DTBE in Rwanda
Capital City: Kigali
Area*:26,338 sq. km. (10,169 sq. mi.)
Population (est.), 2011*: 10.7 million
Estimated TB Incidence, 2010**: 106/100,000
Estimated TB Prevalence, 2010**: 128/100,000
Adult HIV Prevalence Rate, 2009***: 2.9%
Number of people living with HIV (PLHIV), 2009***:170,000
Percent of tested TB patients who were HIV+, 2010**: 32%
**Source: WHO Global TB Control Report 2011
***Source: UNAIDS, Report on the Global AIDS Epidemic, 2010
Rwanda’s rural, mountainous terrain presents many difficulties to provide health services; however, Rwanda reduced the HIV prevalence rate nearly in half from 1990 to 2009. Rwanda has a relatively low HIV prevalence rate (2.9%) and a tuberculosis (TB) incidence rate similar to its neighbors. The Centers for Disease Control and Prevention’s Division of Tuberculosis Elimination (CDC/DTBE) has been providing ongoing support to CDC/Global AIDS Program (GAP) Rwanda and the Ministry of Health (MOH) for TB/HIV activities since 2002, with a primary focus on integrated TB/HIV services, screening for TB among children, health systems strengthening, and laboratory support.
Recent Accomplishments & Ongoing Collaborations
Program Strengthening and Epidemiology
New Diagnostics: CDC/DTBE is working closely with U.S. Agency for International Development (USAID) and the National TB Program (NTP) and Rwanda MOH to purchase, implement, and evaluate the impact of GeneXpert MTB/RIF. Specifically, the evaluation will look at time to diagnosis and treatment, treatment outcomes, and other programmatic indicators.
TB Risk Assessment among Healthcare Staff: In 2011,CDC/DTBE conducted an assessment of the risk of TB infection and TB disease among healthcare staff in different facilities and in different roles. The findings from this study serve as a baseline for future infection control interventions for these staff. The results will guide infection control implementation and will help determine what is needed to protect healthcare workers from TB and guide rational scale-up of infection control interventions.
Multidrug-Resistant TB (MDR TB), TB/HIV, and Other At-Risk Populations
Training on the Management of Drug-Resistant TB: In January 2011, CDC/DTBE facilitated the first training course sponsored by the Rwandan Center of Excellence (COE) in Programmatic Management of Drug-resistant TB (PMDT) and Infection Control (IC). Plans are underway to develop future courses that emphasize the IC and laboratory aspects of drug-resistant TB in the region. CDC will work with partners to provide ongoing technical assistance to the NTP regarding COE training activities, including development of curricula and supporting tools, and plans for monitoring and evaluation.
Supporting Management of MDR TB: CDC/DTBE has supported a number of activities designed to strengthen ability to diagnose and manage MDR TB and to guard against service disruption. A few of these activities have been to support access to second-line drugs through the WHO Green Light Committee, conduct programmatic evaluations of new diagnostics to determine performance and cost, and developed and evaluated models for MDR TB management for use nation-wide. CDC/DTBE is also supporting an evaluation of the treatment outcomes of the first group of patients in Russia to complete therapy on the internationally recommended strategy for treating MDR TB patients, Directly Observed Therapy Short-course (DOTS) Plus (second-line treatment).
Diagnosing TB among People Living with HIV (PLHIV): CDC/DTBE is working closely with the National TB Program and the MOH to evaluate the implementation of new international recommendations for TB screening among PLHIV to determine its performance in appropriately diagnosing TB among this population. There is a related study seeking to determine how the scale-up of anti-retroviral therapy (ART) for PLHIV may impact the number of TB cases found among PLHIV in Rwanda, with the hope that better ART access will reduce the number of patients developing TB.
TB Screening among Children with HIV: In 2008, CDC/DTBE in collaboration with the National TB Program conducted an evaluation of TB screening approaches among children with HIV in Rwanda. These prospective screening approaches informed international and national pediatric TB/HIV program guidelines and recommendations. The main findings were 1) a TB screening approach using a symptom screen plus a tuberculin skin test (TST) had a sensitivity of 95%; 2) a symptoms screen using multiple symptoms performed better than those using only one; and 3) there remains an urgent need for better diagnostic tests for TB in children, specifically in countries with a high prevalence of HIV. A follow-up study to assess the performance of new screening approaches among children is planned for 2012. This study will assess the prevalence of TB disease and latent TB infection among children with HIV attending outpatient clinics in Rwanda and develop further evidence for an approach to TB screening among this population.