Improving health outcomes through concurrent HIV program scale-up and health system development in Rwanda: 20 years of experience

BMC Medicine

Agnes Binagwaho²  Edward J. Mills¹  Paul Farmer³  Peter Drobac³  Jamie I. Forrest¹  Etienne Karita⁵  Haley McDermott³  Krishna Prabhu⁴  Sabin Nsanzimana⁶ 

[1] Global Evaluative Sciences, Vancouver, Canada;Geisel School of Medicine, Dartmouth College, Hanover, USA;Partners in Health, Boston, USA;Harvard University Medical School, Boston, USA;Project San Francisco, Kigali, Rwanda;Basel Institute for Clinical Epidemiology & Biostatistics and Swiss Tropical and Public Health institute, University of Basel, Basel, Switzerland

关键词: Universal healthcare;    Sub-Saharan Africa;    Rwanda;    HIV/AIDS;    Antiretroviral therapy;   

Others  :  1224631
DOI  :  10.1186/s12916-015-0443-z

 received in 2015-03-30, accepted in 2015-08-07,  发布年份 2015

【 摘 要 】

The 1994 genocide against the Tutsi destroyed the health system in Rwanda. It is impressive that a small country like Rwanda has advanced its health system to the point of now offering near universal health insurance coverage. Through a series of strategic structural changes to its health system, catalyzed through international assistance, Rwanda has demonstrated a commitment towards improving patient and population health indicators. In particular, the rapid scale up of antiretroviral therapy (ART) has become a great success story for Rwanda. The country achieved universal coverage of ART at a CD4 cell count of 200 cells/mm ³in 2007 and increased the threshold for initiation of ART to ≤350 cells/mm ³in 2008. Further, 2013 guidelines raised the threshold for initiation to ≤500 cells/mm ³and suggest immediate therapy for key affected populations. In 2015, guidelines recommend offering immediate treatment to all patients. By reviewing the history of HIV and the scale-up of treatment delivery in Rwanda since the genocide, this paper highlights some of the key innovations of the Government of Rwanda and demonstrates the ways in which the national response to the HIV epidemic has catalyzed the implementation of interventions that have helped strengthen the overall health system.

【 授权许可】

   
2015 Nsanzimana et al.

【 图 表 】

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