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Objective To assess the costs associated with the provision of services for the prevention of mother-to-child transmission (PMTCT) of human immunodeficiency virus in two African countries. Methods In 2009, the costs to health-care providers of providing comprehensive PMTCT services were assessed in 20 public health facilities in Namibia and Rwanda. Information on prices and on the total amount of each service provided was collected at the national level. The costs of maternal testing and counselling, male partner testing, CD4+ T-lymphocyte (CD4+ cell) counts, antiretroviral prophylaxis and treatment, community-based activities, contraception for 2 years postpartum and early infant diagnosis were estimated in United States dollars (US$). Findings The estimated costs to the providers of PMTCT, for each mother-infant pair, were US$ 202.75-1029.55 in Namibia and US$ 94.14-342.35 in Rwanda. These costs varied with the drug regimen employed. At 2009 coverage levels, the maximal estimates of the national costs of PMTCT were US$ 3.15 million in Namibia and US$ 7.04 million in Rwanda (or < US$ 0.7.5 per capita in both countries). Adult testing and counselling accounted for the highest proportions of the national costs (37% and 74% in Namibia and Rwanda, respectively), followed by management and supervision. Treatment and prophylaxis accounted for less than 20% of the costs of PMTCT in both study countries. Conclusion The costs involved in the PMTCT of HIV varied widely between study countries and in accordance with the protocols used. However, since per-capita costs were relatively low, the scaling up of PMTCT services in Namibia and Rwanda should be possible. Objectif Evaluer les couts associes a la prestation de services pour la prevention de la transmission mere-enfant (PTME) du virus de l'immunodeficience humaine dans deux pays africains. Methodes En 2009, les couts pour les prestataires de soins lies a l'offre de services complets de PTME ont ete evalues dans 20 etablissements de sante publics en Namibie et au Rwanda. Des informations sur les prix et sur le montant total de chaque service fourni ont ete recueillies au niveau national. Les couts des conseils fournis et des tests realises par les meres, des depistages des partenaires masculins, des comptages des lymphocytes-T CD4+ (cellules CD4+), de la prophylaxie et du traitement antiretroviral ou encore des activites communautaires, de la contraception pendant 2 ans apres l'accouchement et du diagnostic precoce des nourrissons ont ete estimes en dollars. Resultats Les couts pour les prestataires de PTME, pour chaque couple mere-enfant, ont ete estimes a 202,75-1029,55 dollars en Namibie et a 94,14-342,35 dollars au Rwanda. Ces couts variaient selon le protocole medicamenteux utilise. Au niveau de la couverture atteinte en 2009, les couts nationaux maximum de la PTME ont ete estimes a 3,15 millions de dollars en Namibie et a 7,04 millions de dollars au Rwanda (soit < 0,75 dollars par habitant dans les deux pays). Les conseils fournis et les tests realises par les adultes ont represente La plus grande proportion des couts nationaux (37% et 74% en Namibie et au Rwanda, respectivement), suivis du traitement medical et de la surveillance. Le traitement et la prophylaxie ont represente moins de 20% des couts de la PTME dans les deux pays etudies. Conclusion Les couts lies a la PTME du VlH ont varie considerablement d'un pays etudie a l'autre et selon les protocoles utilises. Toutefois, etant donne que les couts par habitant ont ete relativement faibles, l'intensification des services de PTME en Namibie et au Rwanda devrait etre possible. Objetivo Evaluar los costes asociados con la prestacion de servicios para la prevencion de la transmision maternofilial del virus de la inmunodeficiencia humana en dos paises africanos. Metodos En el ano 2009 se evaluaron los costes de los proveedores de atencion sanitaria que prestaban servicios completos de prevencion de la transmision maternofilial en 20 centros sanitarios publicos en Namibia y Rwanda. La informacion sobre los precios y sobre la cantidad total de cada servicio prestado se recogio a nivel nacional. Los costes de las pruebas y el asesoramiento materno, las pruebas para las parejas masculinas, los recuentos de linfocitos T CD4+ (celulas CD4+), el tratamiento y profilaxis antirretrovirales, las actividades comunitarias, los anticonceptivos durante 2 anos despues del parto y el diagnostico precoz de lactantes se calcularon en dolares americanos (US$). Resultados Para cada par madre-hijo, los costes estimados de los proveedores de servicios para prevenir la transmision maternofilial fueron de US$ 202,75-1029,55 en Namibia y US$ 94,14-342,35 en Rwanda. Estos costes variaron segun la terapia empleada. En los niveles de cobertura del 2009, las estimaciones maximas de los costes nacionales de la prevencion de la transmision maternofilial fueron de US$ 3,15 millones en Namibia y US$ 7,04 millones en Rwanda (o < US$ 0,75 per capita en ambos paises). Las pruebas y el asesoramiento de adultos representaron la mayor parte de los costes nacionales (37% en Namibia y 74% en Rwanda), seguidos por la gestion y la supervision. El tratamiento y la profilaxis significaron menos del 20% de los costes de la prevencion de la transmision maternofilial en ambos paises. Conclusion Los costes implicados en la prevencion de la transmision maternofilial del VlH variaron mucho entre los paises de estudio y segun los protocolos empleados. Sin embargo, puesto que los costes per capita fueron relativamente bajos, si seria posible ampliar los servicios de prevencion de la transmision maternofilial tanto en Namibia como el Rwanda., Introduction It has been estimated that 330 000 children became infected with the human immunodeficiency virus (HIV) in 2011 and that most of these children lived in sub-Saharan Africa, where [...]

Background: Operational effectiveness of large‐scale national programmes for the prevention of mother to child transmission (PMTCT) of HIV in sub‐Saharan Africa remains limited. We report on HIV‐free survival among nine‐ to 24‐month‐old children born to HIV‐positive mothers in the national PMTCT programme in Rwanda. Methods: We conducted a national representative household survey between February and May 2009. Participants were mothers who had attended antenatal care at least once during their most recent pregnancy, and whose children were aged nine to 24 months. A two‐stage stratified (geographic location of PMTCT site, maternal HIV status during pregnancy) cluster sampling was used to select mother‐infant pairs to be interviewed during household visits. Alive children born from HIV‐positive mothers (HIV‐exposed children) were tested for HIV according to routine HIV testing protocol. We calculated HIV‐free survival at nine to 24 months. We subsequently determined factors associated with mother to child transmission of HIV, child death and HIV‐free survival using logistic regression. Results: Out of 1448 HIV‐exposed children surveyed, 44 (3.0%) were reported dead by nine months of age. Of the 1340 children alive, 53 (4.0%) tested HIV positive. HIV‐free survival was estimated at 91.9% (95% confidence interval: 90.4‐93.3%) at nine to 24 months. Adjusting for maternal, child and health system factors, being a member of an association of people living with HIV (adjusted odds ratio: 0.7, 95% CI: 0.1‐0.995) improved by 30% HIV‐free survival among children, whereas the maternal use of a highly active antiretroviral therapy (HAART) regimen for PMTCT (aOR: 0.6, 95% CI: 0.3‐1.07) had a borderline effect. Conclusions: HIV‐free survival among HIV‐exposed children aged nine to 24 months is estimated at 91.9% in Rwanda. The national PMTCT programme could achieve greater impact on child survival by ensuring access to HAART for all HIV‐positive pregnant women in need, improving the quality of the programme in rural areas, and strengthening linkages with community‐based support systems, including associations of people living with HIV., Background Worldwide, 2.5 million children younger than 15 years were living with HIV in 2009, and more than 90% had been infected via mother to child transmission (MTCT) of HIV [...]

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.