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

Abstract

BackgroundIn 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.MethodsA 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).ResultsThe 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.ConclusionART 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.

Prevalence of vertical HIV infection and its risk factors among HIV exposed infants in East Africa: a systematic review and meta-analysis

“…Articles done both on cohort and cross-sectional study designs were incorporated in this study. The peak prevalence (32.1%) of MTCT of HIV was found from a study done in Ethiopia [ 28 ], while the lowest magnitude (1.58%) was found in Rwanda [ 36 ]. A total of nine countries and 33 studies were included in this systematic review and meta-analysis.…”

“…A total of nine countries and 33 studies were included in this systematic review and meta-analysis. Of this, sixteen studies were from Ethiopia (5-11, 21-24, 26-28, 37, 38 ), five studies were from Kenya [ 12 , 15 , 20 ], three studies were from Tanzania [ 13 , 16 ], three studies were from Uganda [ 14 , 18 , 19 , 31 ], two studies were from Zimbabwe [ 33 , 34 ], and the remaining one study was from Eritrea [ 19 ], South Sudan [ 32 ], Malawi [ 35 ], and Rewanda [ 36 ]. In this review, eighteen studies were cross-sectional study designs while fifteen studies were cohorts (Table 1 ).…”

24‐Month HIV‐free survival among HIV‐exposed Infants in Lesotho: the PEAWIL cohort study

“…Several studies conducted within sub-Saharan Africa have assessed HIV-free survival up to six weeks of infant age [9][10][11]13]. Outcomes at six weeks of infant age reflect the transmission that occurs during pregnancy and the peripartum period but fail to show the outcomes of continued HIV exposure that occurs during the breastfeeding period.…”

Ordinal Regression Modeling of Mother to Infant HIV Transmission in Nyeri County, Kenya

“…Fondoh et al (2017) used the multivariate logistic regression in their study to determine the predictors of mother to child HIV transmissions in Bamenda Regional Hospital [3]. Mugwenza et al (2018) used the Binary Logistic Regression to determine the predictors of HIV transmission [9]. Izudi et al (2018) used the Multivariable logistic regression to determine the factors that were independently associated with mother to child transmission of HIV [13] while Obsa et al (2018) used the Binary logistic regression [8].…”

“…It is assumed that there is a negative association between breast milk HIV shedding and use of combined oral contraceptives and thus the need for further studies on the same [13]. Further proposals are on the use of replacement feeding methods by lactating mothers so as to reduce the potential risk of HIV transmission [7,9,11].…”