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