Rwanda Biomedical Centre (RBC) and partners have recognized and recommended the need to scale up the Community Adolescent Treatment Supporters (CATS) model that has for the past five years increased access to HIV/Aids information, treatment and care among young Rwandans.
The CATS model, a youth led program, was adopted from the Zvandiri program in Zimbabwe and introduced in Rwanda in 2019 through a partnership between RBC, Dream Village Rwanda- a local Nongovernmental organization.
Zvandiri program- a peer-driven adolescent HIV care model has been recognized as a best practice program by the World Health Organization (WHO).
This model aims to transform the lives of young people through peer connections, health services, community outreach, psychosocial and mental healthcare support; capacity-strengthening programs, and advocacy initiatives.
With technical assistance from Zvandiri, Dream Village Rwanda provides a package (CATS Model) of differentiated services for children, adolescents and young people living with HIV so that they know, understand, and accept their HIV status.
This enables them to start and remain on antiretroviral (ARV) treatment with understanding and confidence; stay engaged in treatment, care and support services and that they feel cared for, understood, supported and valued.
Through young trained, mentored adolescents, the model provides information, counselling and support for other children, comprehensive sexuality education, and adolescents and young people living with HIV through home visits, clinic visits, and support groups.
In Rwanda, the prevalence of HIV among Adolescent girls and young women (AGYW) is 3.7%. Although progress has been made in promoting HIV testing among this population, there is still an unmet need for testing.
The 2019/2020 Rwanda Demographic and Health Survey (DHS) revealed that only 55.4% of AGYW reported having undergone HIV testing. Despite efforts to reduce HIV transmission and improve viral load suppression rates, challenges persist, particularly among PLHIV under the age of 25.
At the accreditation and dissemination of the end-line assessment of the CATS program in Rwanda, over this weekend, officials shared the results, evaluated progress in implementing and strategized how to address HIV among children, adolescents, and youths.
Results from the past five years showed that the CATS program, which is currently implemented in 12 Health Centers (HCs) in Kigali city needs to be disseminated to other districts to increase reach to the children, adolescents and youth in other parts of the country.
For instance, with 12 health facilities working with the CATS program; 3, 175 adolescents had benefited (as of 2023) and currently 2,745 are being supported between June 2019 – June 2023.
Figures also show that the program enabled beneficiaries Viral Suppression improve from 67.8% to 93.7% while the performance score of health centres (WHO standards average) have increased from 75% to 86% in the same period.
“For me, before CATs my parents and I never understood each other, because I had not yet accepted my situation. They would tell me to take medications and I would accept but I don’t take them, it was always as if there is tension between us, but ever since the CATS came, we are good and on same page,” said one of the program beneficiaries.
Dr. Simeon Tuyishime, the Director of HIV Care and Treatment Unit said that this model should be scaled up to reach more youth because of the program activities have direct and needed impact on health interventions of the government.
“We see the results and this model it shows us that we can reach the national targets of treatment, medication and suppressing viral loads,” Tuyishime said.
Scaling up this model, Tuyishime said that it is expected that the United Nations Programme on HIV/AIDS (UNAIDS) 95-95-95 targets can be achieved, leading to a reduction in new HIV infections among young women and girls in Rwanda.
The targets are that 95% of people who are living with HIV to know their HIV status, 95% of people who know that they are living with HIV to be on lifesaving antiretroviral treatment, and 95% of people who are on treatment to be virally suppressed.
Norman Manzi, the founder of Dream Village said that the CATS idea started as a vague idea and possibly with no idea of how it will evolve but its success has been because of the youth and their engagement which is needed to scale up the model to achieve the UNAIDS targets.
Nicola Willis, the Founder and Executive Director of Zvandiri program (which stand for “As I am” in Shona- a ventricular in Zimbabwe) said African models becoming necessary in the fight against HIV/Aids.
“We don’t have to look beyond. The program has integrated the component of mental health care as part of the additional support needed on top on treatment. There are big achievements for the CATS project, a reason to celebrate as we have learnt a lot from other countries including Rwanda,” Willis said.
Though funding and leadership are core for Rwanda to scale up the model, Willis said that nine Steps to Scaling have to be followed for this to be attain.
These steps include: Government leadership to integrated the model within national plans and coordination systems; using evidence-based models, secure funding; setting up the system with training; monitoring and linkages; set up guidelines and tools; recruitment and training; supervision and mentorship; transition to support for CATS’ own health and well-being; and continuous measuring Impact.