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Prevention of mother-to-child transmission of HIV---13 2

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Academic year: 2021

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Acknowledgements---2

Table of contents---3

Abbreviations---5

Tables & figures---6

Abstract---8

Résumé (Français) ---9

1. Background---11

1.1. HIV infection epidemic---12

1.2. Prevention of mother-to-child transmission of HIV---13

2. Hypotheses & Objectives---15

2.1. Research question---15

2.2. Hypotheses---16

2.3. Objectives---18

3. Methods---19

3.1. Systematic review of health care systems strengthening and coverage Maternal health services in Rwanda---19

3.2. Prospective cohort study in Muhima health centre---20

3.3. Ethical considerations---21

3.4. Study funding---21

4. Results & Discussion---24

4.1. Impact of health systems strengthening on coverage of maternal health services in Rwanda (2000-2010) ---24

4.2. Incidence & socio-economic, clinical and biological risk factors for mother-to-child transmission of HIV-1---49

4.3. Implementing primary health care –based PMTCT interventions: Operational perspectives from Muhima cohort analysis---79

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4.4. Links between the three papers---105

5. Conclusions, Implications & Recommendations---107

References References Background/Hypotheses/Objectives & Methods---22

References paper 1---44

References paper 2---72

References paper 3---98

Appendix A: Data collection form---111

Appendix B: Consent form---119

Appendix C: Publications---122

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LIST OF TABLES

Table1b: Rwanda maternal-newborn health and family planning:

major policy events, 1999–2010---26 Table2b: Studies reviewed on the impact of health systems strengthening

on coverage of maternal health services in Rwanda. ---32 Table3b: Levels of coverage (% of women surveyed) for four maternal health indicators, DHS data, 2000, 2005, 2010, Rwanda. ---36 Table1c: Background characteristics of mothers and infants meeting inclusion criteria in the study. Muhima health centre cohort, Kigali/Rwanda, 2007 – 2010---58 Table2c: Univariate analysis of factors associated with mother-to-child transmission of HIV-1 at 6 weeks and at 6 months of life. Muhima health centre cohort,

Kigali/Rwanda, 2007 – 2010. ---62

Table3c: Multivariable logistic regression analysis of risk factors associated with mother-to- child transmission of HIV at 6 weeks and at 6 months of life.

Muhima health centre cohort, Kigali/Rwanda, 2007 – 2010---64

Table1d: Background characteristics of mothers meeting inclusion criteria

in the Muhima cohort study---87

Table2d. Univariate analysis of PMTCT service use–related coverage indicators by infant HIV-1 status at 6 weeks of life among participants in Muhima cohort study---90 Table3d. Multivariate analysis of PMTCT service use–related indicators of MTCT of HIV-1 at 6 weeks of life---91

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LIST OF FIGURES

Figure1a: Conceptual model for socio-economic, clinical and biological risk factors for mother – to – child transmission of HIV-1---18 Figure1b: Trends in selected maternal health indicators, 2000–2010---37 Figure1c: Muhima health centre cohort profile: Mothers and infants meeting

inclusion criteria in the study. Kigali/Rwanda, 2007-2010---60 Figure2c: Path diagram for mediation effect of HIV status disclosure.

Mothers and infants meeting inclusion criteria in the study.

Muhima health centre cohort, Kigali/Rwanda, 2007-2010---66

Figure1d: Muhima study cohort profile - infants at 6 weeks of life,

2007 – 2010 (Rwanda) ---89

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