Impact of maternal ART on mother-to-child transmission (MTCT) of HIV at six weeks postpartum in Rwanda
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Date
2018
Journal Title
Journal ISSN
Volume Title
Publisher
BMC
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-childtransmission
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 sociodemographic
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.
Description
Keywords
EMTCT, HIV, Operational effectiveness, Sentinel survey, Rwanda, MTCT, EMTCT surveillance, Maternal ART
Citation
Mugwaneza, P. et al. (2018). Impact of maternal ART on mother-to-child transmission (MTCT) of HIV at six weeks postpartum in Rwanda. BMC Public Health, 18: 1248