Prevention of mother-to-child HIV transmission in Rwanda: a multi-perspective qualitative investigation of barriers and facilitators to retention in HIV care

Improving access and retention in programs aimed at reducing the transmission of HIV from mothers to children is a key focus area for HIV care and prevention. Despite these efforts, retention in the prevention of mother-to-child transmission (PMTCT) programming in Rwanda is suboptimal. This study gathered nuanced information on the experiences of patients and providers of PMTCT services to identify strategies for improving retention. 25 interviews were conducted across 14 health facilities in Rwanda. The data were analyzed using a thematic analysis. Both patients and providers described resource deficiencies that impeded their ability to attend or provide optimal PMTCT services. Specifically, patients described struggling with poverty (e.g., ensuring access to food and shelter), let alone covering transportation fees to attend PMTCT appointments. Providers described not having enough space or personnel to attend to patients. They also described the absence of the required equipment and medications. Participants also identified facilitators of patient retention in PMTCT services, including acceptance of HIV status, knowledge of PMTCT services, and social support. These findings highlight the persistence of known barriers to the successful implementation of PMTCT services, suggesting that new strategies are needed to address the context-specific challenges experienced by patients and providers in Rwanda.