La prise en charge therapeutique du VIH au Centre Hospitalier Universitaire de Kigali: 8 ans d'experience (2002 - 2009)

Introduction: Au Rwanda; le programme de prise en charge; par les ARV; des personnes vivant avec le VIH; a commence en 1999 dans le Centre Hospitalier de Kigali. Le nombre de sites est passe de 4 en 2002 a 396 en 2010 (1).Methodes: C'est une etude retrospective portant sur 2767 patients enregistres depuis 2002 Jusqu'en 2009. La presente etude revoit les donnees sur la therapie ARVs au CHUK en utilisant le logiciel FUCHIA; afin de transmettre des informations detaillees en la matiere aux prestataires de soins pour un meilleur suivi des patients HIV/SIDA. L'evolution des patients est presentee par annee; par age; par stade clinique de l'OMS; schemas therapeutique; ect. La recommandation principale est de renforcer les strategies qui peuvent augmenter la proportion des enfants VIH positifs sous ARV; doivent etre mise en place au CHUK.Resultats: 71 patients (soit 2;5) n'ont pas de dossiers complets. Depuis 2002; il ya plus de femmes que d'hommes qui sont sous ARVs. La moyenne d'age de 38;64 ans et une deviation standard de 11;061 (entre 1 et 80). Les enfants sont moins nombreux a etre sous ARVs durant cette periode. La majorite des patients a commence les ARVs au stade clinique III ou IV de la classification OMS. Les patients sous ARVs en premiere ligne ont augmente depuis le debut de la prise en charge au CHUK. Conclusion: L'enrolement des nouveaux patients tend a diminuer au fur des annees au CHUK suite a l'augmentation des sites de Prise en charge des patients vivant avec le HIV. Des schemas de traitement suivi sont recommandes par la politique nationale de Prise en charge des PVVIH

Abortion Incidence and Postabortion Care in Rwanda

Abortion is illegal in Rwanda except when necessary to protect a woman's physical health or to save her life. Many women in Rwanda obtain unsafe abortions; and some experience health complications as a result. To estimate the incidence of induced abortion; we conducted a national sample survey of health facilities that provide postabortion care and a purposive sample survey of key informants knowledgeable about abortion conditions. We found that more than 16;700 women received care for complications resulting from induced abortion in Rwanda in 2009; or 7 per 1;000 women aged 15-44. Approximately 40 percent of abortions are estimated to lead to complications requiring treatment; but about a third of those who experienced a complication did not obtain treatment. Nationally; the estimated induced abortion rate is 25 abortions per 1;000 women aged 15-44; or approximately 60;000 abortions annually. An urgent need exists in Rwanda to address unmet need for contraception; to strengthen family planning services; to broaden access to legal abortion; and to improve postabortion care. (StudieS in Family Planning 2012; 43[1]: 11-20)

Results of a national survey on drug resistance among pulmonary tuberculosis patients in Rwanda.

BACKGROUND: One of the principal objectives of tuberculosis (TB) control is to minimise the emergence of drug resistance. The first national survey was conducted in Rwanda to determine the prevalence of M. tuberculosis drug resistance. METHODS: Sputum samples were collected from all new and retreatment cases in the health districts from November 2004 to February 2005. Drug susceptibility testing of isolates against first-line drugs was performed by the proportion method. RESULTS: Of 616 strains from new cases, 6.2% were resistant to isoniazid, 3.9% to rifampicin and 3.9% were multidrug-resistant TB. Among 85 strains from previously treated cases, the prevalence of resistance was respectively 10.6%, 10.6% and 9.4% (MDR-TB strains). Eight MDR cases showed additional resistance to ethambutol and streptomycin. CONCLUSION: The level of MDR-TB among TB patients in Rwanda is high. The main reasons of this emergence of MDR-TB can be attributed to the disorganisation of the health system, migration of the population during the 1994 civil war and poor success rates, with a high number of patients transferred out and lost to follow-up. On the other hand, the use of treatment regimens administered twice weekly during the continuation phase could be another important factor and merit further investigations.

Preparing for microbicide trials in Rwanda: focus group discussions with Rwandan women and men.

The acceptability and feasibility of microbicide studies and future microbicide use are influenced by existing norms and values regarding sexual and contraceptive behaviour. In preparation for microbicide research in Rwanda, focus group discussions were conducted to assess sexual and contraceptive behaviour, preferences for vaginal lubrication, and hypothetical acceptability of microbicides among Rwandan women and men. Seven focus group discussions were conducted among sexually active married women, unmarried women, sex workers, female students, older women and men living in Kigali, Rwanda, and an additional group of women living in a rural area. The results indicate that condom use is low among Rwandan men and women and that condoms are mainly used by men during commercial sex. Women have limited power to negotiate condom or family planning use. Vaginal hygiene practices are very common and consist primarily of washing with water. Lubrication during sex is highly preferred by both men and women. Hypothetical microbicide acceptability after an explanation of what microbicides are and a demonstration with lubricant jelly was high.