The Prevention of Mother to Child Transmission (MTCT) programme in Mahama Refugee Camp has achieved near‑zero mother‑to‑child HIV transmission—only one case in eight years—thanks to accessible care and strong community health workers support, though funding cuts threaten these gains.
Jacky*'s Journey Toward Hope
Faced with the uncertainty of her own future and that of her unborn child in a completely new environment, Jacky*, a 38-year old mother of two, felt overwhelmed. “When I arrived at the camp, I didn’t have the courage to seek support. I feared my neighbours would find out and label me ‘the woman with AIDS’. I also wasn’t sure how I would be received at the clinic,” she recalls.
Upon arrival, Jacky received information about the camp and its services, including the mandatory health screening conducted for all new arrivals. The process stirred painful memories, reminding her of the trauma she had endured before fleeing her home. Starting life over in Mahama Refugee Camp was both a challenge and a turning point. She reconnected with extended family members and acquaintances who had settled earlier, yet she longed for anonymity, hoping no one would discover her past or suspect her HIV status. Despite limited food rations, she held on to the hope of rebuilding her life and finding a source of income.
HIV remains one of the most highly stigmatized health conditions. Despite ongoing community education, many still associate an HIV positive diagnosis with hopelessness and death. It is equally challenging to change perceptions and help people understand that a mother living with HIV can give birth to an HIV free child and the latter remains safe during breastfeeding period.
The PMTCT Programme: A Lifeline for Mothers and Newborns
Jacky* is one of 31 mothers currently enrolled in the Prevention of Mother to Child Transmission (PMTCT) programme inititiated by Save the Children at Mahama Health Clinic in the Refugee Camp since 2017. She arrived in the camp in 2016, fleeing insecurity in the neighbouring Democratic Republic of Congo. At the time, she was pregnant and had recently learned she was HIV positive.
Before the programme was established, mothers had to travel more than 70 kilometres to Kirehe District Hospital to access essential PMTCT services, including HIV testing, clinical check-ups, and treatment. These long and challenging journeys often caused delays in care. As a result, some women could give birth at home, increasing the risk of HIV transmission to their infants.
At the time, the HIV infection rate among mothers seeking prenatal and postnatal care was 1.1%. The introduction of the PMTCT programme transformed this landscape by providing systematic HIV screening for pregnant and lactating women, along with targeted education sessions during antenatal visits. Couples were encouraged to test together, support one another, and follow treatment protocols to protect their newborns from HIV. In collaboration with partners, the clinic also conducted regular community awareness campaigns to promote HIV prevention and encourage positive behavioural change.
“The health workers kept mentoring me, and I eventually changed my mind. Community health workers visit me at home, teach me how to care for myself and my child, and remind me to maintain a balanced diet. They also ensure I never miss my medication and encourage me to report to the clinic immediately if my son or I feel unwell,” Jacky* shared.
Progress and Impact
Today, HIV prevalence in Mahama Refugee Camp has been stabilised at 1%, slightly lower than the national rate of 3%. Women—particularly sex workers, adolescents, and mobile populations—remain the most at risk of infection.
Since the PMTCT programme began, only one case of mother to child transmission has been recorded in eight years. This remarkable success is attributed to early HIV testing for couples, systematic antenatal screening, consistent follow up for HIV exposed infants from birth to 24 months, and Early Infant Diagnosis (EID). Additional support includes routine growth monitoring, immunization, and timely HIV testing at recommended intervals. Immediate initiation of antiretroviral therapy for HIV positive mothers, paired with regular follow ups by clinic staff and community health workers, has also been critical.
In addition to medical care and counselling, pregnant and lactating women—as well as infants at risk of malnutrition—are enrolled in a supplementary feeding programme to ensure proper nutrition and further reduce vulnerability.
Regular community campaigns have also helped discourage traditional practices that pose health risks—such as using unsterile tools to cut umbilical cords (“gukura uburo”) or burning wounds (“kwotsa”) as a form of treatment. One of these practices was linked to the only reported HIV transmission case in 2025.
“Mahama Refugee Camp hosts Burundian and Congolese communities, many of whom had limited prior exposure to HIV/AIDS information. Coming from rural areas with strong traditional norms and beliefs, some patients used to arrive at the clinic in critical condition. Today, thanks to intensive education efforts, more couples seek reproductive health services together,” noted Jeanne Pauline Ingabire, Nurse in Charge of HIV at Mahama Health Centre.
Vital Role of Community Health Workers — and Emerging Challenges
Rwanda’s national Community Health Worker (CHW) programme, launched in 1995, relies on trained village level volunteers who provide health education, promote positive behaviour change, and mobilize families to seek essential care, particularly for maternal and child health. Nationally, 98% of pregnant women living with HIV receive care, and over 96% of newborns are placed on preventive antiretroviral treatment—results made possible in large part through active CHW engagement.
In Mahama Refugee Camp, these volunteers regularly visit clients in their neighbourhoods, offering continuous support and reporting back to the clinic for follow up actions. Building on these successful outcomes, Save the Children has expanded the PMTCT programme to Nyabiheke Refugee Camp and Nkamira Transit Centre.
Despite these achievements, the programme faces significant challenges due to funding cuts. Sustaining health promotion activities and maintaining clinic capacity are essential to safeguarding the progress made. Continued community education remains vital to eliminating harmful practices and ensuring safe maternal and child health—especially as most risks arise when women give birth at home without skilled assistance.
“My younger son and I are healthy. Whenever we feel unwell, we go to the clinic and receive care. The staff is attentive and very keen on supporting us. My son is safe despite the difficult life we lead in the camp,” Jacky* concluded.
