Integration of Maternal, Newborn and Child Health and HIV Services for Prevention of Mother to Child Transmission of HIV in Rwanda: An Interrupted Time Series Analysis

Presenter: Monique Abimpaye, Rwanda Biomedical Center

Background:  Rwanda has achieved remarkable success in improving maternal and child health (MCH). Much of this success results from innovative service delivery platforms. An example is Rwanda’s implementation of the WHO Option B guidelines in 2010 for using antiretroviral therapy (ART) throughout pregnancy and breastfeeding, with infant prophylaxis, for the prevention of mother-to-child transmission of HIV (PMTCT). In implementing this policy, Rwanda integrated MCH and HIV services to improve coverage by using one healthcare provider for both, harmonizing mother-infant visits and combining monitoring/evaluation tools. Our analysis assesses the impact of this integrated approach to implementing Option B on mother-to-child HIV transmission rates.

Methods:  A quasi-experimental design and interrupted time series analysis was conducted to assess the impact of implementing Option B on HIV transmission. Our study population included HIV-exposed children attending 348 facilities that reported on PMTCT outcomes to Rwanda’s national HIV tracking system (TRACnet) from August 2010-July 2014. We analyzed the rate of positive HIV tests at 18 months per 100 HIV-exposed children and compared the level and trend of HIV transmission rates before and after May 2012 (18 months after the PMTCT guideline change to Option B).

Results:  The trend of mother-to-child HIV transmission at 18 months of age increased throughout the period prior to May 2012 (baseline trend 0.043/100, 95%CI: [0.0015, 0.085], p=0.048). Following the change in PMTCT guidelines, we found a reduction in both the level (-0.91/100, 95%CI: [-1.58, -0.25, p=0.01) and the trend (-0.054/100, 95%CI: [-0.105, -0.0036],p=0.041) in the 18-month transmission rate.

Conclusion: We found that Option B was associated with a decrease in 18-month HIV transmission rates from mother-to-child in Rwanda. Scale-up of PMTCT and ART programs, as well as integrating with MCH services, could have contributed to the decline in transmission by creating an opportunity for improved access to PMTCT services.