Beyond HIV: Confronting the Rise of NCDs Among PLHIV

Laetitia Mukarwego (not real name), is a resident of Nyamata sector in Bugesera district (Eastern province). She runs a small business as a fruit seller along a group of other women in Nyamata market. 

Every morning, Mukarwego starts her day like any other business women. She prepares her children for school including making breakfast, takes her medication, and heads out to work.  Mukarwego’s routine is not just about keeping a busy occupation, but rather a daily battle against both HIV and the constant threat of non-communicable diseases (NCDs),

The use of antiretroviral therapy (ART) has transformed HIV from being a deadly diagnosis to a manageable condition, allowing PLHIV to live longer. Nevertheless, this increased longevity has brought about new health challenges. Mukarwego is one of the many people living with HIV, who are increasingly facing the burden of NCDs, including diabetes, hypertension, and cardiovascular diseases.

“This challenging journey in my life started when I was diagnosed with HIV in 2011,” Mukarwego recalls. “Thanks to ART, I’ve been able to live a healthy life. But about four years ago, I was diagnosed with hypertension. Sincerely, it was a shock, and I realized I had to take-up better care of my health.”

According to the World Health Organization, NCDs are responsible for 71% of all deaths worldwide. Among PLHIV, the risk is even higher, as Studies show that PLHIV are at increased risk of developing NCDs due to a combination of factors, including the long-term effects of HIV infection, and other risk factors such as smoking, poor diet, and lack of exercise.

Findings from the 2022 Population-based National Survey on the prevalence of noncommunicable diseases by the Rwanda Biomedical Center (RBC), indicate prevalence of individuals aged 40–69 years with a 10-year cardiovascular disease risk of ≥ 20% or with existing cardiovascular disease was at 7.0% (95% Confidence interval (CI).

The Rwanda Network of People Living with HIV/AIDS/RRP+ recently conducted a 5-day follow up workshop for Community Monitors & Healthcare Professionals engaged in the Study for Health Determinants for Major Non-Communicable Diseases among People Living with HIV in Rwanda. This was in collaboration with the Rwanda Biomedical Centre (RBC), Rwanda NCD Alliance, Eritcus and UR-CMHS School of Nursing and Midwifery.

During the workshop, participants covered basics on good clinical practice, Communication skills, defining & measuring blood pressure, counselling patients, data collection & entry into the Heartcare mobile application that helps users to monitor and manage the health of PLHIV effectively.

One of the trainees Pacifique Nshimiyimana, a peer educator from Rubavu district said that the skills acquired are vital in reaching out to people at high risk of losing their lives due to NCDs. She commended the move to avail them with Blood Pressure testing devices and knowledge about the Heartcare mobile application, that will quicken entry and dissemination of collected data.

“Obviously, there are still challenges with people who don’t take seriously the act of being examined, claiming they have not felt any sickness. There is need for intensive sensitization on NCDs so that they can be detected at an early stage in most people”, said Nshimiyimana.

This was a patient mobilizer, assessment & follow up on the last 24th months of the data collection, aimed at having a comprehensive analysis on major NCDs & associated determinants in People Living with HIV, in order to generate the most informative NCDs country profile information.

Another workshop was conducted for Medical Doctors, Nurses, Data Managers & Social Workers engaged in the study for Health Determinants on Major Non-Communicable Diseases among People Living with HIV in Rwanda.

Rwandan health authorities have set screening targets as a means of measuring effectiveness, and the NCD tracker recorded more than 2.9 million total enrollments for the 2021-2022 fiscal year. In the 2022-2023 fiscal year, health workers recorded an additional 2.5 million screenings, which is 91% of the target population, outstanding the original goal of 85%.

While addressing trainees, Dr. Simeon Tuyishime, Director, HIV/AIDS Care & Treatment at RBC, he urged them to go beyond examining NCDs, to sensitizing people on taking regular tests, for early detection. He further told them to encourage people above the age 50 always to go for screening NCDs, since they are at a higher risk. 

“It is also important to pass on skills you have acquired during this workshop and previous ones to fellow workmates, since fighting NCDs requires concerted efforts in the health sector. Attend to patients as professionals, with the aim   to save their lives, but not simply driving at presenting reports and statistics for the work done”, added Dr. Tuyishime.

The National Strategy and Costed Action Plan for the Prevention and Control of non-Communicable diseases in Rwanda (JULY 2020 – JUNE 2025) states three key domains to guide action on tackling NCDs in Rwanda; Communityawareness and engagement for behavioral change and early detection, Prevention and control of NCD risk factors, and Quality NCD diagnosis and treatment services at all levels of care.

Deo Mutambuka, the Executive Secretary of the Rwanda Network of People Living with HIV/RRP+ encourage participants to ensure the quality and progress of data collection, pledging any possible support in case of challenges, for smooth implementation.

“It is intending that this integrated approach ensures that we catch NCDs early and manage them effectively alongside HIV. Our concerted efforts will encourage patients to stay healthy and positive.”, Mutambuka remarked.

Healthcare Professionals helping to Overcome NCDs and empowering Patients

Educating and empowering patients is vital in the fight against NCDs. Mukarwego attends regular support from peer educators and Community Health workers, where she learns about healthy eating, exercise, and stress management. She says such sessions, are not only informative but also provide emotional support amidst her health challenges.

 Mukarwego testified that every day signifies her resilience and hope. “Living with HIV and hypertension has taught me to be strong and positive about my health. I believe that with the right support and care, I can live a long and healthy life.”

The fight against NCDs among PLHIV calls for concerted efforts from all sectors of society; Government’s investment in healthcare infrastructure, access to affordable medications, and promoting public health campaigns are paramount.  Additionally, communities are called upon to support those living with HIV and NCDs, reducing stigma and encouraging healthy lifestyles.