HIV‐free survival among nine‐ to 24‐month‐old children born to HIV‐positive mothers in the Rwandan national PMTCT programme: a community‐based household survey

Ruton, Hinda; Mugwaneza, Placidie; Shema, Nadine Umutoni Wa; Lyambabaje, Alexandre; Bizimana, Jean de Dieu; Tsague, Landry; Nyankesha, Elevanie; Wagner, Claire; Mutabazi, Vincent; Nyemazi, Jean Pierre; Nsanzimana, Sabin; Karema, Corine; Binagwaho, Agnès

doi:10.1186/1758-2652-15-4

Cited by 38 publications

(47 citation statements)

References 28 publications

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“…[16] However, the Zambian evaluation was small scale and assessed a pilot program implementing Option B in four facilities. National-level assessments of the recent WHO guidelines are underway in Rwanda (Option B),[17] Malawi (Option B+),[18] and South Africa,[19] however only the baseline estimates of these evaluations have been published so far. [17–19]…”

Section: Discussionmentioning

confidence: 99%

“…This study design, initially used in the four-country PEARL study[20], has also been used in the above-mentioned Zambian[16] and Rwandan[17] evaluations. In contrast, the Malawian and South African assessments consist of serial cross-sectional serosurveys of mother-infant pairs attending childhood immunizations,[18,19] which can only estimate early MTCT (<3 months) because they do not account for breastfeeding-related transmission.…”

Section: Discussionmentioning

confidence: 99%

“…Community-based surveys such as ours are able to: assess both MTCT and HIV-free infant survival; include all mother-infant pairs, not just those who use health facilities; and account for HIV infections occurring through breastfeeding (e.g., we assessed these outcomes at 9–18 months of age, the Zambian and Rwandan evaluations assessed outcomes at 24 months). [16,17]…”

Section: Discussionmentioning

confidence: 99%

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Option A improved HIV-free infant survival and mother to child HIV transmission at 9–18 months in Zimbabwe

Buzdugan

Dufour

McCoy

et al. 2016

Aids

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Objective We evaluated the impact of Option A on HIV-free infant survival and mother-to-child transmission (MTCT) in Zimbabwe. Design Serial cross-sectional community-based serosurveys. Methods We analyzed serosurvey data collected in 2012 and 2014 among mother-infant pairs from catchment areas (CAs) of 132 health facilities from 5 of 10 provinces in Zimbabwe. Eligible infants (alive or deceased) were born 9–18 months before each survey to mothers ≥16 years old. We randomly selected mother-infant pairs and conducted questionnaires, verbal autopsies and collected blood samples. We estimated: 1) the HIV-free infant survival and MTCT rate within each CA and compared the 2012 and 2014 estimates using a paired t-test, 2) number of HIV infections averted due to the intervention. Results We analyzed 7,249 mother-infant pairs with viable maternal specimens collected in 2012 and 8,551 in 2014. The mean difference in the CA-level MTCT between 2014 and 2012 was −5.2 percentage points (95% confidence interval (CI)=−8.1, −2.3, p<0.001). The mean difference in the CA-level HIV-free survival was 5.5 percentage points (95%CI=2.6,8.5, p<0.001). Between 2012 and 2014, 1,779 infant infections were averted compared to the pre-Option A regimen. The association between HIV-free infant survival and duration of Option A implementation was not significant at the multivariate level (p=0.093). Conclusions We found a substantial and statistically significant increase in HIV-free survival and decrease in MTCT among infants aged 9–18 months following Option A rollout in Zimbabwe. This is the only impact evaluation of Option A and shows the effectiveness of Option A and Zimbabwe’s remarkable progress towards eMTCT.

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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

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Option A improved HIV-free infant survival and mother to child HIV transmission at 9–18 months in Zimbabwe

Buzdugan

Dufour

McCoy

et al. 2016

Aids

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“…11,12 By the end of the study period, all 475 health facilities in Rwanda were using TRACnet for PCR results transmission.…”

Section: Methodsmentioning

confidence: 99%

TRACnet Internet and Short Message Service Technology Improves Time to Antiretroviral Therapy Initiation Among HIV-infected Infants in Rwanda

Kayumba

Nsanzimana

Binagwaho

et al. 2016

Pediatric Infectious Disease Journal

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Background Delays in testing HIV-exposed infants and obtaining results in resource-limited settings contribute to delays for initiating antiretroviral therapy(ART) in infants. To overcome this challenge, Rwanda expanded its national mobile and internet-based HIV/AIDS informatics system, called TRACnet, to include HIV PCR results in 2010. This study was performed to evaluate the impact of TRACnet technology on the time to delivery of test results and the subsequent initiation of ART in HIV-infected infants. Methods A retrospective cohort study was conducted on 380 infants who initiated ART in 190 health facilities in Rwanda from March 2010 to June 2013. Program data collected by the TRACnet system was extracted and analyzed. Results Since the introduction of TRACnet for processing PCR results, the time to receive results has significantly decreased from a median of 144 days[IQR 121-197] to 23 days[IQR 17-43]. The number of days between PCR sampling and health facility receipt of results decreased substantially from a median of 90 days[IQR 83-158] to 5 days[IQR 2-8]. After receiving PCR results at a health facility, it takes a median of 44 days[IQR 32-77] before ART initiation. Result turnaround time was significantly associated with time to initiating ART(P<0.001). An increased number of staff trained for HIV care and treatment was also significantly associated with decreased time to ART initiation(P=0.004). Conclusions The use of mobile technology for communication of HIV PCR results, coupled with well-trained and skilled personnel, can reduce delays in communicating results to providers. Such reductions may improve timely ART initiation in resource-limited settings.

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“…Botswana, Rwanda, and South Africa report good access to and uptake of PMTCT services and low rates of early MTCT. [26][27][28] In a national survey conducted at 580 facilities in 9 South African provinces, caregiver-infant pairs were tested for HIV at the first immunization visit. 28 The prevalence of HIV exposure among infants was 32.3% (95% CI: 30.7% to 33.6%) and the national perinatal MTCT rate at 4-8 weeks postpartum was 2.7% (85% CI: 2.1% to 3.2%).…”

Section: The Practice Of Preventing Pediatric Hiv Infectionmentioning

confidence: 99%

Can We Achieve an AIDS-Free Generation? Perspectives on the Global Campaign to Eliminate New Pediatric HIV Infections

Abrams

Myer

2013

JAIDS Journal of Acquired Immune Deficiency Syndromes

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Efforts to prevent the mother-to-child transmission (PMTCT) of HIV infection have encountered remarkable successes and considerable challenges around the globe. The reductions in vertical HIV transmission observed in Europe and North America have helped raise the possibility of the virtual elimination of new pediatric HIV infections and in turn an "AIDS-free generation". Yet in many resource-limited settings, preventable new pediatric infections continue to occur daily. Here, we consider what will be required to reach an end to the global pediatric HIV epidemic, and what we can hope for in the context of resurgent international interest. The science of PMTCT has advanced dramatically since the first evidence for the use of antiretroviral (ARV) drugs for PMTCT in 1994. The timing and causes of vertical transmission are now well understood, and this knowledge has led directly to highly efficacious PMTCT interventions based on the use of combination ARV regimens. The application of these interventions around the world has been uneven, however. Several African countries report good access to and uptake of PMTCT services and corresponding low rates of early mother-to-child transmission. However, limited population coverage of PMTCT programs with continued use of suboptimal ARV regimens still hamper prevention efforts in many other countries. Looking forward, reaching ambitious international targets to reduce pediatric HIV infections will require a combination of increased access to efficacious ARV regimens and strengthened health systems for maternal and child health, supported by continued strong political will and international attention.

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HIV‐free survival among nine‐ to 24‐month‐old children born to HIV‐positive mothers in the Rwandan national PMTCT programme: a community‐based household survey

Cited by 38 publications

References 28 publications

Option A improved HIV-free infant survival and mother to child HIV transmission at 9–18 months in Zimbabwe

Option A improved HIV-free infant survival and mother to child HIV transmission at 9–18 months in Zimbabwe

TRACnet Internet and Short Message Service Technology Improves Time to Antiretroviral Therapy Initiation Among HIV-infected Infants in Rwanda

Can We Achieve an AIDS-Free Generation? Perspectives on the Global Campaign to Eliminate New Pediatric HIV Infections

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