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. 2022 Jan 18;19(3):1023.
doi: 10.3390/ijerph19031023.

Experience of Rwanda on COVID-19 Case Management: From Uncertainties to the Era of Neutralizing Monoclonal Antibodies

Menelas Nkeshimana  1   2   3 , Deborah Igiraneza  1 , David Turatsinze  1   2   3 , Otto Niyonsenga  3   4 , Deborah Abimana  5 , Cyprien Iradukunda  1 , Emmanuel Bizimana  1 , Jean Muragizi  1 , Lise Mumporeze  3   6 , Laurent Lussungu  7 , Hackim Mugisha  1 , Elizabeth Mgamb  8 , Noella Bigirimana  9 , Edison Rwagasore  9 , Swaibu Gatare  9 , Hassan Mugabo  9 , Olivier Nsekuye  9 , Muhammed Semakula  9 , Augustin Sendegeya  4   6 , Ephraim Rurangwa  10 , Edgar Kalimba  6 , Sanctus Musafiri  2   3 , Corneille Ntihabose  11 , Eric Seruyange  3   10 , Charlotte Bavuma  2   3 , Theogene Twagirumugabe  3   4 , Daniel Nyamwasa  11   12 , Sabin Nsanzimana  9   11
Affiliations

Experience of Rwanda on COVID-19 Case Management: From Uncertainties to the Era of Neutralizing Monoclonal Antibodies

Menelas Nkeshimana et al. Int J Environ Res Public Health. .

Abstract

The management of COVID-19 in Rwanda has been dynamic, and the use of COVID-19 therapeutics has gradually been updated based on scientific discoveries. The treatment for COVID-19 remained patient-centered and entirely state-sponsored during the first and second waves. From the time of identification of the index case in March 2020 up to August 2021, three versions of the clinical management guidelines were developed, with the aim of ensuring that the COVID-19 patients treated in Rwanda were receiving care based on the most recent therapeutic discoveries. As the case load increased and imposed imminent heavy burdens on the healthcare system, a smooth transition was made to enable that the asymptomatic and mild COVID-19 cases could continue to be closely observed and managed while they remained in their homes. The care provided to patients requiring facility-based interventions mainly focused on the provision of anti-inflammatory drugs, anticoagulation, broad-spectrum antibiotic therapy, management of hyperglycemia and the provision of therapeutics with a direct antiviral effect such as favipiravir and neutralizing monoclonal antibodies. The time to viral clearance was observed to be shortest among eligible patients treated with neutralizing monoclonal antibodies (bamlanivimab). Moving forward, as we strive to continue detecting COVID-19 cases as early as possible, and promptly initiate supportive interventions, the use of neutralizing monoclonal antibodies constitutes an attractive and cost-effective therapeutic approach. If this approach is used strategically along with other measures in place (i.e., COVID-19 vaccine roll out, etc.), it will enable us to bring this global battle against the COVID-19 pandemic under full control and with a low case fatality rate.

Keywords: COVID-19; Rwanda; guidelines; interventions; monoclonal antibodies; outcomes.

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Conflict of interest statement

The authors declare no conflict of interest.

Figures

Figure 1
Figure 1
Timeline of COVID-19 case management interventions.
Figure 2
Figure 2
Trend in proportions of COVID-19 cases in HBC and treatment centers.
Figure 3
Figure 3
Major case management therapeutic interventions during COVID-19 deaths surge.
Figure 4
Figure 4
Kaplan–Meier curve for viral clearance according to the therapeutic intervention.
See this image and copyright information in PMC

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