Neil Gupta1, Felix R Cyamatare, Peter Niyigena, John W Niyigena, Sara Stulac, Placidie Mugwaneza, Peter Drobac, Michael Rich, Molly F Franke. 1. *Partners In Health, Rwinkwavu, Rwanda †Division of Global Health Equity, Department of Medicine, Brigham and Women's Hospital, Boston, MA ‡Department of Medicine, Children's Hospital Boston, Boston, MA §Department of Global Health and Social Medicine, Harvard Medical School, Boston, MA ‖HIV/AIDS, STIs and Other Blood Borne Infections Division, Rwanda Biomedical Center, Kigali, Rwanda.
Abstract
BACKGROUND: Prevention of mother-to-child transmission of HIV services are often inadequate in promoting HIV-free child survival in rural areas with limited resources. An integrated comprehensive child survival program in rural Rwanda with special emphasis on HIV-exposed infants was established in 2005 and scaled-up. The objective of this study was to report program outcomes and identify predictors of program retention. METHODS: We conducted a retrospective study of infants born to HIV-infected women enrolled in the program at or before birth from March 1, 2007, to February 28, 2010, in Eastern Rwanda. Key program elements included improved access to health care, antiretroviral prophylaxis for prevention of mother-to-child transmission of HIV, clean water sources and replacement feeding, home visits by community health workers, prevention and treatment of childhood illness, nutritional support, family planning, and socioeconomic support for the extremely vulnerable. RESULTS: Overall,1038 infants enrolled in the program in the study period during which time there was a 4-fold increase in the number of current participants. Uptake of contraception and treatment for diarrheal disease were high. The 18-month survival probability and retention probability were 0.93 (95% confidence interval: 0.91 to 0.94) and 0.88 (95% confidence interval: 0.86 to 0.90), respectively. Twenty-seven (2.6%) children tested positive for HIV, of which 1 died and none were lost-to-follow-up at 18 months. No statistically significant predictors of retention were identified. CONCLUSIONS: Our findings demonstrate that a comprehensive integrated program to promote HIV-free survival can achieve high rates of retention and survival in a highly vulnerable population, even during a period of rapid growth.
BACKGROUND: Prevention of mother-to-child transmission of HIV services are often inadequate in promoting HIV-freechild survival in rural areas with limited resources. An integrated comprehensive child survival program in rural Rwanda with special emphasis on HIV-exposed infants was established in 2005 and scaled-up. The objective of this study was to report program outcomes and identify predictors of program retention. METHODS: We conducted a retrospective study of infants born to HIV-infectedwomen enrolled in the program at or before birth from March 1, 2007, to February 28, 2010, in Eastern Rwanda. Key program elements included improved access to health care, antiretroviral prophylaxis for prevention of mother-to-child transmission of HIV, clean water sources and replacement feeding, home visits by community health workers, prevention and treatment of childhood illness, nutritional support, family planning, and socioeconomic support for the extremely vulnerable. RESULTS: Overall,1038 infants enrolled in the program in the study period during which time there was a 4-fold increase in the number of current participants. Uptake of contraception and treatment for diarrheal disease were high. The 18-month survival probability and retention probability were 0.93 (95% confidence interval: 0.91 to 0.94) and 0.88 (95% confidence interval: 0.86 to 0.90), respectively. Twenty-seven (2.6%) children tested positive for HIV, of which 1 died and none were lost-to-follow-up at 18 months. No statistically significant predictors of retention were identified. CONCLUSIONS: Our findings demonstrate that a comprehensive integrated program to promote HIV-free survival can achieve high rates of retention and survival in a highly vulnerable population, even during a period of rapid growth.
Authors: Neza Guillaine; Wilberforce Mwizerwa; Jackline Odhiambo; Bethany L Hedt-Gauthier; Lisa R Hirschhorn; Placidie Mugwaneza; Jean Paul Umugisha; Felix Rwabukwisi Cyamatare; Christine Mutaganzwa; Neil Gupta Journal: Int J MCH AIDS Date: 2017
Authors: Brianna L Smith; Sara Zizzo; Anouk Amzel; Sarah Wiant; Molly C Pezzulo; Sarah Konopka; Rachel Golin; Alexandra C Vrazo Journal: Int J MCH AIDS Date: 2018
Authors: Ivy Mushamiri; Wintana Belai; Emma Sacks; Becky Genberg; Sundeep Gupta; Henry B Perry Journal: J Glob Health Date: 2021-07-10 Impact factor: 4.413