1. Effectiveness of the National PMTCT Program in RwandaBy
Dr Alexandre LYAMBABAJE, School of Public Health/ National University of Rwanda
Dr Placidie MUGWANEZA, Institute of HIV Diseases Prevention and Control (IHDPC/RBC), Rwanda

2. Male partner HIV counseling and testing, during ANC, Rwanda PMTCT program, 2005-2010
Population Coverage, HIV+ preg. Women receiving ARV, Rwanda PMTCT program,
Transitioning from Sd-NVP to Efficacious ARV regimens, Rwanda PMTCT program,

3. 1st PMTCT Program Effectiveness Study - Household Survey (2008-2009)-
Aim: HIV prevalence and key determinants among exposed children in the Rwanda PMTCT program.
Methods
Study design: cross sectional
Inclusion criteria: 9-24 months children with their mother
Sampling frame: Stratified 2-stage cluster sampling (1st unit: sites; 2nd unit: ANC mothers).
Both HIV+ and –ves mothers were included to ensure community is blind about status of participants.
Data collection:
Interview with mothers at household,
HIV testing of all children (rapid test and PCR)

4. Key findings -

5. Limitations of the 1st PMTCT effectiveness study
Recall bias: 9 to 24 months is a long period after birth. Some mothers could not recall exactly events and treatments during pregnancy and delivery periods
End point measurement: Wide interval ( months) making it difficult to interpret the HIV free- survival rate, as we could not rule out exposure to breastfeeding
Adherence to PMTCT regimens: Registries could not provide exhaustive information about the adherence of the mothers to PMTCT regimens.

6. 2nd PMTCT 6-week Impact Study Facility-based, 2010-2012
Primary Objective
To periodically measure rates of early mother-to-child transmission (MTCT) of HIV at 6-weeks postpartum
Secondary Objectives
To periodically estimate the national coverage of key PMTCT interventions,
To estimate the association between early MTCT rate and maternal, infant and health system factors.
Endpoints:
6-week infant HIV prevalence
6-week infant MTCT rate (Overall, PMTCT mother, non-PMTCT mother, Serodiscordant couples)

7. 6-week facility based PMTCT Impact Study - Design
Design: Cross-sectional
Two-stage Stratified Cluster sampling design
Primary units: Health facilities
Stratified by (rural vs urban; PMTCT vs Non-PMTCT site)
Probability proportional to size sampling: size estimated using historical DTP1 data (previous year)
Secondary units: Mother-infant pairs
Sample size
161 sites (36 non-PMTCT sites; 20 urban)
2,000 pairs (exposed infant, mother or legal caregiver)

8. 6-week facility based PMTCT Impact Study - Data collection
Age group: 6-10 weeks
Where: Facility-based at MCH/EPI unit
How: enrollment at DTP1 immunization visit
By Who: Health facility personnel
Main steps
Screening based on standard algorithm (exposed infant)
Interviews of mother or caregiver
Blood sample collection (using DBS)
Data collection started in June 13th 2011
Final results expected by May 2012

9. 6-week facility based PMTCT Impact Study - Screening Algorithm for enrollment

10. Challenges and Potential Bias
Outreach Immunization strategy
How to integrate screening for the study?
How to administer the questionnaire?
Who will manage the transfer of potential eligible mothers and infants to Health facilities for further screening?
Reaching the hardest to reach populations: do not participate in immunization campaigns (Beliefs, Ignorance, hard to reach areas)
Long period for data collection (7 months)
Health Center Personnel mobility

11. Advantages and Disadvantages compared to MRC Generic Protocol
Low cost for blood samples collection and testing
Zero risk for non-exposed children
Capacity building for health facilities and better sustainability
Better coverage by including recruitment from outreach immunization strategy
Disadvantages
Difficult screening phase to identify exposed children
Long period for data collection (7 months)
Mobility of trained personnel and need to retrain new people for data collection

12. Thank You For Your Attention - MURAKOZE
Acknowledgements
Rwanda Biomedical Center/
Institute of HIV, Diseases Prevention and Control (RBC/IHDPC)
Rwanda School of Public Health
LABORATOIRE NATIONAL DE REFERENCE
NATIONAL REFERENCE LABORATORY
Thank You For Your Attention - MURAKOZE