Factors Associated with Men Engagement in HIV Continuum of Care in Rwanda: A Cross Sectional Study to Identify Gaps to be Closed Towards HIV Epidemic Control in Rwanda

Research Article

Austin J Nurs Health Care. 2021; 8(1): 1059.

Factors Associated with Men Engagement in HIV Continuum of Care in Rwanda: A Cross Sectional Study to Identify Gaps to be Closed Towards HIV Epidemic Control in Rwanda

Rwibasira GN1,2 and Rutayisire E2*

¹Institute of HIV/AIDS, Diseases Prevention and Control, Rwanda Biomedical Centre, Rwanda,

²Department of Public Health, Mount Kenya University, Kigali, Rwanda

*Corresponding author: Erigene Rutayisire, Department of Public Health, Mount Kenya University, Kigali, Rwanda

Received: June 28, 2021; Accepted: July 15, 2021; Published: July 22, 2021


Despite the global achievements to control HIV epidemic and end AIDS by 2030, there is still a discrepancy in accessing HIV services. Men are among the population that are lagging behind when it comes to consuming available services to mitigate the impact of HIV/AIDS. We conducted this study to determine the level of Rwandan men engagement in HIV services delivery. We used cross- sectional design to analyze data from a Population- based HIV impact assessment, a household-based survey conducted in Rwanda from October 2018 to March 2019. Cascade from awareness of the HIV status, linkage to ART and Viral load suppression were analyzed. Logistic regression analysis was conducted to establish relationship between independent variables and outcomes. Data cleaning and analysis was conducted using SAS 9.4. 13. A total of 821 males aged 15 to 64 years participated in the survey, 302 (2.1%) of them tested positive, 92.2% (95% CI: 89.2-95.2) reported tested once for HIV. Overall, 78.2% (95% CI: 72.4-84) reported to be aware of their status and on ART. 70.5% (95% CI: 63.8-77.2) reported to have suppressed viral load. Married or living together with a partner showed to be 7 times more likely to be on ART vs single or never married (OR: 7.42, 95% CI: (1.75;31.38), P <0.01). Odds of viral load suppression increases with age, and those aged above 55 years showed to be more suppressing their virus (OR: 3.94, (95% CI: 0.92-16.9), P=0.07). Findings from this study revealed the gaps to be closed to include all population in maximizing HIV service delivery.

Keywords: Men; Engagement; HIV; Continuum of care; Rwanda


RPHIA: Rwanda Population based HIV Impact Assessment Survey; ART: Anti-Retroviral Therapy; VLS; Viral Load Suppression


Globally, UNAIDS estimated 37.9 Million people living with HIV by 2019 [1]. To increase the HIV testing coverage and raise awareness about HIV status and maximize coverage of ART, UNAIDS has set global target for 2020, where by 90 of all PLHIV will know their status, 90 percent of them on treatment and 90 percent of them achieving viral suppression [2]. Among them 81% of all total PLHIV are aware of their status but only 68% were accessing anti-retroviral drugs. Despite various strategies put in place to contain the epidemic, Eastern and southern Africa remain the most affected continent with around 54% of all total PLHIV [3]. Specifically, to this region, effort have been intensified to reduce the AIDS related death by several mechanisms including universal ART coverage, reduction of mother to child transmission, decentralized HIV services delivery to the primary health care and community awareness and engagement of HIV prevention measures [4]. Nonetheless, gender disparity in HIV services uptake is still observed especially in this region with high burden, with men less contributing to the progress [5,6]. Rwanda like other African countries experienced the first case of HIV/AIDS in 1983.

However, several studies conducted in Rwanda during past decade and data reported in fact sheets showed that men category is still lagging in terms of acceptance of HIV services but also engagement in available HIV services [7-9]. The above data showed that prevalence in female is higher than in men [9,10]. Level of male testing remains lower compared to female [11]. This affect the whole cascade of continuum of care in Rwanda where male categories always seems to be lower while there are the main key bridge to HIV transmission from the key population to the general population [6]. Various approaches have been put in place to maximize male engagement in HIV testing, including HIV self-testing kit and home testing [12] but the gender disparity remains [13]; hence, the significance of conducting this analysis to evaluate the level of men’s engagement and factors associated with this engagement in Rwanda. This study was to determine factors associated with men’s engagement in HIV continuum of care from HIV testing, linkage to ART, retention to ART and viral load suppression in Rwanda.

Materials and Methods

This was a cross sectional study design. It used data from RPHIA, a cross sectional household-based national survey. The design of this study has quantitative approaches of data collection. Using interviews and blood draw. Questionnaire was set to design cross sectional study to extract data from testing, linkage to ART and viral load suppression from RPHIA data set conducted between October 2018 and March 2019. The survey has a national representative sample to cover both urban and rural areas countrywide.

Sampling technique

All men aged 15-64 years participated in the survey were included in the analysis. A two -stage cluster sampling design was used for the primary survey. Within each province, Enumeration Areas (EAs) were selected based on probability proportional to size; the number of households in it defines the size of an EA at the time of the 2012 census. Second stage sampling was consisting of households listing of each selected EA that was updated by NISR. This updated list of HHs (with unique serials identifiers) served as the sampling frame for the selection of HHs in the second stage of sampling. An average of 30 HHs were selected randomly in every EA within each stratum. The selected HHs were visited and there will be no replacements and no changes of the selected HHs will be allowed. The expected number of missing HHs, either by refusal or absence, is already taken into account in the sampling design by increasing the number of HHs surveyed in each EA. During the listing, Global Positioning System (GPS) coordinates of all selected households were collected to help filed staff to identify and relocate sampled HHs during data collection. Males were selected from Household’s member’s interviews and blood draws.

Data extraction and data analysis

Data were extracted from RPHIA dataset. Variables were set according to the questionnaires. Preliminary and final reports of the surveys will present descriptive analysis with point estimates and 95% CI for both prevalence and incidence of HIV infection of key parameters of interest across demographics characteristics as independent variables. Table of variables have been used to populate tables according to variables set to analyze. Independent variables such as age, sex, residence (rural vs urban), marital status, level of education, wealth quantile were analyzed per objectives, from HIV testing, linkage and retention to ART as well as sustained viral load suppression as final outcome in HIV continuum of care. Using bivariate and multivariate logistic regression, relationship with the outcome variable was determined at P-value <0.05 and 95% Confidence Intervals. SAS version 9.4 was used for analysis and to generate tables.

Ethical consideration

RPHIA survey was approved by Rwanda National Ethical committee (RNEC). In addition, RPHIA was approved in Institutional Review Boards (IRB) in the Human research protection office at Columbia University, New York. The approval to conduct secondary data analysis from RPHIA survey was sought from Mount Kenya University and HIV Division from Rwanda Biomedical center (RBC) which is the owner and direct implementer of RPHIA findings.


Demographic characteristics of the respondents

Sample population of this study is presented in frequencies and percentages. From all 13,821 males aged 15 to 64 years participated in the survey, 3,607 were from urban area and 10,214 were from rural places, representing 26.1% and 73.9% respectively. City of Kigali contributed to 2,787 (20.2%) participants, 2,713 represents 19.6% from Southern province, 3,226 (23.4%) from Western Province, 2,588 (18.7%) from Northern Province and 2,507 (18.2%) from the Eastern Province.

Among all men aged 15-64 years participated, 22.2% were between 15-19 years, 16.1% between 20-24 years, 12.9% between 35-39 years and only 3.6% aged between 60-64 years. Detailed participants characteristics are presented in Table 1.