentorship and continuous quality improvement that strengthens health services and programs.
Laboratory systems strengthening
Specific to HIV, CDC works with Rwanda’s National Reference Laboratory (NRL) to coordinate the testing network and strengthen key laboratory functions. CDC supports enhanced laboratory infrastructure and workforce development. CDC also promotes local expertise in continuous quality improvement and helps increase testing capacity to quickly deliver high-quality services.
Rwanda's NRL leads local efforts to advance quality management systems throughout the laboratory network. NRL achieved medical laboratory accreditation (ISO15189:2012) in 2020. CDC helped strengthen local laboratory capabilities to produce and distribute proficiency testing panels to over 4,000 testers annually for quality assurance of HIV testing services.
Key achievements
- More than 108,700 (50%) of adults and children living with HIV in Rwanda receive ART through PEPFAR.
- Rwanda's national ART coverage is 92.4%, treatment retention is 94.5%, and overall viral load suppression is 97%.
- Successful treatment of TB increased from 58% in 2003 to 87% in 2022.
Global health security
Strategic focus
CDC's global health security work in Rwanda focuses on strengthening the country’s public health systems.
Workforce development
CDC supports training scientists through the Field Epidemiology Training Program (FETP). The program consists of three levels of training: frontline, intermediate, and advanced. Through FETP, CDC strengthens Rwanda’s workforce capacity to identify and stop outbreaks before they spread. FETP residents have been instrumental in supporting emergency management operations within Rwanda's provincial Public Health Emergency Operation Centers (PHEOCs). Their contributions include:
- Enhancing surveillance in healthcare facilities and communities
- Conducting risk assessments and screening at points of entry
- Managing case investigations
- Coordinating incident management efforts
Emergency preparedness and response
CDC supports the MOH with strategic planning, national outbreak preparedness, establishment of national and provincial Emergency Operations Centers, and emergency management trainings for MOH staff.
Key achievements
- As of July 2024, a total of 412 residents have been trained through FETP.
- Trainees have led and supported responses to over 80 outbreaks including COVID-19, mpox, measles, cholera, malaria, epidemic typhus fever, and other diseases.
- Trainees have led and supported responses to over 80 outbreaks including COVID-19, mpox, measles, cholera, malaria, epidemic typhus fever, and other diseases.
Malaria
Strategic focus
Malaria is a leading cause of death and disease in many countries, and young children and pregnant women are among the most affected populations. In 2007, CDC began co-implementing malaria prevention and control activities through the PMI. CDC's PMI activities support the Rwanda MOH's National Malaria Control Program to:
- Provide long-lasting insecticide-treated nets and antimalarial medication.
- Support indoor residual spraying in districts with high malaria incidence and prevalence.
- Prevent malaria in pregnancy.
- Enhance malaria diagnostics, case management, and disease surveillance.
- Monitor and evaluate malaria-related activities to inform decision-making.
Key achievements
- Cases of malaria in Rwanda decreased from 8 million cases in 2016 to 844,000 cases in 2022.
- Severe malaria cases decreased from 18,000 cases in 2016 to 1,740 cases in 2022.
- Deaths due to malaria decreased from 715 in 2016 to 74 in 2022.
- Severe malaria cases decreased from 18,000 cases in 2016 to 1,740 cases in 2022.
- As of 2020, 66% of households in Rwanda own at least one insecticide-treated bed net.
Success story spotlight
Pursuing Health Equity for Those Most Affected by HIV
Rwanda has been among the most successful countries in the world in treating AIDS and reducing the rate of new HIV infections. However, compared to the overall population in Rwanda, men who have sex with men (MSM) continue to have a much higher prevalence of HIV infection with a 6.9 % rate among MSM vs. 2.2% among non-MSM in the adult population, according to the 2019 Rwanda Population-Based HIV Impact Assessment. MSM in Rwanda still face stigma and discrimination that negatively affect access to HIV prevention and treatment services.
The U.S. Government, through PEPFAR and CDC, funds a local implementing partner called Society for Family Health (SFH) to reach key populations (KP), including MSM. Activities include providing HIV services adapted to their unique needs at 24 health facilities throughout Rwanda. By the end of 2022, CDC through SFH reached and enrolled 9,715 MSM in the KP program. This achievement reflected a close collaboration and technical support provided by MSM key informants to reach so many MSM with peer education and linkage to Health facilities for HIV services.
MSM key informants, known as Peer Educators are recruited through MSM networks. They work closely with SFH and Government of Rwanda's health facilities to recruit, mobilize and refer KP peers from their network for HIV services. They also help distribute HIV self-test kits, condoms, and lubricants. Health care providers at these sites continue to gain skills through capacity building and mentorship opportunities on providing KP friendly services. This training helps to reduce KP barriers to HIV prevention and treatment services, and ensures their safety and security by strengthening gender-based violence and stigma and discrimination services at health facilities.