HIV Information for Action: Planning Prevention Strategies in Rwanda

1. HIV Information for Action: Planning Prevention Strategies in Rwanda CenterforTreatment andResearchonAIDS, Malaria, TuberculosisandOtherEpidemics TRACPlus Ruton Hinda, Data Analyst TRAC Plus, Ministry of Health, Rwanda

2. BackgroundRwandan HIV Epidemic • ~ 9.2 million inhabitants • 83% live in rural areas • 3.0 % prevalence in adults aged 15-49 • DHS 2005 • 7.3% urban vs. 2.2% rural • ~ 150,000 HIV-infected persons • EPP-Spectrum

3. Objective • Maximize use of available data to inform planning priorities • Data triangulation

4. Triangulation Process Gather data Develop & Refine hypotheses Examine data Communicating Planning Synthesizing

5. 12 Step Triangulation Process

6. Phase 1 – Planning • 2 priority questions identified: • What are the differences in HIV prevalence among different population groups over time? What are the potential causes for these differences? • Are there gaps in HIV/AIDS programmatic coverage according to prevalence and/or need?

7. Phase 2 – Synthesis • Identified and collected all HIV/AIDSdata sources • Reviewed 113 data sources from 2000 to 2008, including: • Surveillance and surveys • Research • Programmatic • Conducted preliminary quality rating of available studies • Abstracted relevant information from available surveys

8. Phase 2 – Synthesis (2) • Working group made a preliminary synthesis and interpretation • Workshop convened to: • Complete data synthesis • Interpret findings • Working groups based on geographic region and risk groups • 5 Provinces • Youth, refugees, female sex workers, truckers, etc.

9. Findings Truckers • Prevalence higher compared to general population • 17.4% (2007, mobile VCT; PSI) vs. 6.9% (2008; mobile VCT; PSI) • Interaction between truck drivers and sex workers decreasing • Many interventions implemented Refugees • Prevalence low compared to surrounding populations • Relatively high coverage of VCT and PMTCT services and education

10. Findings (2) Prisoners • Mobile VCT prevalence declined from 10% in 2006 to 4% in 2007; remains static (4%) as of July 2008. • Condoms are contraband, poor condom knowledge • MSM for food, security, power, no alternative partner • While outside prison, transactional sex, sex with partners Female Sex Workers • Prevalence 19.2%, PSI 2007; 16.4% PSI 2008 (mobile VCT) • Only 36.2% had comprehensive knowledge of HIV • No special health/prevention services for sex workers

11. Findings (3) Discordant Couples • 2.2% of heterosexual couples are discordant (DHS), greater number with positive men • HIV transmission from HIV-positive to HIV-negative partners was 20–25% per year • No programs targeting discordant couples at national level Youth • Overall low prevalence; women>men • 3.9% > 1.1 % urban; 1%> 0.3 % rural • Low and decreasing condom utilization • Lower for females • Increased high risk intercourse in past 12 months • Increase testing trend

12. Public Health Actions Triangulation findings were used to develop the new Rwanda National HIV/AIDS Strategic Plan for 2009-12, particularly in prevention Truckers & Refugees • Current programmatic efforts should continue • Factors behind successes in these populations should inform future surveillance efforts and to translate best practices to other at-risk groups Prisoners Strengthen HIV prevention programs, particularly condoms

13. Public Health Actions (2) Female Sex Workers • Intensify programs, e.g., treatment for STIs linked with prevention interventions Discordant Couples & Youth • Couples counseling and Prevention with Positives (PwP) programs reinforced • Targeted prevention program • Several important data gaps exist on these populations, • Second triangulation ongoing

14. Acknowledgement National • TRAC PLUS: A. KABEJA, H. RUTON, M. KRAMER • CNLS: A. ASSIMWE • CDC-GAP Rwanda: E. KAYIRANGWA International • UCSF: S. TACHE, H. FRANK • CDC Atlanta: J. ABERLE-GRASSE

15. Thank you