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evaluation
of access to and utilization of services for the prevention of mother
to child transmission (pmtct) of hiv in rwanda
Authors Anita Asiimwe, Thérèse Delvaux, Batya Elul, Felix Ndagije, Dominique Roberfroid, Elevanie Munyana, Marie-Claire Nyiransabimana, Celestin Mugenzi, Jeroen Vant Pad Bosch, Veronicah Mugisha, Vianney Nizeyimana, Ruben Sahabo Executive summaryIn Rwanda, despite a relatively low HIV prevalence rate of 3%, an estimated 22,000 children under the age of 16 are living with HIV/AIDS and account for nearly 10% of all infections nationwide. As most of these infections are believed to be perintally acquired, services to prevent mother-to-child transmission (PMTCT) have rapidly scaled up at the national level from 23 sites in 2002 to 234 in 2006. Until recently, single-dose nevirapine (SD-NVP) was the standard antiretroviral (ARV) prophylaxis for women and infants but in late 2006 more complex PMTCT regimens were adopted. As the introduction of these new regimens are likely to be accompanied by many on-the-ground challenges, it is important to highlight lessons learned with regard to access, uptake and ultimately adherence to the complete PMTCT package. To this end, the Government of Rwanda, through the Ministry of Health’s Treatment and Research AIDS Center (TRAC) and in collaboration with Columbia University’s International Center for AIDS Care and Treatment Programs (ICAP) and participation from the Elizabeth Glaser Pediatric AIDS Foundation (EGPAF), undertook an evaluation to: 1) Describe experiences with HIV testing among pregnant women (HIV-infected and uninfected) receiving antenatal care (ANC) services; and 2) Describe experiences with and identify factors affecting adherence to the PMTCT protocol, defined as mother-infant pairs ingesting single-dose nevirapine (SD-NVP) at the onset of/during labor for mothers and within 72 hours of delivery for infants, among HIV-infected women receiving ANC services. We also explored women’s (HIV-infected and HIV-uninfected, where appropriate) experiences with other aspects of PMTCT services, including the acceptability of ANC and delivery services; involvement of family members in decisions regarding HIV testing, delivery and ingestion of PMTCT prophylaxis; infant feeding and post-partum family planning knowledge, attitudes and practices; and referral from PMTCT to HIV care and treatment services.
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