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Open Access Research article

Comparing two service delivery models for the prevention of mother-to-child transmission (PMTCT) of HIV during transition from single-dose nevirapine to multi-drug antiretroviral regimens

Landry Tsague15*, Fatima Oliveira Tsiouris2, Rosalind J Carter2, Veronicah Mugisha1, Gilbert Tene1, Elevanie Nyankesha3, Stephania Koblavi-Deme1, Placidie Mugwaneza3, Eugenie Kayirangwa4, Ruben Sahabo1 and Elaine J Abrams2

Author Affiliations

1 International Center for AIDS Care and Treatment Programs, Kigali, Rwanda

2 International Center for AIDS Care and Treatment Programs, Mailman School of Public Health, Columbia University, NY, USA

3 Treatment and Research AIDS Center (TRAC-Plus), Ministry of Health, Kigali, Rwanda

4 Centers for Disease Control and Prevention, Kigali, Rwanda

5 UNICEF-Rwanda

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BMC Public Health 2010, 10:753  doi:10.1186/1471-2458-10-753

Published: 6 December 2010

Abstract

Background

Mother-to-child transmission (MTCT) of HIV has been eliminated from the developed world with the introduction of multi-drug antiretroviral (md-ARV) regimens for the prevention of MTCT (PMTCT); but remains the major cause of HIV infection among sub-Saharan African children. This study compares two service delivery models of PMTCT interventions and documents the lessons learned and the challenges encountered during the transition from single-dose nevirapine (sd-nvp) to md-ARV regimens in a resource-limited setting.

Methods

Program data collected from 32 clinical sites was used to describe trends and compare the performance (uptake of HIV testing, CD4 screening and ARV regimens initiated during pregnancy) of sites providing PMTCT as a stand-alone service (stand-alone site) versus sites providing PMTCT as well as antiretroviral therapy (ART) (full package site). CD4 cell count screening, enrolment into ART services and the initiation of md-ARV regimens during pregnancy, including dual (zidovudine [AZT] +sd-nvp) prophylaxis and highly active antiretroviral therapy (HAART) were analysed.

Results

From July 2006 to December 2008, 1,622 pregnant women tested HIV positive (HIV+) during antenatal care (ANC). CD4 cell count screening during pregnancy increased from 60% to 70%, and the initiation of md-ARV regimens increased from 35.5% to 97% during this period. In 2008, women attending ANC at full package sites were 30% more likely to undergo CD4 cell count assessment during pregnancy than women attending stand-alone sites (relative risk (RR) = 1.3; 95% confidence interval (CI): 1.1-1.4). Enrolment of HIV+ pregnant women in ART services was almost twice as likely at full package sites than at stand-alone sites (RR = 1.9; 95% CI: 1.5-2.3). However, no significant differences were detected between the two models of care in providing md-ARV (RR = 0.9; 95% CI: 0.9-1.0).

Conclusions

All sites successfully transitioned from sd-nvp to md-ARV regimens for PMTCT. Full package sites offer the most efficient model for providing immunological assessment and enrolment into care and treatment of HIV+ pregnant women. Strengthening the capacity of stand-alone PMTCT sites to achieve the same objectives is paramount.