Use of routine data collected by the prevention of mother-to-child transmission program for HIV surveillance among pregnant women in Rwanda: opportunities and limitations.

To compare HIV prevalence measured by antenatal clinics (ANC) sentinel surveillance and by the prevention of mother-to-child transmission (PMTCT) program in Rwanda. We compared HIV prevalence from anonymous testing performed under ANC surveillance, and that measured from voluntary counselling and testing performed under the PMTCT program, in a random sample of the same population of pregnant women attending for their first antenatal visit at 29 ANC surveillance sites with a PMTCT program in 2007 in Rwanda. All of the 13,318 pregnant women recruited in the ANC surveillance accepted to participate in the PMTCT program. HIV prevalence measured by sentinel surveillance was 4.35% whereas that measured for 1873 pregnant women (out of the total sentinel population) by the PMTCT program was 3.49% (p=0.07). For 3% of the PMTCT population, HIV test results were missing from the counselling logbook versus 0.3% in the ANC laboratory logbooks. For 10 pregnant women, HIV test results were divergent between the PMTCT and the ANC laboratory logbooks. After missing data and errors were corrected, HIV prevalence results from PMTCT was 3.27% (significantly different from ANC surveillance: p =0.03). High uptake of PMTCT program among pregnant women was observed in Rwanda in 2007. HIV prevalence measured by the ANC surveillance and PMTCT program were significantly different. Poor performance in HIV testing practices and PMTCT/laboratories data management could explain this difference. Improvement in HIV testing practices and in PMTCT/laboratory data management are needed in order to use PMTCT data for HIV surveillance and to ensure good performance of all the package of care provided by the PMTCT program.

Latent Tuberculosis Infection and Associated Factors among Health Care Workers in Kigali, Rwanda.

INTRODUCTION: Data are limited regarding tuberculosis (TB) and latent TB infection prevalence in Rwandan health facilities. METHODS: We conducted a cross-sectional survey among healthcare workers (HCWs) in Kigali during 2010. We purposively selected the public referral hospital, both district hospitals, and randomly selected 7 of 17 health centers. School workers (SWs) from the nearest willing public schools served as a local reference group. We tested for latent TB infection (LTBI) using tuberculin skin testing (TST) and asked about past TB disease. We assessed risk of LTBI and past history of TB disease associated with hospital employment. Among HCWs, we assessed risk associated with facility type (district hospital, referral hospital, health center), work setting (inpatient, outpatient), and occupation. RESULTS: Age, gender, and HIV status was similar between the enrolled 1,131 HCWs and 381 SWs. LTBI was more prevalent among HCWs (62%) than SWs (39%). Adjusted odds of a positive TST result were 2.71 (95% CI 2.01-3.67) times greater among HCWs than SWs. Among HCWs, there was no detectable difference between prevalence of LTBI according to facility type, work setting, or occupation. CONCLUSION: HCWs are at greater risk of LTBI, regardless of facility type, work setting, or occupation. The current status of TB infection control practices should be evaluated in the entire workforce in all Rwandan healthcare facilities.

Scaling up early infant diagnosis of HIV in Rwanda, 2008-2010.

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.

HIV Prevalence Comparison Between Antenatal Sentinel Surveillance and Demographic and Health Survey in Rwanda.

OBJECTIVE: To compare HIV prevalence from antenatal surveillance to that of the demographic and health survey (DHS), and to identify factors determining the difference of HIV prevalence between women recruited in these two surveys in Rwanda in 2005. METHODS: Comparative cross-sectional study of HIV prevalence and socio-demographic factors collected by the antenatal survey in 13,745 pregnant women, seen in 30 health centres located throughout the country and those collected by the DHS among 5641 women, aged 15-49 years living in households located throughout the country. Log-binomial regression and direct standardization were used to estimate and compare HIV prevalence between the two surveys. RESULTS: HIV prevalence in the antenatal survey was slightly higher than that in DHS women (4.1% versus 3.6% p=0.103). Socio-demographic characteristics were differently distributed between the two populations. Whereas, 59%, 93%, 53% of pregnant women were aged 20-29 years, married or cohabiting and living in rural areas respectively, the corresponding proportions among DHS women were 35%, 48% and 83% (p<0.001). Simultaneous standardization of antenatal prevalence according to the distribution of socio-demographic characteristics in the DHS gave an overall HIV prevalence estimate of 3.6%, similar to the prevalence measured among DHS women. CONCLUSIONS: HIV prevalence in the antenatal survey overestimated that among women of the general population in Rwanda in 2005. This overestimation could be corrected by standardization of antenatal prevalence according to the distribution of age, geographical area, marital status, parity, and education, in the general population.