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Socio-economic, clinical and biological risk factors for mother - to – child transmission of HIV-1 in Muhima health centre (Rwanda): a prospective cohort study

Maurice Bucagu1*, Jean de Dieu Bizimana2, John Muganda3 and Claire Perrine Humblet4

Author Affiliations

1 World Health Organization Department of Maternal, Newborn, Child and Adolescent Health, 20, Avenue Appia, CH – 1211, Geneva 27, Switzerland

2 CAMRIS International, 6931 Arlington Road, Suite 575, Bethesda, MD 20814, USA

3 Department of Obstetrics & Gynecology, Rwanda Biomedical Center/ King Faisal Hospital, P.O. Box 2534, Kigali, Rwanda

4 Université Libre de Bruxelles/Ecole de Santé Publique, Route de Lennik 808, 1070, Bruxelles, Belgium

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Archives of Public Health 2013, 71:4  doi:10.1186/0778-7367-71-4

Published: 28 February 2013



Three decades since the first HIV-1 infected patients in Rwanda were identified in 1983; the Acquired Immunodeficiency Syndrome epidemic has had a devastating history and is still a major public health challenge in the country. This study was aimed at assessing socioeconomic, clinical and biological risk factors for mother – to – child transmission of HIV- in Muhima health centre (Kigali/Rwanda).


The prospective cohort study was conducted at Muhima Health centre (Kigali/Rwanda).

During the study period (May 2007 – April 2010), of 8,669 pregnant women who attended antenatal visits and screened for HIV-1, 736 tested HIV-1 positive and among them 700 were eligible study participants. Hemoglobin, CD4 count and viral load tests were performed for participant mothers and HIV-1 testing using DNA PCR technique for infants.

Follow up data for eligible mother-infant pairs were obtained from women themselves and log books in Muhima health centre and maternity, using a structured questionnaire.

Predictors of mother-to-child transmission of HIV-1 were assessed by multivariable logistic regression analysis.


Among the 679 exposed and followed-up infants, HIV-1 status was significantly associated with disclosure of HIV status to partner both at 6 weeks of age (non-disclosure of HIV status, adjusted odds ratio [AOR] 4.68, CI 1.39 to 15.77, p < 0.05; compared to disclosure) and at 6 months of age (non-disclosure of HIV status, AOR, 3.41, CI 1.09 to 10.65, p < 0.05, compared to disclosure).

A significant association between mother’s viral load (HIV-1 RNA) and infant HIV-1 status was found both at 6 weeks of age (> = 1000 copies/ml, AOR 7.30, CI 2.65 to 20.08, p < 0.01, compared to <1000 copies/ml) and at 6 months of age (> = 1000 copies/ml, AOR 4.60, CI 1.84 to 11.49, p < 0.01, compared to <1000 copies/ml).


In this study, the most relevant factors independently associated with increased risk of mother – to – child transmission of HIV-1 included non-disclosure of HIV status to partner and high HIV-1 RNA. Members of this cohort also showed socioeconomic inequalities, with unmarried status carrying higher risk of undisclosed HIV status. The monitoring of maternal HIV-1 RNA level might be considered as a routinely used test to assess the risk of transmission with the goal of achieving viral suppression as critical for elimination of pediatric HIV, particularly in breastfeeding populations.

Socioeconomic, Clinical and biological risk factors; HIV-1; Mother - to – child transmission; Cohort; Muhima/Rwanda