The document outlines the opportunities and challenges to adherence in prevention of mother-to-child transmission (PMTCT) programs in Rwanda. It describes the follow-up procedures for PMTCT women in the ante-partum, intra-partum, and post-partum periods. It also outlines the follow-up procedures for PMTCT infants in the intra-partum and post-partum periods. Lastly, it identifies opportunities such as the large proportion of clients tested for HIV and availability of CD4 count machines, and challenges such as the number of visits required and lack of reporting on refills and CD4 count indicators.

1. Some Opportunities and Challenges to Adherence in PMTCT Fabienne Shumbusho, Family Health International Kigali, 19 October 2009

3. Follow-up of PMTCT Women in Ante-Partum Period Not eligible to triple therapy ? ? ? ? Lab exams Every 2 weeks for 1 month Delivery at facility Labour & delivery Every 3-6 months CD4 control Refills for ART prophylaxis Monthly Start of AZT ≥ 28 weeks pregnancy Result CD4 count test (CD4 > 350/mm 3 ) Week 2-3 Sample for CD4 Week 1 HIV test Hg RPR test 1 st contact (t 0 )

4. Follow-up of PMTCT Women in Intra & Post-Partum Period ? ? Every 3-6 months CD4 control Cotrimoxazole prophylaxis refills ART (if on txt) Each 4 weeks (monthly) AZT/3TC After delivery: for 7 days AZT/3TC/NVP During labour

5. Follow-up of PMTCT Infants in Intra & Post-Partum Period ? ? ? Cotrimoxazole prophylaxis refills Each 4 weeks (monthly) Result DBS/PCR +/- 10 weeks and over Immunization DBS/PCR Cotrimoxazole prophylaxis 6 weeks NVP SD at birth and AZT (>90%) Delivery up to 4 weeks