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IntroductionThe World Health Organization reported that one third of global population was tobacco smoker. In countries with a high tuberculosis burden, a big proportion was attributed to tobacco smoking. In the general population of Rwanda, the prevalence of tobacco smoking was higher among males (14%) compared to females (3%). We conducted a second analysis to assess factor associated with tobacco smoking among patient with TB attending Health Facilities.MethodologyA retrospective case-control study in Centres of Diagnosis and Treatment of tuberculosis (CDT). Cases were patients with bacteriological TB confirmation; controls were persons with signs and symptoms without TB confirmation. Proportions and logistic regression were used in data analysis.ResultsThe total number of tobacco smokers was 680. Among tobacco smokers, 88.1% tobacco smokers were males, 94.3% tobacco smokers had at least 25 years old and 64.6% were living in union. By education, 84.9% tobacco smokers were illiterate or attained primary school. Almost all tobacco smokers (97.0%) ever drunk alcohol while 67.9% used illicit drugs and 25.3% had low BMI (≤ 18.5) with increased proportion among cases (29.1%). A proportion of 38.3% in tobacco smokers had history of imprisonment. In multivariable logistic regression data analysis, males compared to females (aOR = 3.49[95%CI:1.76–6.94]), ever drunk alcohol compared to never drank alcohol (aOR = 6.39[95%CI:2.67–15.31]) and ever used illicit drugs compared to never used illicit drugs (aOR = 9.89[95%CI:3.87–25.25]) were associated with high odds of tobacco smoking. In addition, illiterate people or people who attained only primary school education level compared to people having primary education level and above (aOR = 0.39[95%CI:0.23–0.69]) were associated with low odds of tobacco smoking.ConclusionTobacco smoking is common in pulmonary TB patients. Males were more likely using tobacco smoking compared to females. Alcohol drinkers and illicit drug users were associated to tobacco smoking. A campaign on tobacco cessation, focusing on males, should be conducted in the general population starting by people on TB treatment.

Background Estimates of influenza-associated hospitalization are limited in low- and middle-income countries, especially in Africa. Objective To estimate the national number of influenza-associated severe acute respiratory illness (SARI) hospitalization in Zambia. Methods We conducted active prospective hospital-based surveillance for SARI at the University Teaching Hospital (UTH) situated in Lusaka Province during 2011-2014. Upper respiratory tract samples were tested for influenza virus using a reverse transcriptase polymerase chain reaction assay. We estimated age-specific rates of influenza-associated SARI hospitalizations for the UTH using census and secondary data on respiratory hospitalizations following estimation approaches recommended by the World Health Organization. We used the UTH hospitalization rates as a proxy for Lusaka Province. These rates were adjusted for each of the remaining 9 provinces based on their prevalence of risk factors for pneumonia and healthcare-seeking behavior. Rates were expressed per 100,000 population. Results SARI cases accounted for 77.1% (13 389/17 354) of respiratory admissions at the UTH; 82.7% (11 859/14 344) and 50.8% (1530/3010) among individuals aged

Human immunodeficiency virus (HIV) prevalence is often high among female sex workers (FSWs) in sub-Saharan Africa. Understanding the dynamics of HIV infection in this key population is critical to developing appropriate prevention strategies. We aimed to describe the prevalence and associated risk factors among a sample of FSWs in Rwanda from a survey conducted in 2010. A cross-sectional biological and behavioral survey was conducted among FSWs in Rwanda. Time–location sampling was used for participant recruitment from 4 to 18 February 2010. HIV testing was done using HIV rapid diagnostic tests (RDT) as per Rwandan national guidelines at the time of the survey. Elisa tests were simultaneously done on all samples tested HIV-positive on RDT. Proportions were used for sample description; multivariable logistic regression model was performed to analyze factors associated with HIV infection. Of 1338 women included in the study, 1112 consented to HIV testing, and the overall HIV prevalence was 51.0%. Sixty percent had been engaged in sex work for less than five years and 80% were street based. In multivariable logistic regression, HIV prevalence was higher in FSWs 25 years or older (adjusted odds ratio [aOR] = 1.83, 95% [confidence interval (CI): 1.42–2.37]), FSWs with consistent condom use in the last 30 days (aOR = 1.39, [95% CI: 1.05–1.82]), and FSWs experiencing at least one STI symptom in the last 12 months (aOR = 1.74 [95% CI: 1.34–2.26]). There was an inverse relationship between HIV prevalence and comprehensive HIV knowledge (aOR = 0.65, [95% CI: 0.48–0.88]). HIV prevalence was high among a sample of FSWs in Rwanda, and successful prevention strategies should focus on HIV education, treatment of sexually transmitted infections, and proper and consistent condom use using an outreach approach.

Summary Background In 2013, the World Health Organization (WHO) recommended that for efficiency and ethical considerations, transitioning from antenatal clinic-based surveillance to prevention of mother-to-child transmission (PMTCT)-based routine data should be investigated. An assessment of the readiness for this transition was carried out in Rwanda in 2011 and 2013. Methods This assessment applied the WHO recommended method. Individual HIV rapid testing at site was compared to antenatal surveillance results at all existing 30 sites, involving 13 292 women. In addition, PMTCT HIV testing quality assurance and PMTCT routine data quality were assessed at 27 out of the 30 sites. Results All sentinel sites provided PMTCT services and had a high uptake of HIV testing (more than 90%). At all sites, PMTCT data were recorded in longitudinal and standardized antenatal clinic registers. Twenty-six out of 27 sites had HIV result completeness above 90%. A positive percentage agreement of 97.5% and negative percentage agreement of 99.9% were observed between routine PMTCT and sero-surveillance HIV test results. Of 27 sites, 25 scored more than 80% in all phases of HIV testing quality assurance. Conclusions According to WHO standards, Rwanda antenatal care HIV sero-surveillance is ready to transition to PMTCT-based sero-surveillance.

Syphilis can be transmitted by pregnant women to their children and is a public health problem in Africa. A cross-sectional survey was conducted in 24 antenatal clinics from 2002 to 2003 and increased to 30 sites from 2005 to 2011. Participants were tested for syphilis and HIV. Multi-variate logistic regression was performed to identify risks associated with syphilis and its co-infection with HIV. Results showed that syphilis decreased from 3.8% in 2002 to 2.0% in 2011. Syphilis in the HIV-infected participants increased from 6.0% in 2002 to 10.8% in 2011, but decreased from 3.7% to 1.7% in the HIV-negative participants. In 2011, syphilis in urban participants was 2.7% and 1.4% in rural ones. HIV-infected participants screened positive for syphilis more frequently in both rural (aOR = 3.64 [95% CI: 1.56%–8.51%]) and urban areas (aOR = 7.26 [95% CI: 5.04%–10.46%]). Older participants (25–49 years) residing in urban areas (aOR = 0.43[95% CI: 0.32%–0.58%]) and women with secondary or high education (aOR = 0.35[95% CI: 0.20%–0.62%]) were less likely to screen positive for syphilis. HIV-syphilis co-infection was more likely in women residing in urban areas (aOR = 8.32[95% CI: 3.54%–19.56%]), but less likely in women with secondary/high education (aOR = 0.11[95% CI: 0.01%–0.77%]). In conclusion, syphilis increased in HIV-positive pregnant women, but decreased in HIV-negative women. Positive HIV status and young age were associated risks for syphilis. HIV-syphilis co-infection was associated with a lower level of education and urban residence.

Female sex workers (FSWs) frequently face violence in their working place. This study assessed the physical and sexual violence and associated factors among FSWs in Rwanda. A cross-sectional study was conducted among FSWs in Rwanda in 2015. Venue–Day–Time sampling method was used for recruitment. Descriptive analyses and logistic regression models were computed to assess factors associated with violence. In total, 1978 FSWs were recruited. A large proportion (18.3%) had been sexually abused outside of the family circle, and 37.8% had faced physical violence before 15 years of age. Clients were most often reported (67.0%) as perpetrators of physical violence in sex work. Being aged 25 years old and above, and having sexually transmitted infections (STIs) were positively associated with sexual violence (aOR = 2.1[95%CI: 1.80–2.39]) and (aOR = 3.0[95%CI: 1.01–2.14], respectively). Being aged 25 years old and above (aOR = 0.8[95%CI: 0.76–0.89]) and drinking alcohol every day (aOR = 0.6[95%CI: 0.42–0.87]) were negatively associated with physical violence. Sexual and physical violence was common among FSWs in Rwanda. Single FSWs are the most vulnerable to sexual violence. Alcohol consumption and having STIs are associated with violence against FSWs. Human rights and social protection as well as health promotion among FSWs is needed.

Female sex workers (FSWs) are at high risk for HIV. Cross-sectional surveys using a venue–day–time approach for recruitment were conducted among FSWs in Rwanda in 2006, 2010 and 2015. Chi square test for trends was computed to determine behavior changes. Logistic regression models were computed to determine risk factors associated with consistent condom use for the 2015 survey. There were 1041, 1338, and 1978 FSWs surveyed in 2006, 2010, and 2015, respectively. Condom use at the last sexual encounter with a client was similar in all surveys: 84.2%, 64.1%, and 83.3% (p = 1.0), respectively. Comprehensive HIV knowledge among FSWs was higher in 2015 than in 2006: 18.4%, 53.1%, and 71.1% (p = 0.00), respectively. Living in Kigali City and the Western province (aOR = 1.9 [95% CI: 1.3–2.8] and aOR = 2.0 [95% CI: 1.4–2.9], respectively) and higher level of education (OR = 2.0 [95% CI: 1.4–2.9]) were positively associated with consistent condom use with a client. Street-based FSWs (aOR = 0.7 [95% CI: 0.6–0.9]); FSWs with sex work as sole occupation (aOR = 0.6 [95% CI: 0.5–0.7]); FSWs who experienced sexually transmitted infections in the last year (aOR = 0.7 [95% CI: 0.5–0.8]) and HIV-positive FSWs (aOR = 0.8 [95% CI: 0.6–0.9]) were less likely to report consistent condom use. HIV prevention methods have evolved among FSWs in RWanda over the last decade, but HIV prevalence remains high. Condom use among many FSWs is inconsistent. New approaches for behavior change and income-generating activities are needed to reduce the vulnerability of FSWs in Rwanda.

Clinical, socioeconomic, and access barriers remain a critical problem to antiretroviral (ART) programs in sub-Saharan Africa. Community-based accompaniment (CBA), including daily home visits and psychosocial and socioeconomic support, has been associated with improved patient outcomes at 1 year. We conducted a prospective observational cohort study of 578 HIV-infected adults initiating ART in 2007-2008 with or without CBA in rural Rwanda. Among patients without CBA, those with advanced HIV disease, low CD4 cell counts, lower social support, and transport costs had significantly higher odds of negative outcomes at 1 year; amongst patients who received CBA, only those with low CD4 cell counts had significantly higher odds of negative outcomes at 1 year. CBA also significantly mitigated the effect of transport costs and inaccessibility of services on the likelihood of negative outcome. CBA may be one approach to mitigating known risk factors for negative outcomes for patients on ART in resource-poor settings.

Background Human Immunodeficiency Virus (HIV), syphilis, Hepatitis B Virus (HBV) and Hepatitis C Virus (HCV) are sexually transmitted infections (STIs) and share modes of transmission. These infections are generally more prevalent among female sex workers (FSWs). Methods This is a cross-sectional study conducted among female sex workers (FSWs) in Rwanda in 2015. Venue-Day-Time (VDT) sampling method was used in recruiting participants. HIV, syphilis, HBV, and HCV testing were performed. Descriptive analyses and logistic regression models were computed. Results In total, 1978 FSWs were recruited. The majority (58.5%) was aged between 20 and 29 years old. Up to 63.9% of FSWs were single, 62.3% attained primary school, and 68.0% had no additional occupation beside sex work. Almost all FSWs (81.2%) had children. The majority of FSWs (68.4%) were venue-based, and most (53.5%) had spent less than five years in sex work. The overall prevalence of syphilis was 51.1%; it was 2.5% for HBV, 1.4% for HCV, 42.9% for HIV and 27.4% for syphilis/HIV co-infection. The prevalence of syphilis, HIV, and syphilis + HIV co-infection was increasing with age and decreasing with the level of education. A positive association with syphilis/HIV co-infection was found in: 25 years and older (aOR = 1.82 [95% CI:1.33–2.50]), having had a genital sore in the last 12 months (aOR = 1.34 [95% CI:1.05–1.71]), and having HBsAg-positive test (aOR = 2.09 [1.08–4.08]). Conclusion The prevalence of HIV and syphilis infections and HIV/syphilis co-infection are very high among FSWs in Rwanda. A strong, specific prevention program for FSWs and to avert HIV infection and other STIs transmission to their clients is needed.

Summary Background: HIV prevalence is disproportionately high among female sex workers compared to the general population. Many African countries lack useful data on the size of female sex worker populations to inform national HIV programs. Methodology: A female sex worker size estimation exercise using three different venue-based methodologies was conducted among female sex workers in all provinces of Rwanda in August 2010. The female sex worker national population size was estimated using capture–recapture and enumeration methods, and the multiplier method was used to estimate the size of female sex worker in Kigali. A structured questionnaire was also used to supplement the data. Results: The estimated number of female sex workers by the capture–recapture method was 3205 (95% confidence interval: 2998–3412). The female sex worker size was estimated at 3348 using the enumeration method. In Kigali, the female sex worker size was estimated at 2253 (95% confidence interval: 1916–2524) using the multiplier method. Nearly 80% of all female sex workers in Rwanda were found to be based in the capital, Kigali. Conclusion: This study provided a first-time estimate of the female sex worker population size in Rwanda using capture–recapture, enumeration, and multiplier methods. The capture–recapture and enumeration methods provided similar estimates of female sex worker in Rwanda. Combination of such size estimation methods is feasible and productive in low-resource settings and should be considered vital to inform national HIV programs.

Hepatitis B virus (HBV) affects people worldwide but the local burden especially in pregnant women and their new born babies is unknown. In Rwanda HIV-infected individuals who are also infected with HBV are supposed to be initiated on ART immediately. HBV is easily transmitted from mother to child during delivery. We sought to estimate the prevalence of chronic HBV infection among pregnant women attending ante-natal clinic (ANC) in Rwanda and to determine factors associated with HBV and HIV co-infection. This study used a cross-sectional survey, targeting pregnant women in sentinel sites. Pregnant women were tested for hepatitis B surface antigen (HBsAg) and HIV infection. A series of tests were done to ensure high sensitivity. Multivariable logistic regression was used to identify independent predictors of HBV-HIV co-infection among those collected during ANC sentinel surveillance, these included: age, marital status, education level, occupation, residence, pregnancy and syphilis infection. The prevalence of HBsAg among 13,121 pregnant women was 3.7% (95% CI: 3.4–4.0%) and was similar among different socio-demographic characteristics that were assessed. The proportion of HIV-infection among HBsAg-positive pregnant women was 4.1% [95% CI: 2.5–6.3%]. The prevalence of HBV-HIV co-infection was higher among women aged 15-24 years compared to those women aged 25–49 years [aOR = 6.9 (95% CI: 1.8–27.0)]. Women residing in urban areas seemed having HBV-HIV co-infection compared with women residing in rural areas [aOR = 4.3 (95% CI: 1.2–16.4)]. Women with more than two pregnancies were potentially having the co-infection compared to those with two or less (aOR = 6.9 (95% CI: 1.7–27.8). Women with RPR-positive test were seemed associated with HBV-HIV co-infection (aOR = 24.9 (95% CI: 5.0–122.9). Chronic HBV infection is a public health problem among pregnant women in Rwanda. Understanding that HBV-HIV co-infection may be more prominent in younger women from urban residences will help inform and strengthen HBV prevention and treatment programmes among HIV-infected pregnant women, which is crucial to this population.

Background. The prevalence of syphilis among HIV-infected people is a public health concern, but there is limited literature to describe the true burden of syphilis in resource-limited settings. We conducted this survey in 2013 to estimate the prevalence of syphilis. Methods. A cross-sectional survey. Participants were tested for syphilis and HIV. Factors associated with syphilis infection were identified. Results. The prevalence of syphilis was 0.9% (95% CI: 0.7–1.1). This prevalence was higher in the 25–49-year-old age (1.1% [95% CI: 0.8–1.3]) than in the 15–24-year-old age (0.6% (95% CI: 0.4–0.9)). Women with lower education had a higher prevalence of syphilis (1.2% (95% CI: 0.9–1.5)) compared to others (0.4% (95% CI: 0.2–0.8)). This prevalence among HIV-infected people was six times higher: 4.8% (95% CI: 2.9–7.9) compared to HIV-negative people (0.8% (95% CI: 0.6–1.0)). The prevalence of syphilis among HIV-infected females was 5.9% (95% CI: 3.4–10.0). HIV-infected or concurrent sexual partners was associated with increased syphilis prevalence with aOR = 4.2 (95% CI: 2.5–7.2) and aOR = 4.2 (95% CI: 2.8–6.5), respectively. Conclusions. The prevalence of syphilis was significantly higher among HIV-infected patients. HIV infection and concurrent sexual partners are associated with an increased prevalence of syphilis. Preventing HIV might help in preventing syphilis.