Investigating access to hepatitis C testing and treatment in Rwanda and beyond
department or school: Medicine, Faculty of
department or school: Population and Public Health (SPPH), School of
data provider: DSpace
degree campus: UBCV
creator: Nisingizwe, Marie Paul
issued: 2025-10-31T07:00:00Z
issued: 2023
related degree: Doctor of Philosophy - PhD
degree grantor: University of British Columbia
description: Hepatitis C virus (HCV) affects 58 million people globally and resulted in 290,000 deaths in 2019. While global targets aim to eliminate HCV by 2030, there remains limited knowledge regarding the accessibility and impact of HCV treatment, particularly in resource-limited settings. This dissertation assessed access to HCV testing and treatment in Rwanda and investigated inequities in global access to HCV medicines. I conducted a retrospective cohort study and hierarchical logistic regression to assess factors associated with HCV positivity, treatment dropout, and treatment failure among people who received HCV services during the 2017-19 mass campaign. In addition, I used qualitative methods to investigate patients' perspectives on accessing HCV care during the campaign. Lastly, I used data from 54 countries to describe sales of HCV medicines and conducted an Interrupted Time Series (ITS) analysis to assess the effect of COVID-19 on sales using Autoregressive Integrated Moving Average Model (ARIMA). Among people who attended the campaign, the prevalence of HCV was 2.9%, and 52% of those who tested positive initiated treatment. Sustained Virological Response (SVR) was achieved in 88% of individuals who initiated treatment and returned for assessment. Age, socioeconomic status, and comorbidities were associated with higher HCV positivity and dropout rates. Treatment failure was associated with advanced stage of HCV, and a prior history of HCV. My qualitative study found that patients experienced unavailability of second-line treatment and delays in testing results and treatment initiation. Lastly, globally I found that high-income countries had much higher sales of Direct Acting Antivirals (DAAs) and higher use of newer generations of DAAs. The COVID-19 pandemic led to a decrease of DAA sales of 85% of the countries I studied. This dissertation suggests that future HCV treatment interventions in Rwanda should focus on older individuals and people with comorbidities. In…
aggregated CHO: https://circle.library.ubc.ca/rest/handle/2429/86121
note: INVESTIGATING ACCESS TO HEPATITIS C TESTING AND TREATMENT IN RWANDA AND BEYOND by Marie Paul Nisingizwe MSc., Jomo Kenyatta University of Agriculture and Technology, 2016 A THESIS SUBMITTED IN PARTIAL FULFILLMENT OF THE REQUIREMENTS FOR THE DEGREE OF DOCTOR OF PHILOSOPHY in THE FACULTY OF GRADUATE AND POSTDOCTORAL STUDIES (Population and Public Health) THE UNIVERSITY OF BRITISH COLUMBIA (Vancouver) October 2023 © Marie Paul Nisingizwe, 2023 ii The following individuals certify that they have read, and recommend to the Faculty of Graduate and Postdoctoral Studies for acceptance, the dissertation entitled: Investigating Access to Hepatitis C Testing and Treatment in Rwanda and Beyond submitted by Marie Paul Nisingizwe in partial fulfilment of the requirements for the degree of Doctor of Philosophy in Population and Public Health Examining Committee: Michael R. Law, Professor, Population and Public Health, UBC Supervisor Nick Bansback, Associate Professor, Population and Public Health, UBC Supervisory Committee Member Naveed Z. Janjua, Professor, Population and Public Health, UBC Supervisory Committee Member Jerry Spiegel, Professor, Population and Public Health, UBC University Examiner Mary de Vera, Associate Professor, Pharmaceutical Sciences, UBC University Examiner Additional Supervisory Committee Members: Bethany Hedt-Gauthier, Associate Professor, Global Health and Social Medicine, Harvard Medical School Supervisory Committee Member iii Abstract Hepatitis C virus (HCV) affects 58 million people globally and resulted in 290,000 deaths in 2019. While global targets aim to eliminate HCV by 2030, there remains limited knowledge regarding the accessibility and impact of HCV treatment, particularly in resource-limited settings. This dissertation assessed access to HCV testing and treatment in Rwanda and investigated inequities in global access to HCV medicines. I conducted a retrospective cohort study and hierarchical logistic regression to assess factors associated wi…
has type: Thesis/Dissertation
date issued: 2023-11
is shown at: 10.14288/1.0437105
language: eng
degree discipline: Population and Public Health
provider: Vancouver : University of British Columbia Library
publisher: University of British Columbia
rights: Attribution-NonCommercial-NoDerivatives 4.0 International
rights URI: http://creativecommons.org/licenses/by-nc-nd/4.0/
scholar level: Graduate
contributor: Law, Michael R.
type: Text
identifier URI: http://hdl.handle.net/2429/86121