Stretch Goals: Eliminate Hepatitis C in Rwanda

I’m in week 3 of my PULSE assignment with Partners in Health/Inshuti Mu Buzima (PIH/IMB). I have learned a tremendous amount but have only scratched the surface of all the services provided by PIH/IMB. I hope to improve my information absorption so I can become a somewhat competent team member. PIH/IMB, in coordination with Rwandan Ministry of Health, has been able to help bring the mortality rate for HIV/AIDS infected individuals from 60%, at the end of the 1994 genocide against the Tutsis, to below 5% today. That impressive achievement occurred, in part, through “task sharing” or the process of moving the delivery of screening, diagnosis, treatment and follow-up closer to the patient. Task sharing required certain things to fall in place such as the ability to screen for HIV at the point of care and the ability to educate and provide treatment at the point of care. In Rwanda, the point of care can be the local community health center or the patient’s home. In order to reach the goal of eliminating Hepatitis C (HCV) in Rwanda by 2024, it makes sense to mimic the task sharing approach already proven effective for HIV/AIDS care. Just as screening tests needed to become cheaper and easier to use for HIV/AIDS, the same needs to occur for HCV. Just as global HIV/AIDS advocacy reduced the cost of Anti-Retroviral Therapy (ART), then global advocacy on viral Hepatitis needs to reduce the cost of Direct Acting Antivirals (DAA) for HCV. Until screening, diagnostic testing and treatment become more affordable, the PIH/IMB team and the Rwandan Ministry of Health are piggybacking on the existing HIV/AIDS infrastructure to look first at micro-elimination of HCV in specific groups (e.g. healthcare workers). Lessons learned through screening, diagnosis and treatment of HCV in specific populations will help guide broader efforts at HCV elimination throughout Rwanda.

I would be remiss if I did not include some pictures and descriptions of my life in Rwanda. My mode of transportation, and the main mode for just about everybody, is walking. Everyone greets you while you are out and I’ve been comfortable walking day and night. The next mode of transport in Kigali is the “moto”. Motos are everywhere and available anytime. Moto drivers know how to get pretty much anywhere in the city.

Motos fill the streets in Kigali

I was fortunate last week to be able to visit the Burera District in the Northern Province of Rwanda. Butaro Hospital is the district hospital there and the first hospital in Rwanda to offer cancer care. Prior to 2011, any patient with a cancer diagnosis had to seek treatment outside the country. PIH/IMB partnered with the Ministry of Health to begin providing cancer diagnosis and treatment services at the hospital. GSK helped supply some of the first cancer medicines to the hospital. Below is the view from the infusion center at the hospital. While chemo infusion sucks, the view can only help.

View from the Butaro hospital infusion room

9 comments

  1. Hi Stephen, thanks for sharing. Remember that absorption is critical in the early stages of your journey but there’s so much to learn and it does take time so don’t put undue stress on yourself. Also, remember that you are already a competent team member, our team knows it and so does PIH. It’s remarkable the progress Rwanda has made in so many areas since 1994. Also, it’s nice to hear that they’re not re-inventing the wheel and are looking to leverage the “task sharing” model that worked with HIV. Oh how I miss Rwanda – the people, the work, the climate, the scenery… even the roar of the motos from a start at the stop lights :).

  2. Hi Steve, happy to read your first blog!
    Glad you got to Butaro already, it took me 4 months before I decided to get there 😉 Beautiful sceneries, isn’t it?
    Yesterday I told (as a comment to his blog) another Pulse volunteer in Liberia with CHAI to get in touch with you as they are starting cancer treatment over there and don’t want to reinvent the wheel… Now that you’re familiar with what PIH is doing in Butaro, you might have some good advises to share with them…!
    Keep going, we’re reading you with enthusiasm… Say hello to my friend Hans!
    Francois_

  3. Good to hear from you Stephen! It’s hard to believe that cancer diagnosis has come so late in the country and it still is a barrier! I am sure PIH is grateful to have you and even if you are not competent in their specilaty, I am sure you are adding value through your past experiences & an outsider perspective! So glad you can help support PIH in this immensely impactful work for people in Rwanda! All the best, Manu.

  4. Hi Steve, thanks for sharing your experience with us! I’m sure your experience and your work will be really helpful and appreciated by PIH! All the best. myriam

  5. Hi Steve, great to read your blog. It gives a nice insight in your PULSE adventure and the challenges of the team you are now part of. Great work! Bart

  6. Hello Steve! Have you hopped on one of the motos? I am sure you are more than competent. We miss you here at UP, but I’m sure you are making a tremendous difference there in the lives of so many. Take a selfie on the back of moto and send it back to us!

  7. Hi Stephen, Sounds like you are learning quickly and are going to be a valuable asset to the team. It is encouraging to see both alums of the global PULSE program and PIH Rwanda keeping up with the ongoing work. Hello to all of our friends in Rwanda!

  8. Thanks, Steve, for sharing your experiences – it sounds amazing. I think you are also sharing insights that will be valuable to us at GSK in the clinical trial space. The successful HIV treatment paradigm you describe (task sharing and point-of-care activities) align with the thinking behind the decentralized clinical trial approach (bring the trial to the patient rather than forcing the patient to always come to the clinical trial site). As we look to modernize the way we conduct trials, I think your PULSE experience can provide some interesting perspectives. Looking forward to hearing more!

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