Comprehensive HIV/AIDS strategy in Burundi achieves 90-90-90 targets by 2020 and sets ambitious goals for 95-95-95 by 2025

Burundi

Photo: WHO Burundi PEPFAR recognized Burundi’s success in its remarkable progress toward reaching the UNAIDS 95-95-95 targets and ending HIV/AIDS by 2030.

Burundi aims for 95-95-95 HIV/AIDS targets

In Burundi, 0.9 percent of people aged 15 to 49 years have HIV, with the epidemic being more pronounced in certain higher-risk subgroups.[1] In response, the country launched a comprehensive strategy to enhance HIV testing and treatment accessibility, aligning with World Health Organization (WHO) guidelines.[2][3] Key measures included decentralizing HIV services to community levels and increasing the number of treatment centres from 512 to 885 between 2016 and 2020 which expanded national antiretroviral treatment coverage from 61 to 80 percent. Moreover, Burundi adopted innovative testing methods and treatment protocols based on evidence-based guidelines. These efforts were directed towards achieving the UNAIDS 90-90-90 targets.[4] By 2022, Burundi had made remarkable progress and was acknowledged and awarded by PEPFAR as a regional leader in HIV control during regional planning meeting for PEPFAR (COP23) held in Johannesburg in March 2023. The country reported that 89 percent of people living with HIV (PLHIV) knew their status, 98 percent of those diagnosed were receiving antiretroviral therapy (ART), and among those on ART, 90 percent had achieved viral load suppression.[5][6][7] Encouraged by these achievements, Burundi set its sights on the more ambitious 95-95-95 targets by 2025. The latest data shows encouraging trends: 92 percent of PLHIV are aware of their HIV status, 98 percent of those who know their status are receiving treatment, and 93 percent of those on treatment have successfully suppressed their viral loads.[8] This work is in harmony with the objectives of both the Country Cooperation Strategy (CCS) and the United Nations Sustainable Development Cooperation Framework (UNSDCF). These frameworks emphasize the

Key WHO Contributions

Mobilized financial resources from partners and supported the establishment of a National AIDS Fund, facilitating the expansion of HIV prevention, diagnosis, and treatment programs.
Provided global guidelines, and co-developed comprehensive HIV/AIDS strategies with Burundi's Ministry of Public Health and AIDS Control.
Co-facilitated training and mentoring to implement updated guidelines and best practices in HIV testing and treatment.
Conducted an evaluation of Burundi's HIV program, providing insights that shaped the nation’s strategic roadmap for 2025.

How did Burundi, with the support of WHO, achieve this?

WHO plays a pivotal role in the global HIV/AIDS response by setting international standards and guidelines throughout the continuum of care. Recognizing the significance of synchronizing Burundi's national efforts with these standards, the government partnered with WHO to establish a domestically financed National AIDS Fund in Burundi and raise funds from international partners such as the Global Fund, U.S. President's Emergency Plan for AIDS Relief (PEPFAR), and the United States Agency for International Development (USAID). The First Lady of Burundi, Mrs. Angeline Ndayishimiye, played a particularly prominent role in actively bolstering engagement and resource mobilization efforts.

^{PEPFAR recognized Burundi’s success in its remarkable progress toward reaching the UNAIDS 95-95-95 targets and ending HIV/AIDS by 2030.}Photo credit: WHO Burundi

Working closely with Burundi's Ministry of Public Health and AIDS Control, WHO co-developed and rapidly implemented comprehensive strategies. This collaboration included updating national guidelines in accordance with WHO's 2016 recommendations on HIV testing services, updates to the 2016 national guidelines, and introducing new standards on HIV prevention, infant diagnosis, antiretroviral initiation, and monitoring.[9][10][11] WHO was instrumental in translating these guidelines into practice by developing a curriculum, creating training materials, and instructing master trainers from various partner organizations. This groundwork enabled effective training and clinical mentoring for healthcare providers in prevention of mother-to-child transmission (PMTCT) and paediatric care.

The adoption of a "test, treat, and track everyone" approach was crucial for swift advancements in HIV management and ensuring harmonization with the efforts of neighbouring countries. To improve access to HIV/AIDS health services, Burundi enhanced its healthcare infrastructure, adopting a patient-centric model with an emphasis on reaching the underserved. The decentralization of healthcare services, which began for adults in 2012 and expanded to include children by 2016, significantly increased the availability of treatment.

"We feel different in the community, but in the group we dispel fear... we develop relationships, and we avoid isolating and discriminating against ourselves."

Testimonial from a participant in the Burundian National Association of Support for People Living with HIV and AIDS Patients (ANSS) compliance club

People Living with HIV were involved in the design and implementation of community-based points of ART distribution (PODI) which were launched in 2020, facilitating medication access. The country also formed youth adherence clubs and community observatories to monitor and improve healthcare service delivery. To address testing gaps, self-testing kits were introduced, particularly in areas with scarce healthcare resources. For improved diagnostic accuracy, infants received virological testing, while older age groups underwent serological testing.

"Here, I get the right information about my health and that helps me to behave well."

Testimonial from a participant in the Burundian National Association of Support for People Living with HIV and AIDS Patients (ANSS) compliance club

A comprehensive "treat-all" strategy was adopted, ensuring that everyone diagnosed with HIV received appropriate treatment. This included the integration of advanced treatment options like the harmonized triple regimen and third-line therapies, thereby eliminating the need for genotyping. Dolutegravir (DTG)-based treatments were introduced for all, including children and pregnant women, gradually replacing nevirapine-based regimens. Additionally, pre-exposure prophylaxis (PrEP) was provided to people considered to be at high-risk of HIV exposure.

In 2022, WHO conducted an assessment and worked with technical committees to address HIV/AIDS in Burundi. The insights gained from this evaluation informed the development of a strategic roadmap, which focuses on improving areas that lag behind in meeting the 2025 targets, particularly addressing the challenges faced by specific high-risk groups such as intravenous drug users. The roadmap highlighted the importance of community engagement, particularly the active involvement of PLHIV, as essential for achieving future objectives.

To successfully realize the 95-95-95 targets by 2025, a collaborative approach involving multiple stakeholders is crucial. This includes both domestic and international partners, including sustained commitment from the National Council for the Fight against AIDS. Revitalizing the national AIDS fund will also be pivotal.

References

Troisième Enquête Démographique et de Santé au Burundi (EDSB-III) 2016-2017 [report]. EDSB-III Report, accessed 31 January 2024.
Republique du Burundi. Ministere de la Sante Publique et de la Lutte contre le SIDA. Addendum aux Directives Nationales d’utilisation des Antiretroviraus pour la prévention et le traitement du VIH. Nouvelles Orientations en Matière de dépistage et de diagnostic de l’infection a VIH. July 2018 [report in French].
Republique du Burundi. Ministere de la Sante Publique et de la Lutte contre le SIDA. Cabinet du Ministre. Ordonnance Ministerielle No 1750 du 28/2018 portant mise a echelle du traitement antiretroviral et de la prevention de la transmission du VIH de la mere a l’enfant [Ministerial Order].
UNAIDS. 90-90-90: An ambitious treatment target to help end the AIDS epidemic [web portal]. 90-90-90 UNAIDS, accessed 31 January 2024.
World Health Organization Regional Office for Africa. Documentation de bonnes pratiques du Burundi dans l'atteinte des objectifs 90-90-90 dans la lutte contre le VIH/SIDA. Juillet 2022 [report].
World Health Organization. Rapport de la revue de performance du Programme de lutte contre le VIH/Sida et les hépatites, 2021 [report].
2023 regional planning meeting for PEPFAR Country Operational Plan (PEPFAR COP23), held in Johannesburg in 2023.
UNAIDS. AIDSinfo [web portal]. AIDSinfo UNAIDS, accessed 31 January 2024.
World Health Organization. Consolidated guidelines on HIV testing services [guideline]. HIV Testing Services Guidelines, accessed 31 January 2024.
Directives Nationales pour la prévention et le traitement du VIH au Burundi. National HIV Prevention and Treatment Guidelines Burundi, accessed 31 January 2024.
World Health Organization. Updated recommendations on HIV prevention, infant diagnosis, antiretroviral initiation and monitoring [guideline]. WHO Updated HIV Recommendations, accessed 31 January 2024.