title: Clinical outcomes of a comprehensive integrated program for HIV-exposed infants: a 3-year experience promoting HIV-free survival in rural Rwanda.
abstract: BACKGROUND
  Prevention of mother-to-child transmission of HIV services are often inadequate in promoting HIV-free child survival in rural areas with limited resources. An integrated comprehensive child survival program in rural Rwanda with special emphasis on HIV-exposed infants was established in 2005 and scaled-up. The objective of this study was to report program outcomes and identify predictors of program retention.
  
  
  METHODS
  We conducted a retrospective study of infants born to HIV-infected women enrolled in the program at or before birth from March 1, 2007, to February 28, 2010, in Eastern Rwanda. Key program elements included improved access to health care, antiretroviral prophylaxis for prevention of mother-to-child transmission of HIV, clean water sources and replacement feeding, home visits by community health workers, prevention and treatment of childhood illness, nutritional support, family planning, and socioeconomic support for the extremely vulnerable.
  
  
  RESULTS
  Overall,1038 infants enrolled in the program in the study period during which time there was a 4-fold increase in the number of current participants. Uptake of contraception and treatment for diarrheal disease were high. The 18-month survival probability and retention probability were 0.93 (95% confidence interval: 0.91 to 0.94) and 0.88 (95% confidence interval: 0.86 to 0.90), respectively. Twenty-seven (2.6%) children tested positive for HIV, of which 1 died and none were lost-to-follow-up at 18 months. No statistically significant predictors of retention were identified.
  
  
  CONCLUSIONS
  Our findings demonstrate that a comprehensive integrated program to promote HIV-free survival can achieve high rates of retention and survival in a highly vulnerable population, even during a period of rapid growth.
authors.affiliation: *Partners In Health, Rwinkwavu, Rwanda †Division of Global Health Equity, Department of Medicine, Brigham and Women's Hospital, Boston, MA ‡Department of Medicine, Children's Hospital Boston, Boston, MA §Department of Global Health and Social Medicine, Harvard Medical School, Boston, MA ‖HIV/AIDS, STIs and Other Blood Borne Infections Division, Rwanda Biomedical Center, Kigali, Rwanda.
authors.forename: Neil
authors.initials: N
authors.lastname: Gupta
authors.forename: Felix R
authors.initials: FR
authors.lastname: Cyamatare
authors.forename: Peter
authors.initials: P
authors.lastname: Niyigena
authors.forename: John W
authors.initials: JW
authors.lastname: Niyigena
authors.forename: Sara
authors.initials: S
authors.lastname: Stulac
authors.forename: Placidie
authors.initials: P
authors.lastname: Mugwaneza
authors.forename: Peter
authors.initials: P
authors.lastname: Drobac
authors.forename: Michael
authors.initials: M
authors.lastname: Rich
authors.forename: Molly F
authors.initials: MF
authors.lastname: Franke
mesh_terms: D015658:HIV Infections / Q000517:prevention & control*; D006293:Health Promotion; D006801:Humans; D007223:Infant; D007231:Infant, Newborn; D012189:Retrospective Studies; D012424:Rural Population; D012432:Rwanda; D013534:Survival; D016896:Treatment Outcome