“Undetectable=Untransmittable”: A game-changer in Rwanda’s HIV prevention, treatment course

In 2012, Rukundo received the devastating news that he had acquired HIV. He delayed medication, thinking his results might have been swapped with other students during the school checkup. He went without medication or visiting a healthcare centre for three years, causing his immune system to weaken and become more susceptible to diseases. “I developed wrinkles on my skin, pimples draped my face, and wounds covered my lips. I tested again in 2015 and the results showed HIV Positive, still. I therefore started medication immediately with the support of my father. ALSO READ: HIV/AIDS: RBC calls for testing, safety practices in nationwide prevention campaign “I didn’t take my medication consistently as I feared that students would find out my status and start stigmatising me,” Rukundo said. He wasn’t too enthused about continuing medication since he had already imagined the worst outcome — death, considering the disease had, and still has no cure. His academic performance declined as he struggled to focus in class and lost sight of his life’s purpose. Rukundo’s life changed after visiting Gatenga Health Centre. There, he learned the importance of taking antiretroviral (ARV) medication daily. Taking the medication consistently was emphasised for his health and well-being, and over time, he gained physical strength and excelled academically. He now teaches in a local NGO that empowers women and girls in HIV prevention, gender-based violence prevention, nutrition provision, and gender equality. In 2021, the Undetectable=Untransmittable (U=U) programme was introduced by the Rwanda Biomedical Centre (RBC) in partnership with the Rwanda Network of People Living with HIV (RPP+). Rukundo is among those who have benefited from it, as the regular use of ARVs has reduced his viral load to the point where the virus is no longer detectable in his blood. The U=U strategy is where individuals with HIV, undergoing treatment and maintaining an undetectable viral load, cannot transmit the virus to an HIV-negative partner. Rukundo is now advocating to combat stigma and discrimination against individuals with HIV. He recently disclosed his HIV status to inspire young people that being HIV positive is not the end of life. He urges those with HIV to keep taking their medications and encourages those who have not been tested to do so to be aware of their status. ALSO READ: RBC relies on youth centres, campaigns to curb HIV in Eastern Province According to Dr Simeon Tuyishime, Director of the HIV/AIDS Care and Treatment unit at RBC, the U=U plays a significant role in the battle against HIV stigma, raising awareness about the efficacy of antiretroviral therapies (ARTs) within communities and empowering people living with HIV in their sexual relationships. He noted that this strategy considers secondary prevention of HIV, targeting people who have HIV to avert transmitting it to HIV-negative people. This programme aims to give hope to people living with HIV, and enable them to have a reason to stay alive, motivated, and execute their daily tasks and activities, just like any other person, he added. “For people living with HIV, taking HIV drugs can reduce the amount of virus in their blood (viral load), thus making their blood, vaginal fluids, and semen much less likely to transmit HIV to others. “Taking HIV drugs also helps people living with HIV feel better because it keeps their viral load low. A low viral load means a healthier immune system, which in turn prevents the person from progressing to AIDS.” According to Tuyishime, a person living with HIV takes antiretroviral treatment, which works by stopping the virus from replicating in the body, resulting in viral suppression — having less than 200 copies of HIV per millilitre of blood. He revealed that most international documentation sets the cutoff of at least 1,000 copies per millilitre of blood. This means that someone who is taking antiretroviral treatment for at least six months consistently without interruption, should not have more than 1,000 copies of the viruses per single millilitre of their blood. People taking ARVs with viral copies of more than 1,000 by a single millilitre of their blood signify that they don’t have an effective treatment outcome, and this could be due to failure to adhere to the treatment, Tuyishime stated. “There are interventions provided to such people, such as reinforcing or emphasising counselling, and those with issues, we discover the root cause of such problems. We also ensure that we find out why their treatment is intermittent. In case the issue is with the medication, we can prescribe another one that can support them effectually. “We have noticed that self-stigma and other issues limit constant medication discipline. We urge people living with HIV to stick to ARVs, and conduct regular checkups to know their viral load.” Deo Mutambuka, Executive Secretary at RRP+, stated that although the U=U strategy is new in Rwanda, it has been packaged in an all-inclusive approach in terms of communicating and engaging with the peer HIV communities and other members of the community. “Rwanda has already achieved a big milestone in the HIV prevalence, which is stable at three per cent of the general population, but with specific groups like the youth, the numbers are still high. But we are confident that the U=U programme will be effective as there is already advocacy in different districts of the country,” Mutambuka stated. He mentioned that due to the different factors in place like campaigns, better treatment, and services, HIV-positive people can live improved lives. Mutambuka emphasised that the U=U is an enhanced impact of treatment. When someone is well treated and follows instructions from their healthcare providers, they possess a higher chance to obtain a healthy life. “Health centres have a programmatic approach of giving treatment for three months, and six months. People no longer queue on a weekly or daily basis for prescriptions and when they go back to the hospital for their appointment, they test and know their viral load status. When the viral load lowers, they are motivated.”

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“Undetectable=Untransmittable”: A game-changer in Rwanda’s HIV prevention, treatment course