A Novel Combined Mother-Infant Clinic to Optimize Post-Partum Maternal Retention, Service Utilization, and Linkage to Services in HIV Care in Rural Rwanda

Abstract

Background and Objectives:Despite recent improvements in accessibility of services to prevent mother-to-child transmission of HIV, maternal retention in HIV care remains a challenge in the post-partum period. This study assessed service utilization, program retention, and linkage to routine services, as well as clinical outcomes for mothers and infants, following implementation of an integrated mother-infant clinic in rural Rwanda.Methods:We conducted a retrospective cohort study of all HIV-positive mothers and their infants enrolled in the integrated clinics in two rural districts between July 1, 2012, and June 30, 2013. At 18 months post-partum, data on mother-infant service utilization and program outcomes were reported.Results:Of the 185 mother-infant pairs in the clinics, 98.4% of mothers were on antiretroviral therapy (ART) and 30.3% used modern contraception at enrollment. At 18 months post-partum, 98.4% of mothers were retained and linked back to adult HIV program. All mothers were on ART and 72.0% on modern contraception. For infants, 93.0% completed follow-up. Two (1.1%) infants tested HIV positive.Conclusion and Global Health Implication:An integrated clinic was successfully implemented in rural Rwanda with high mother retention in care and low mother to child HIV transmission rates. This model of integration of services may contribute to improved mother-infant retention in care during post-partum period and should be considered as one approach to addressing this challenge in similar settings.

Does family planning and HIV services integration increase contraceptive prevalence? A comparative analysis of modern contraceptive prevalence among HIV-positive and HIV-negative women of reproductive age in Tanzania-analysis of the 2016/17 Tanzania HIV impact survey

“…In a prospective study conducted in Rwanda, a higher impact was reported where modern contraception prevalence of 72% was found following service integration intervention compared to 30% before the intervention. [25] In our multivariate analysis that combined HIV-positive and negative women (Model 1), HIV-positive status awareness increased the odds of modern contraceptives by 48%. In HIV-positive women (Model 2), being on integrated service increased the odds of modern contraceptives by 85%.…”

Cost-effectiveness of integrating postpartum antiretroviral therapy and infant care into maternal & child health services in South Africa

“…The MCH-ART trial demonstrated improved maternal engagement and virologic suppression with the MCH-ART intervention compared to the standard of care [8]. Other studies have demonstrated a similar, positive effect of integrated services on retention, but to our knowledge, MCH-ART is the first to show improvement in both retention and virologic suppression [39, 40]. Our results demonstrate that, in addition to being clinically effective, the MCH-ART intervention is cost-effective, with an ICER of $599/YLS.…”

Beyond Early Infant Diagnosis: Changing the Approach to HIV-Exposed Infants

“…A comprehensive approach to the mother–infant pair’s health needs during the breastfeeding period is promising for this population. Guillaine et al 22 describe the success of a “Combined Clinic” in Rwanda, which provided maternal and infant care, including regular home visits and nutritional supplementation, until the child was 18 months of age; in this program no mothers were lost to follow-up during breastfeeding and 95% of HEI received HIV testing. Successful “mother–infant pair” clinics have incorporated innovative approaches, such as text message reminders, and have relied on a comprehensive approach to encourage retention and linkage.…”