Esther Uwababyeyi’s life with HIV began at a tender age. Diagnosed in 2002 after contracting the virus during her mother’s pregnancy, she has spent her entire life on antiretroviral treatment. Today, at 22 and living in Rwanda’s Rwamagana district, Uwababyeyi’s journey reflects not only her resilience but also the transformative advancements in Rwanda’s HIV treatment program.

“I started HIV treatment at the age of three,” says Uwababyeyi. “During my high school years, monthly clinic visits were challenging because of stigma. I had to come up with excuses for my absences.”

Her challenges highlight the hurdles faced by people living with HIV, particularly adolescents, before Rwanda’s adoption of the differentiated service delivery model in 2016. This model, recommended by the World Health Organization (WHO), has revolutionized HIV care in the country, offering innovations like multi-month drug dispensing.

Transforming HIV Care Through Multi-Month Dispensing

The multi-month dispensing system allows individuals on stable treatment to receive medications for several months at a time, reducing the burden of frequent clinic visits. Initially limited to three-month refills, the program expanded in 2020 to provide six-month refills for those meeting adherence and viral suppression criteria.

For Uwababyeyi, the change was life-altering. “In 2019, I was enrolled in a three-month refill program, which allowed me to focus on my education. Later, my good adherence record led to six-month refills. It’s made a significant difference in my life,” she says.

Dr. Ribakare Muhayimpundu, the HIV/STIs/Tuberculosis/Hepatitis Program Officer at WHO Rwanda, explains the model’s impact: “It improved adherence while alleviating the burden on healthcare systems from monthly visits. WHO supported Rwanda in adapting global guidelines, training healthcare workers, and implementing the strategy effectively.”

Community-Based Peer Education

Rwanda’s HIV program further enhanced patient support with a community-based peer education model introduced in 2017. Trained peer educators like Havugimana Faustin, who began HIV treatment in 2006, play a pivotal role in ensuring adherence and providing psychosocial support.

“As a peer educator, I visit individuals to check adherence, address issues, and facilitate referrals when needed,” says Faustin. “Most of my peers exhibit strong adherence and appreciate the refill program’s benefits.”

The initiative, developed with WHO support, has trained 5,000 peer educators, fostering a community-driven approach to HIV care.

Global Leadership in HIV Response

Rwanda’s commitment to innovation and patient-centered care has positioned it as a global leader in the HIV response. It is one of only five countries to achieve the UNAIDS 95-95-95 targets ahead of schedule: 95% of people living with HIV know their status, 95% of those diagnosed are on treatment, and 95% of those on treatment have achieved viral suppression. Rwanda has surpassed these benchmarks with rates of 95%, 97.5%, and 98%, respectively.

“Multi-month drug dispensing has saved our patients time and money,” says Dr. Simeon Tuyishime, Director of HIV Care and Treatment at the Rwanda Biomedical Centre. “Patients now visit health facilities every three to six months, saving on transportation costs and allowing more time for family and personal responsibilities. This convenience has significantly enhanced treatment adherence and viral suppression.”

A Model for the Future

Rwanda’s approach offers a blueprint for other nations striving to strengthen HIV care systems. By integrating global recommendations with locally tailored strategies, the country has improved the lives of its citizens and set a new standard in the global fight against HIV.

For Uwababyeyi and thousands like her, Rwanda’s advancements mean more than convenience—they represent hope, dignity, and a brighter future.