title: Implementing primary health care-based PMTCT interventions: operational perspectives from Muhima cohort analysis (Rwanda).
abstract: BACKGROUND
  In countries with high burden of HIV, major programmatic challenges have been identified to preventing new infections among children and scaling up of treatment for pregnant mothers. We initiated this study to examine operational approaches that were used to enhance implementation of PMTCT interventions in Muhima health Centre (Kigali/Rwanda) from 2007 to 2010.
  
  
  METHODS
  The prospective cohort study was conducted at Muhima health centre. A sample size of 656 was the minimum number required for the study. The main outcome was cumulative incidence of mother - to - child transmission of HIV-1 measured at 6 weeks of life among live born children.
  
  
  RESULTS
  Among the 679 live born babies and followed up in this study, the overall cumulative rate of HIV-1 mother - to - child transmission observed was 3.2% at 6 weeks of age after birth. Disclosure of HIV status to partner was significantly associated with HIV-1 status of infants at 6 weeks of age (non-disclosure of HIV status adjusted odds ratio [AOR] 4.68, CI 1.39 to 15.77, p.
  
  
  CONCLUSIONS
  The Muhima type of decentralized health facility offered an appropriate platform for implementation of PMTCT interventions, with the following operational features: family - centered approach; integrated service delivery for PMTCT/MCH interventions, task shifting; subsidized membership fees for people living with HIV, allowing for access to the community-based health insurance benefits.
authors.affiliation: World Health Organization Department of Maternal, Newborn, Child and Adolescent Health, Geneva, Switzerland.
authors.forename: Maurice
authors.initials: M
authors.lastname: Bucagu
authors.affiliation: King Faisal Hospital, Department of Obstetrics & Gynecology, Kigali, Rwanda.
authors.forename: John
authors.initials: J
authors.lastname: Muganda
mesh_terms: D000293:Adolescent; D000328:Adult; D019380:Anti-HIV Agents / Q000627:therapeutic use; D015331:Cohort Studies; D005260:Female; D015658:HIV Infections / Q000188:drug therapy / Q000517:prevention & control*; D015497:HIV-1; D006801:Humans; D018445:Infectious Disease Transmission, Vertical / Q000517:prevention & control*; D008297:Male; D008875:Middle Aged; D011247:Pregnancy; D011251:Pregnancy Complications, Infectious / Q000188:drug therapy* / Q000821:virology; D011320:Primary Health Care / Q000379:methods*; D011446:Prospective Studies; D012432:Rwanda; D055815:Young Adult
chemical_list: D019380:Anti-HIV Agents
keywords: PMTCT implementation; Rwanda; cohort; community-based health insurance; integrated service delivery; operational considerations; primary health care; task shifting