| Title |
Improving health outcomes through concurrent HIV program scale-up and health system development in Rwanda: 20 years of experience
|
|---|---|
| Published in |
BMC Medicine, September 2015
|
| DOI | 10.1186/s12916-015-0443-z |
| Pubmed ID | |
| Authors |
Sabin Nsanzimana, Krishna Prabhu, Haley McDermott, Etienne Karita, Jamie I. Forrest, Peter Drobac, Paul Farmer, Edward J. Mills, Agnes Binagwaho |
| Abstract |
The 1994 genocide against the Tutsi destroyed the health system in Rwanda. It is impressive that a small country like Rwanda has advanced its health system to the point of now offering near universal health insurance coverage. Through a series of strategic structural changes to its health system, catalyzed through international assistance, Rwanda has demonstrated a commitment towards improving patient and population health indicators. In particular, the rapid scale up of antiretroviral therapy (ART) has become a great success story for Rwanda. The country achieved universal coverage of ART at a CD4 cell count of 200 cells/mm(3) in 2007 and increased the threshold for initiation of ART to ≤350 cells/mm(3) in 2008. Further, 2013 guidelines raised the threshold for initiation to ≤500 cells/mm(3) and suggest immediate therapy for key affected populations. In 2015, guidelines recommend offering immediate treatment to all patients. By reviewing the history of HIV and the scale-up of treatment delivery in Rwanda since the genocide, this paper highlights some of the key innovations of the Government of Rwanda and demonstrates the ways in which the national response to the HIV epidemic has catalyzed the implementation of interventions that have helped strengthen the overall health system. |
X Demographics
The data shown below were collected from the profiles of 27 X users who shared this research output. Click here to find out more about how the information was compiled.
Geographical breakdown
| Country | Count | As % |
|---|---|---|
| United Kingdom | 4 | 15% |
| United States | 3 | 11% |
| Nigeria | 2 | 7% |
| Argentina | 1 | 4% |
| Canada | 1 | 4% |
| Italy | 1 | 4% |
| Rwanda | 1 | 4% |
| Switzerland | 1 | 4% |
| Ukraine | 1 | 4% |
| Other | 0 | 0% |
| Unknown | 12 | 44% |
Demographic breakdown
| Type | Count | As % |
|---|---|---|
| Members of the public | 17 | 63% |
| Scientists | 4 | 15% |
| Practitioners (doctors, other healthcare professionals) | 4 | 15% |
| Science communicators (journalists, bloggers, editors) | 2 | 7% |
Mendeley readers
The data shown below were compiled from readership statistics for 145 Mendeley readers of this research output. Click here to see the associated Mendeley record.
Geographical breakdown
| Country | Count | As % |
|---|---|---|
| Bolivia, Plurinational State of | 1 | <1% |
| Unknown | 144 | 99% |
Demographic breakdown
| Readers by professional status | Count | As % |
|---|---|---|
| Student > Master | 36 | 25% |
| Researcher | 24 | 17% |
| Student > Ph. D. Student | 18 | 12% |
| Student > Bachelor | 11 | 8% |
| Other | 10 | 7% |
| Other | 19 | 13% |
| Unknown | 27 | 19% |
| Readers by discipline | Count | As % |
|---|---|---|
| Medicine and Dentistry | 41 | 28% |
| Nursing and Health Professions | 15 | 10% |
| Social Sciences | 15 | 10% |
| Agricultural and Biological Sciences | 7 | 5% |
| Business, Management and Accounting | 6 | 4% |
| Other | 26 | 18% |
| Unknown | 35 | 24% |
Attention Score in Context
This research output has an Altmetric Attention Score of 15. This is our high-level measure of the quality and quantity of online attention that it has received. This Attention Score, as well as the ranking and number of research outputs shown below, was calculated when the research output was last mentioned on 01 October 2015.
All research outputs
#2,332,254
of 24,994,150 outputs
Outputs from BMC Medicine
#1,560
of 3,910 outputs
Outputs of similar age
#30,421
of 272,888 outputs
Outputs of similar age from BMC Medicine
#49
of 101 outputs
Altmetric has tracked 24,994,150 research outputs across all sources so far. Compared to these this one has done particularly well and is in the 90th percentile: it's in the top 10% of all research outputs ever tracked by Altmetric.
So far Altmetric has tracked 3,910 research outputs from this source. They typically receive a lot more attention than average, with a mean Attention Score of 45.3. This one has gotten more attention than average, scoring higher than 60% of its peers.
Older research outputs will score higher simply because they've had more time to accumulate mentions. To account for age we can compare this Altmetric Attention Score to the 272,888 tracked outputs that were published within six weeks on either side of this one in any source. This one has done well, scoring higher than 88% of its contemporaries.
We're also able to compare this research output to 101 others from the same source and published within six weeks on either side of this one. This one has gotten more attention than average, scoring higher than 52% of its contemporaries.