Scaling up early infant diagnosis of HIV in Rwanda, 2008–2010
- 67 Downloads
More than 390 000 children are newly infected with HIV each year, only 28 per cent of whom benefit from early infant diagnosis (EID). Rwanda's Ministry of Health identified several major challenges hindering EID scale-up in care of HIV-positive infants. It found poor counseling and follow-up by caregivers of HIV-exposed infants, lack of coordination with maternal and child health-care programs, and long delays between the collection of samples and return of results to the health facility and caregiver. By increasing geographic access, integrating EID with vaccination programs, and investing in a robust mobile phone reporting system, Rwanda increased population coverage of EID from approximately 28 to 72.4 per cent (and to 90.3 per cent within the prevention of mother to child transmission program) between 2008 and 2011. Turnaround time from sample collection to receipt of results at the originating health facility was reduced from 144 to 20 days. Rwanda rapidly scaled up and improved its EID program, but challenges persist for linking infected infants to care.
Keywordsearly infant diagnosis HIV testing children Rwanda
Authors thank the health professionals and development partners involved in scaling up pediatric HIV service in Rwanda, and gratefully acknowledge the financial support of PEPFAR and The Global Fund to Fight AIDS, Tuberculosis, and Malaria that made this possible.
- World Health Organization, Joint United Nations Program on HIV/AIDS, United Nations Children’s Fund. (2011) Global HIV/AIDS Response Progress Report 2011. Geneva, Switzerland: World Health Organization. http://www.who.int/hiv/pub/progress_report2011/en/index.html, accessed 3 December 2011.
- World Health Organization. (2011) World Health Statistics Report 2011. Geneva, Switzerland: World Health Organization, http://www.who.int/whosis/whostat/2011/en/index.html, accessed 23 December 2011.
- Sundaravaradan, V., Saxena, S.K., Ramakrishnan, R., Yedavalli, V.R.K., Harris, D.T. and Ahmad, N. (2006) Differential HIV-1 replication in neonatal and adult blood mononuclear cells is influenced at the level of HIV-1 gene expression. Proceedings of the National Academy of Sciences 103 (31): 11701–11706.CrossRefGoogle Scholar
- World Health Organization. (2010) Antiretroviral Therapy for HIV Infection in Infants and Children: Towards Universal Access: Recommendations for a Public Health Approach. Geneva, Switzerland: World Health Organization.Google Scholar
- Kellerman, S. and Essajee, S. (2010) HIV testing for children in resource-limited settings: What are we waiting for? Public Library of Science Medicine 7 (7): e1000285.Google Scholar
- Paediatric Care and Treatment Working Group, Interagency Task Team on the Prevention and Treatment of HIV Infection in Pregnant Women, Mothers and Children. (2011) Pediatric advocacy toolkit: For improved pediatric HIV diagnosis, care and treatment in high HIV prevalence countries and regions. Geneva, Switzerland, http://whqlibdoc.who.int/hq/2011/WHO_HIV_11.04_eng.pdf, accessed 23 December 2011.
- Ciaranello, A.L., Park, J., Ramirez-Avila, L., Freedberg, K.A., Walensky, R.P. and Leroy, V. (2011) Early infant HIV-1 diagnosis programs in resource-limited settings: Opportunities for improved outcomes and more cost-effective interventions. BMC Medicine 9 (59), http://www.biomedcentral.com/1741-7015/9/59, accessed 22 December 2011.
- National Institute of Statistics of Rwanda and Macro International, Inc. (2006) Rwanda Demographic and Health Survey 2005. Calverton, MD: Macro International, http://measuredhs.com/what-we-do/survey/survey-display-252.cfm, accessed 23 December 2011.
- National Institute of Statistics of Rwanda and Macro International, Inc. (2012) Rwanda Demographic and Health Survey 2010. Calverton, MD: Macro International, http://measuredhs.com/what-we-do/survey/survey-display-364.cfm, accessed 23 December 2011.
- National AIDS Control Commission. (2010) HIV and AIDS in Rwanda: Epidemiologic Update. Kigali, Rwanda: National AIDS Control Commission.Google Scholar
- National AIDS Control Commission. (2010) UNGASS Country Progress Report: Republic of Rwanda. Kigali, Rwanda: National AIDS Control Commission, http://data.unaids.org/pub/Report/2010/rwanda_2010_country_progress_report_en.pdf, accessed 23 September 2012.
- Binagwaho, A. and Murekatete, I. (2008) Evaluation of Environment of Care for Children Affected by HIV/AIDS in Rwanda: A Research Report. Faith Victory Association, Kigali, Rwanda.Google Scholar
- Rusa, L., Schneiderman, M., Fritsche, G. and Musango, L. (2009) Case study: Rwanda. In: R. Eichler and R. Levine (eds.) Rwanda: Performance-based Financing in the Public Sector. Washington DC: Center for Global Development, http://www.cgdev.org/doc/books/PBI/10_CGD_Eichler_Levine-Ch10.pdf, accessed 23 December 2011.Google Scholar
- MoH of Rwanda. (2012) A Comprehensive Equity-focused Bottlenecks Analysis of the PMTCT Program in Rwanda. Kigali, Rwanda: MoH of Rwanda.Google Scholar
- Irakoze, A.A. (2011) Rwanda experience in implementing HIV early infant diagnosis and treatment program. International Conference on AIDS and STIs in Africa, Addis Ababa, Ethiopia.Google Scholar
- UNAIDS. (2012) Global AIDS response progress reporting 2012: Guidelines for construction of core indicators for monitoring the 2011 political declaration on HIV/AIDS. Geneva, Switzerland, http://www.unaids.org/en/media/unaids/contentassets/documents/document/2011/JC2215_Global_AIDS_Response_Progress_Reporting_en.pdf, accessed 28 September 2012.
- TRACNet HIV/AIDS information system. (2011) MoH of Rwanda. Kigali, Rwanda: TRACNet HIV/AIDS information system, accessed 24 December 2011.Google Scholar
- Nsanzimana, S. et al (2011) TRACnet SMS technology improves care of HIV-infected infants in Rwanda. Public Health Informatics Conference, Atlanta, GA, http://cdc.confex.com/cdc/phi2011/webprogram/Paper28625.html, accessed 23 December 2011.
- Aluisio, A., Richardson, B.A., Bosire, R., John-Stewart, G., Mbori-Ngacha, D. and Farquhar, C. (2011) Male antenatal attendance and HIV testing are associated with decreased infant HIV infection and increased HIV-free survival. Journal of Acquired Immune Deficiency Syndrome 56 (1): 76–82.CrossRefGoogle Scholar
- Peltzer, K., Jones, D., Weiss, S.M. and Shikwane, E. (2011) Promoting male involvement to improve PMTCT uptake and reduce antenatal HIV infection: a cluster randomized controlled trial protocol. BMC Public Health 11 (778), http://www.biomedcentral.com/1471-2458/11/778, accessed 23 December 2011.
- McCollum, E.D. et al (2010) Task shifting routine inpatient pediatric HIV testing improves program outcomes in urban Malawi: A retrospective observational study. Public Library of Science ONE 5 (3): e9626.Google Scholar
- Wanyenze, R.K., Nawavvu, C., Ouma, J., Namale, A., Colebunders, R. and Kamya, M.R. (2010) Provider-initiated HIV testing for paediatric inpatients and their caretakers is feasible and acceptable. Tropical Medicine and International Health 15 (1): 113–119.Google Scholar
- Kiyaga, C. (2011) Challenges to identifying HIV-exposed infants, scaling up early infant diagnosis & linkage to prophylaxis, treatment and care programs. International AIDS Society Conference on HIV Pathogenesis: Treatment and Prevention, Rome, Italy, #http://pag.ias2011.org/session.aspx?s=38#3, accessed 23 December 2011.
- Schimana, W. et al (2011) Systematic analysis of the early infant diagnosis cascade and implementation of specific interventions: Lessons from a program to increase identification and treatment of infants with HIV in Tanzania. International AIDS Society Conference on HIV Pathogenesis: Treatment and Prevention, Rome, Italy, http://pag.ias2011.org/Abstracts.aspx?AID=2312, accessed 23 December 2011.