One Health approaches require community engagement, education, and international collaborations-a lesson from Rwanda One Health approaches recognize the links between the environment, animals, and human disease, but these approaches are successful only with bottom-up community engagement, education, and international collaborations.

Background Over the past decade, 70% of new and re-emerging infectious disease outbreaks in East Africa have originated from the Congo Basin where Rwanda is located. To respond to these increasing risks of disastrous outbreaks, the government began integrating One Health (OH) into its infectious disease response systems in 2011 to strengthen its preparedness and contain outbreaks. The strong performance of Rwanda in responding to the on-going COVID-19 pandemic makes it an excellent example to understand how the structure and principles of OH were applied during this unprecedented situation. Methods A rapid environmental scan of published and grey literature was conducted between August and December 2020, to assess Rwanda’s OH structure and its response to the COVID-19 pandemic. In total, 132 documents including official government documents, published research, newspaper articles, and policies were analysed using thematic analysis. Results Rwanda’s OH structure consists of multidisciplinary teams from sectors responsible for human, animal, and environmental health. The country has developed OH strategic plans and policies outlining its response to zoonotic infections, integrated OH into university curricula to develop a OH workforce, developed multidisciplinary rapid response teams, and created decentralized laboratories in the animal and human health sectors to strengthen surveillance. To address COVID-19, the country created a preparedness and response plan before its onset, and a multisectoral joint task force was set up to coordinate the response to the pandemic. By leveraging its OH structure, Rwanda was able to rapidly implement a OH-informed response to COVID-19. Conclusion Rwanda’s integration of OH into its response systems to infectious diseases and to COVID-19 demonstrates the importance of applying OH principles into the governance of infectious diseases at all levels. Rwanda exemplifies how preparedness and response to outbreaks and pandemics can be strengthened through multisectoral collaboration mechanisms. We do expect limitations in our findings due to the rapid nature of our environmental scan meant to inform the COVID-19 policy response and would encourage a full situational analysis of OH in Rwanda’s Coronavirus response.

Background:The HIV prevalence and incidence among the general population in Rwanda have decreased significantly in the past decade, with only about 3% prevalence as of 2019. However, opposite trends are seen among the key populations (KP). The prevalence among commercial sex workers is as high as 51%, and the HIV rates among this group continue to rise. While the prevalence among key populations remains high, their adherence to HIV treatment is low compared to the general population. Healthcare providers play a vital role in ensuring key populations’ access to HIV treatment, adherence, and program retention. This study aimed to explore the experiences of healthcare providers in providing HIV services to key populations in Rwanda.Methods:A qualitative phenomenological study was conducted with nurses, doctors, social workers, and psychologists who provide HIV services in health facilities in Rwanda. In-depth interviews were conducted using a semi-structured interview guide. Transcribed and translated data were coded according to a structured code book. All data were organized and analyzed using Dedoose software (version 8.3.35).Results: Interviews with 18 healthcare providers were conducted; participants included 1 doctor (5.6%), 5 social workers (27.8%), and 12 nurses (66.7%). All participants had worked with key populations, especially commercial sex workers and men who have sex with men. Three overarching themes emerged from the interviews: healthcare providers’ intrinsic feelings affect the ways they provide HIV services to key populations, key populations face a multitude of challenges related to accessing treatment and preventing the spread of HIV, and a more comprehensive and sensitive approach should be used to improve HIV services for key populations. Conclusion: Healthcare providers expressed difficulties in providing services to key populations as they tend not to adhere to treatment and prevention guidelines, caused by some structural barriers, their lack of trust in the system, and the discrimination and abuse they have faced. More comprehensive services including clinical, financial, and psychosocial support from trusted sources are needed. Some important policy changes may be needed to allow KPs to purchase community-based health insurance.

Background: The overall HIV prevalence and incidence in Rwanda have decreased significantly in the past decade. However, opposite trends are seen among key populations (KP). The HIV prevalence among sex workers is as high as 51% and continues to rise. While the HIV prevalence among KP remains high, their adherence to treatment is low. Healthcare providers play a vital role in KP's access and adherence to HIV treatment. This study aimed to explore the perspectives of healthcare providers on providing HIV services to key populations in Rwanda. Methods: An exploratory qualitative study was conducted with nurses, doctors, social workers, and psychologists who provide HIV services to KP in public health facilities in Rwanda. In-depth interviews were conducted using a semi-structured interview guide. All data were analyzed thematically using Dedoose. Results: Interviews were conducted with 18 healthcare providers. Three overarching themes emerged from the interviews: healthcare providers' intrinsic feelings affect the ways they provide HIV services to key populations, key populations face a multitude of challenges related to accessing treatment and preventing the spread of HIV, and a more comprehensive and sensitive approach should be used to improve HIV services for key populations. Conclusion: Healthcare providers expressed difficulties in providing services to key populations and identified a lack of adherence to treatment and prevention guidelines, structural barriers, KP's lack of trust in the healthcare system, and the discrimination and abuse KP face as challenges to effective HIV prevention and treatment. More comprehensive services including clinical, financial, and psychosocial support from trusted sources are needed. Some important policy changes are essential to facilitate access to HIV services for KP.