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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

Abstract

Background

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).

Methods

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.

Results

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).

Conclusion

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.

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