YLabs in Kigali
Kigali is a 21st Century African city. Immaculate tree-lined boulevards are dotted with billboards advertising mobile phones and insurance policies. The city hums with the sound of construction as high-rise buildings emerge from the lush green hills that dominate the landscape. Artists and businessmen relax in coffee shops and shopping malls, while bank notes confidently display laptops and satellites alongside gorillas and traditional art.
Yet as quickly as Rwanda is developing, life is difficult for many Rwandans. It remains a low-income country with around 40% of the population living in poverty. And while Rwanda leads the region in healthcare and education, access and quality for many of its citizens remains uneven and imperfect.
It is in this context that adolescents living with HIV face particular problems. Usually born to HIV positive mothers who had no access to any treatment, these young people must struggle with the usual problems of adolescence, while dealing with the persistent stigma surrounding HIV and the difficulties of complex drug regimens that do not necessarily provide an immediate benefit. These issues are common to all adolescents living with HIV but adolescents in Rwanda must often navigate poverty, food insecurity and unstable family backgrounds in their efforts to remain healthy.
So it is perhaps unsurprising that the HIV clinic in CHUK, Kigali has found that nearly 30% of their adolescent patients have dangerously high levels of HIV virus in their blood, almost certainly due to struggles with adhering to medication and representing a heavy burden in entirely preventable death and disease. This is despite the clinic being staffed by an extraordinarily dedicated team who endeavour to cater for all aspects of their patients’ lives, including a psychosocial department and monthly support groups run by truly inspirational young people who have lived through many of the problems faced by their peers.
The clinic’s director, Dr Nkurikiyimfura, has asked YLabs to design a program to help the clinic improve adolescent adherence to HIV medications. We arrived in Kigali on January 5th and immediately started working alongside clinic staff. We will be working alongside a team of young Rwandan doctors and students to interview staff, caregivers and adolescents about their ideas of the barriers to adherence and how we can best overcome them. As YLabs is committed to developing new solutions to long-standing problems, we will also be exploring how acceptable the clinic’s community would find the introduction of direct incentives for adolescents to maintain adherence.
The project has just begun, but the enthusiasm and commitment of the staff and young people has been infectious. Caregivers talking animatedly about their ideas for solutions, young teenagers narrating advice for a friend struggling to take their medication and clinic staff offering years worth of insights into the difficulties their patients face. We are excited for our remaining time in Kigali and are already looking forward to work with our friends here to help address this problem.