Democratic Republic of the Congo

The Democratic Republic of the Congo (DRC) is the third largest country in Africa. Despite its wealth in natural resources, the DRC is among the world’s poorest countries, ranking 176 among the 182 countries on the United Nations Development Program’s Human Development Index scale. The country endured more than a decade of civil war that ended in 2003, but resulted in continuing political and economic instability.

Health Care System

The armed conflict of the 1990s and concomitant internal displacement have caused widespread poverty and infrastructure collapse in the DRC. Meeting health care needs for the estimated 68.7 million Congolese, including 1.2 million people living with HIV has stretched the nation’s resources. An estimated 70 percent of Congolese people have little or no access to health care, and the estimated life expectancy is 46 years old. Sexual and gender based violence (SGBV) is alarmingly prevalent in the DRC. Among women age 15-49, 64% have suffered from physical violence at some point since age 15, and 49% suffered from acts of violence during the last 12 months.

HIV/AIDS and TB in the DRC

Between 400,000 and 500,000 Congolese are living with HIV in the DRC. HIV prevalence is 1.3% among the adult population (15-49 years), with higher rates among women than men (1.6% and 0.9%), and higher rates in Kinshasa and in the East provinces (1.9%). Pregnant women also record a higher prevalence than the general population (4.1%). The armed conflict in the DRC disrupted the national AIDS control program, Programme National pour la Lutte contre le SIDA (PNLS), which the DRC government established in 1987 to set policies and coordinate HIV/AIDS efforts.  Following the decrease in hostilities and establishment of a transitional government in 2003, the government renewed its efforts to reduce the impact of HIV, commencing with a grant and followed by the creation of the Multisectoral HIV/AIDS Program. In 2005, the Ministry of Health released its first national HIV/AIDS strategic plan for scaling-up access to ART. The present national health sector HIV/AIDS strategic plan includes strategies for expanding antiretroviral therapy and prevention and care services, for strengthening the national HIV laboratory network, and for improving procurement and supply-chain management systems.

The DRC ranks tenth on the list of 22 high-burden TB countries, with an estimated incidence of 382 per 100,000 population in 2008. TB screening at HIV/AIDS prevention and care and treatment facilities and TB/HIV coinfection service capacity and access remain markedly limited.  Eight percent of incident TB cases are HIV-positive. However, only 19% of TB patients know their HIV status.

TB/HIV co-infection services are operational in only 20 of the 515 health zones in the DRC. Fewer than 3% of TB patients diagnosed every year have access to HIV testing, and among those TB patients who are ART-eligible, only 40% have access to ART. Integration of heath care training, and referral services into TB settings is not systematized and integration of TB screening and treatment into ART programs is rare.

ICAP in the DRC

ICAP began supporting HIV care and treatment services in the DRC in April 2010. As a CDC-DRC partner, ICAP is working with the Congolese government in the country’s capital, Kinshasa to enhance adult and pediatric HIV care and treatment services with a focus on integrating HIV and TB coinfection services at four hospitals and 20 TB clinics and health centers. ICAP is working with supported sites to rehabilitate and renovate site and laboratory infrastructure, procure ARVs and supplies and equipment to improve laboratory capacity at six reference hospitals, and to expand HIV care and treatment services, including related nutritional support and TB/HIV coinfection services. ICAP is also beginning activities to newly expand HIV care and treatment services at a reference-level hospital and affiliated health centers, in the southeast Congolese city of Lubumbashi.