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Effectiveness of the National PMTCT Program in Rwanda

Effectiveness of the National PMTCT Program in Rwanda. By Dr Alexandre LYAMBABAJE, School of Public Health/ National University of Rwanda Dr Placidie MUGWANEZA, Institute of HIV Diseases Prevention and Control (IHDPC/RBC), Rwanda.

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Effectiveness of the National PMTCT Program in Rwanda

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  1. Effectiveness of the National PMTCT Program in Rwanda By Dr Alexandre LYAMBABAJE, School of Public Health/ National University of Rwanda Dr Placidie MUGWANEZA, Institute of HIV Diseases Prevention and Control (IHDPC/RBC), Rwanda

  2. Transitioning from Sd-NVP to Efficacious ARV regimens, Rwanda PMTCT program, 2005-2010 Population Coverage, HIV+ preg. Women receiving ARV, Rwanda PMTCT program, 2005-2010 Male partner HIV counseling and testing, during ANC, Rwanda PMTCT program, 2005-2010

  3. 1st PMTCT Program Effectiveness Study- Household Survey (2008-2009)- • Aim: HIV prevalence and key determinants among exposed children in the Rwanda PMTCT program. • Methods • Study design: cross sectional • Inclusion criteria: 9-24 months children with their mother • Sampling frame: Stratified 2-stage cluster sampling (1st unit: sites; 2nd unit: ANC mothers). • Both HIV+ and –ves mothers were included to ensure community is blind about status of participants. • Data collection: • Interview with mothers at household, • HIV testing of all children (rapid test and PCR)

  4. Key findings -

  5. Limitations of the 1st PMTCT effectiveness study • Recall bias: 9 to 24 months is a long period after birth. Some mothers could not recall exactly events and treatments during pregnancy and delivery periods • End point measurement: Wide interval (9-24 months) making it difficult to interpret the HIV free-survival rate, as we could not rule out exposure to breastfeeding • Adherence to PMTCT regimens: Registries could not provide exhaustive information about the adherence of the mothers to PMTCT regimens.

  6. 2nd PMTCT 6-week Impact Study Facility-based, 2010-2012 • Primary Objective • To periodically measure rates of early mother-to-child transmission (MTCT) of HIV at 6-weeks postpartum • Secondary Objectives • To periodically estimate the national coverage of key PMTCT interventions, • To estimate the association between early MTCT rate and maternal, infant and health system factors. • Endpoints: • 6-week infant HIV prevalence • 6-week infant MTCT rate (Overall, PMTCT mother, non-PMTCT mother, Serodiscordant couples)

  7. 6-week facility based PMTCT Impact Study - Design • Design: Cross-sectional • Two-stage Stratified Cluster sampling design • Primary units: Health facilities • Stratified by (rural vs urban; PMTCT vs Non-PMTCT site) • Probability proportional to size sampling: size estimated using historical DTP1 data (previous year) • Secondary units: Mother-infant pairs • Sample size • 161 sites (36 non-PMTCT sites; 20 urban) • 2,000 pairs (exposed infant, mother or legal caregiver)

  8. 6-week facility based PMTCT Impact Study - Data collection • Age group: 6-10 weeks • Where: Facility-based at MCH/EPI unit • How: enrollment at DTP1 immunization visit • By Who: Health facility personnel • Main steps • Screening based on standard algorithm (exposed infant) • Interviews of mother or caregiver • Blood sample collection (using DBS) • Data collection started in June 13th 2011 • Final results expected by May 2012

  9. 6-week facility based PMTCT Impact Study - Screening Algorithm for enrollment

  10. Challenges and Potential Bias • Outreach Immunization strategy • How to integrate screening for the study? • How to administer the questionnaire? • Who will manage the transfer of potential eligible mothers and infants to Health facilities for further screening? • Reaching the hardest to reach populations: do not participate in immunization campaigns (Beliefs, Ignorance, hard to reach areas) • Long period for data collection (7 months) • Health Center Personnel mobility

  11. Advantages and Disadvantages compared to MRC Generic Protocol • Advantages • Low cost for blood samples collection and testing • Zero risk for non-exposed children • Capacity building for health facilities and better sustainability • Better coverage by including recruitment from outreach immunization strategy • Disadvantages • Difficult screening phase to identify exposed children • Long period for data collection (7 months) • Mobility of trained personnel and need to retrain new people for data collection

  12. LABORATOIRE NATIONAL DE REFERENCE NATIONAL REFERENCE LABORATORY Acknowledgements Thank You For Your Attention - MURAKOZE Rwanda Biomedical Center/ Institute of HIV, Diseases Prevention and Control (RBC/IHDPC) Rwanda School of Public Health

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