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. 2018 Nov 12;18(1):1248.
doi: 10.1186/s12889-018-6154-6.

Impact of maternal ART on mother-to-child transmission (MTCT) of HIV at six weeks postpartum in Rwanda

Placidie Mugwaneza  1 , Alexandre Lyambabaje  2 , Aline Umubyeyi  2 , James Humuza  2 , Landry Tsague  3 , Fabian Mwanyumba  4 , Vincent Mutabazi  1 , Sabin Nsanzimana  1 , Muhayimpundu Ribakare  1 , Ange Irakoze  1 , Emmanuel Mutaganzwa  5 , Carl Lombard  6 , Debra Jackson  7   8   9
Affiliations

Impact of maternal ART on mother-to-child transmission (MTCT) of HIV at six weeks postpartum in Rwanda

Placidie Mugwaneza et al. BMC Public Health. .

Abstract

Background: In 2010, Rwanda adopted ART for prevention of mother to child transmission of HIV from pregnant women living with HIV during pregnancy and breasfeeding period. This study examines rates of mother-to-child-transmission of HIV at 6-10 weeks postpartum and risk factors for mother-to-child transmission of HIV (MTCT) among HIV infected women on ART during pregnancy and breastfeeding.

Methods: A cross-sectional survey study was conducted between July 2011-June 2012 among HIV-exposed infants aged 6-10 weeks and their mothers/caregivers. Stratified multi-stage, probability proportional to size and systematic sampling to select a national representative sample of clients. Consenting mothers/caregivers were interviewed on demographic and program interventions. Dry blood spots from HIV-exposed infants were collected for HIV testing using DNA PCR technique. Results are weighted for sample realization. Univariable analysis of socio-demographic and programmatic determinants of early mother-to-child transmission of HIV was conducted. Variables were retained for final multivariable models if they were either at least of marginal significance (p-value < 0.10) or played a confounding role (the variable had a noticeable impact > 10% change on the effect estimate).

Results: The study sample was 1639 infants with HIV test results. Twenty-six infants were diagnosed HIV-positive translating to a weighted MTCT estimate of 1.58% (95% CI 1.05-2.37%). Coverage of most elimination of MTCT (EMTCT) program interventions, was above 80, and 90.4% of mother-infant pairs received antiretroviral treatment or prophylaxis. Maternal ART and infant antiretroviral prophylaxis (OR 0.01; 95%CI 0.001-0.17) and maternal age older than 25 years were significantly protective (OR 0.33; 95%CI 0.14-0.78). No disclosure of HIV status, not testing for syphilis during pregnancy and preterm birth were significant risk factors for MTCT. Factors suggesting higher socio-demographic status (flush toilet, mother self-employed) were borderline risk factors for MTCT.

Conclusion: ART for all women during pregnancy and breastfeeding was associated with the estimated low MTCT rate of 1.58%. Mothers who did not receive a full package of anti-retroviral therapy according to the Rwanda EMTCT protocol, and young and single mothers were at higher risk of MTCT and should be targeted for support in preventing HIV infection.

Keywords: 6 weeks vertical transmission rate; EMTCT; EMTCT surveillance; MTCT; Maternal ART; Operational effectiveness; Rwanda; Sentinel survey.

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Conflict of interest statement

Ethics approval and consent to participate

This research involved human subjects was performed in accordance with the Declaration of Helsinki. The study was approved by the National Institute of Statistics of Rwanda and by Rwanda National Ethics Committee. All participant mothers/caregivers signed a written informed consent and were assured of no repercussions should they wish not to participate or to withdraw at any time for any reason.

Consent for publication

Not Applicable.

Competing interests

The authors declare that they have no competing interest.

Publisher’s Note

Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.

Figures

Fig. 1
Fig. 1
Testing and Enrollment Algorithm
Fig. 2
Fig. 2
Study Profile
Fig. 3
Fig. 3
Rwanda Elimination of Mother to Child Transmission Programme (EMTCT) Cascade
See this image and copyright information in PMC

References

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    1. WHO and UNAIDS and UNICEF, Global HIV/AIDS response: Epidemic update and health sector progress towards universal access: progress report 2011. Geneva: WHO 2011. http://apps.who.int/iris/bitstream/handle/10665/44787/9789241502986_eng..... [Accessed 16 July 2018].
    1. UNAIDS . Global plan towards the elimination of new HIV infections among children by 2015 and keeping their mothers alive 2011. Geneva: UNAIDS; 2011. - PubMed
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    1. UNAIDS . Country fact sheets Rwanda. 2016.

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