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©The Author(s) 2025. Published by Baishideng Publishing Group Inc. All rights reserved.
Sustained maternal human immunodeficiency virus viral load suppression and cascade of human immunodeficiency virus testing among exposed infants in Rwanda
Hafidha Mhando Bakari, Jackson Sebeza, Haji Mbwana Ally, Hassan Fredrick Fussi, Habib Omari Ramadhani, Peter Memiah, Djemima Umutesi, Basile Ikuzo, Gallican Rwibasira
Hafidha Mhando Bakari, Department of Literature, Communication and Publishing, University of Dar es Salaam, Dar es Salaam 35091, Tanzania
Jackson Sebeza, School of Public Health, College of Medicine and Health Sciences, University of Rwanda, Kigali 4285, Rwanda
Haji Mbwana Ally, Department of Medicine, Kilimanjaro Christian Medical Center, Moshi 3010, Kilimanjaro, Tanzania
Hassan Fredrick Fussi, Department of Medicine, District Hospital, Dar es Salaam 35091, Tanzania
Habib Omari Ramadhani, Department of Medicine, Institute of Human Virology, University of Maryland School of Medicine, Baltimore, MD 21201, United States
Peter Memiah, Department of Global Health, Graduate School, University of Maryland, Baltimore, MD 21201, United States
Djemima Umutesi, Basile Ikuzo, Gallican Rwibasira, Division of Human Immunodeficiency Virus, Rwanda Biomedical Center, Institute of Human Immunodeficiency Virus Disease Prevention and Control, Kigali 4285, Rwanda
Author contributions: Bakari HM wrote the original draft; Bakari HM and Sebeza J designed the study; Sebeza J was responsible for overall data collection; Ally HM, Fussi HF, and Ramadhani HO were responsible for developing the methodology participated in the formal analysis and investigation; Bakari HM, Sebeza J, Ally HM, Fussi HF, Ramadhani HO, Memiah P, Umutesi D, Ikuzo B, and Rwibasira G participated in the review and editing; all of the authors read and approved the final version of the manuscript to be published.
Institutional review board statement: Ethical approval for this study was granted by Rwanda National Ethics Committee (RNEC) with ethical approval registration number, No. 104/RNEC/2022.
Informed consent statement: This was a retrospective review of routinely collected clinical data. No consent was sought.
Conflict-of-interest statement: All the authors report no relevant conflicts of interest for this article.
STROBE statement: The authors have read the STROBE Statement—checklist of items, and the manuscript was prepared and revised according to the STROBE Statement—checklist of items.
Data sharing statement: Consent to share data was not obtained but the presented data were anonymized, and risk of identification is low.
Open Access: This article is an open-access article that was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution NonCommercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See:
https://creativecommons.org/Licenses/by-nc/4.0/ Corresponding author: Jackson Sebeza, MD, MPH, School of Public Health, College of Medicine and Health Sciences, University of Rwanda, KK 737 Street, Kigali 4285, Rwanda.
gallican.rwibasira@rbc.gov.rw
Received: March 20, 2025
Revised: April 13, 2025
Accepted: May 18, 2025
Published online: June 25, 2025
Processing time: 95 Days and 3.6 Hours
BACKGROUND
To prevent mother to child transmission (MTCT) of human immunodeficiency virus (HIV), sustained maternal viral load suppression (VLS) and early HIV testing among HIV exposed infants (HEI) is critical.
AIM
To investigate maternal viral load results and infant HIV testing uptake at 6–weeks, and 9–months and 18–months in Rwanda.
METHODS
Between 2015 and 2022, VLS (< 200 copies/mL) was measured among pregnant women living with HIV (WLHIV) from 38–healthcare facilities. Viral loads (VL) were measured at 6–months, 12–months and 24–months, respectively. For maternal VL, the unit of analysis was visit–pair, and the pairs were created to define those with VL < 200 copies/mL at two consecutive visits as having sustained VLS, persistent viremia (VL ≥ 200 copies/mL at two consecutive visits), viral rebound (VL < 200 copies/mL at prior visit only) and newly suppressed (VL < 200 copies/mL at subsequent visit only). HEI were considered to have persistent HIV testing if they had all three HIV tests. Poisson regression models with generalized estimating equations were used to estimate the adjusted incidence rate ratio (aIRR) and 95%CI for factors associated with sustained VLS and persistent HIV testing.
RESULTS
A total of 1145 mother-infant pairs were analyzed. Infant HIV testing uptake at 6– weeks, 9–months and 18–months was 1145 (100.0%), 1089 (95.1%), 1006 (87.9%) respectively. Nine hundred ninety–nine HEI (87.3%) tested for HIV persistently. At 18–months, the incidence of HIV among HEI was 8 (0.7%). Of 1145 mothers, 1076 (94.0%) had ≥ 2 VL results making a total of 2010 visit–pairs (142–single; 934–double visit–pairs). The incidence rate of sustained VLS, persistent viremia, viral rebound and new suppression were 91.0%, 1.3%, 3.6% and 4.0% respectively. Maternal disclosure of HIV status (aIRR = 1.08, 95%CI: 1.02–1.14) was associated with increased likelihood of sustained VLS. Having peer support (aIRR = 1.05 95%CI: 1.01–1.10) was associated with persistent HIV testing among HEI.
CONCLUSION
Sustained VLS is high among pregnant WLHIV in Rwanda. The low incidence of HIV among HEI may be attributed to high VLS levels. Targeted interventions, including enhanced HIV disclosure and peer support, are crucial for improving sustained VLS and increasing infant HIV testing uptake to reduce MTCT.
Core Tip: Sustained maternal viral load suppression (VLS) is a key component for prevention of mother to child transmission of human immunodeficiency virus (HIV). We explored maternal viral load results, infant HIV testing uptake at 6–weeks, 9-months and 18–months and HIV infant HIV incidence in Rwanda. Of 1145 mothers, the incidence of sustained VLS was 91%. Infant HIV testing uptake at 6–weeks, 9–months and 18–months was 100.0%, 95.1% and 87.9%, respectively. Only 0.7% of infant were diagnosed with HIV at 18 months. Maternal disclosure of HIV status and having peer support were associated with increased likelihood of sustained VLS and infant HIV testing, respectively. High maternal VLS was critical to minimize HIV infection among HIV-exposed infants in this cohort.
