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

Autor: Mugwaneza P; Rwanda Biomedical Center/Institute of HIV, Disease Prevention and Control (RBC/IHDPC), KN 3 Road, Kigali, Rwanda., Lyambabaje A; School of Public Health, College of Medicine and Health Sciences, National University of Rwanda (SPH-CMHS-UR), Kigali, 5229, Rwanda., Umubyeyi A; School of Public Health, College of Medicine and Health Sciences, National University of Rwanda (SPH-CMHS-UR), Kigali, 5229, Rwanda., Humuza J; School of Public Health, College of Medicine and Health Sciences, National University of Rwanda (SPH-CMHS-UR), Kigali, 5229, Rwanda., Tsague L; UNICEF, Western and Central Africa Regional Office, Dakar, Senegal., Mwanyumba F; UNICEF Rwanda, Boulevard de l'Umunganda, Kacyiru, Kigali, Rwanda., Mutabazi V; Rwanda Biomedical Center/Institute of HIV, Disease Prevention and Control (RBC/IHDPC), KN 3 Road, Kigali, Rwanda., Nsanzimana S; Rwanda Biomedical Center/Institute of HIV, Disease Prevention and Control (RBC/IHDPC), KN 3 Road, Kigali, Rwanda., Ribakare M; Rwanda Biomedical Center/Institute of HIV, Disease Prevention and Control (RBC/IHDPC), KN 3 Road, Kigali, Rwanda., Irakoze A; Rwanda Biomedical Center/Institute of HIV, Disease Prevention and Control (RBC/IHDPC), KN 3 Road, Kigali, Rwanda., Mutaganzwa E; National Reference Laboratory Rwanda, KN 3 Road, Kigali, Rwanda., Lombard C; Medical Research Council, South Africa (MRC-SA), Francie van Zyl Drive, Parow, 7505, South Africa., Jackson D; Medical Research Council, South Africa (MRC-SA), Francie van Zyl Drive, Parow, 7505, South Africa. djackson@unicef.org.; University of the Western Cape, South Africa (UWC-SA), PB X17 Robert Sobukwe Road, Bellville, 7535, South Africa. djackson@unicef.org.; UNICEF, New York, 3 UN Plaza, New York, NY, 10017, USA. djackson@unicef.org.
Jazyk: angličtina
Zdroj: BMC public health [BMC Public Health] 2018 Nov 12; Vol. 18 (1), pp. 1248. Date of Electronic Publication: 2018 Nov 12.
DOI: 10.1186/s12889-018-6154-6
Abstrakt: 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.
Databáze: MEDLINE
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