Three decades since the first HIV-1 infected patients in Rwanda were identified (1983), the Acquired Immunodeficiency Syndrome (AIDS) epidemic has had a devastating history and is still a major public health challenge in country [1, 2].
At the end of 2010, an estimated 34 million people [31.6 million-35.2 million] were living with HIV worldwide, up 17% from 2001. The proportion of women among people living with HIV has remained stable at 50% globally, but they are more affected in Sub-Saharan Africa (59% of all people living with HIV). Mother-to-child transmission of HIV remains the primary mode of child contamination during pregnancy, childbirth or breastfeeding. It is estimated that every day there are over 1,000 new HIV infections in children, with vast majority occurring in Sub-Saharan Africa. Nearly 370,000 [230,000 - 510,000] children were infected with HIV through mother- to- child transmission globally in 2009. The scaling up of effective interventions for the prevention of HIV transmission from mother- to- child (PMTCT) is still limited because of inadequate access to antenatal and postnatal services, particularly in developing countries .
With a population of 10.4 million (2010), of whom majority are female (52%), young (67% have less than 25 years) and living in rural areas (83%), Rwanda faces enormous challenges of political, social, economic, health development, and particularly those relating to the consequences of the 1994 genocide. Its gross domestic product is estimated at USD 540 $/capita (2010), with a high level of poverty (56.9% below the poverty line, 2005) . HIV trend from Rwanda Demographic and Health surveys data shows that adult HIV prevalence has remained unchanged from 2005 to 2010. Estimated nationally at 3%, 4% in women and 2% in men, it is 8.7% in urban areas and 2.8% in rural areas (2010) .
The programme for prevention of mother-to-child transmission of HIV-1 was put in place in 1999, with a goal of reducing the incidence of new HIV infections among children born to HIV positive mothers, with the use of antiretroviral medicines [6, 7]. The package of PMTCT services provided during the study period (2007–2010) included antenatal care with testing and counseling; essential obstetric and neonatal care; triple therapy and dual therapy ARV respectively for HIV-positive mothers and infants; as well as family planning . Country’s commitments, towards eliminating new HIV infections among children by 2015 and keeping their mothers alive, are in line with the global plan launched by the UN Secretary General in 2011. The following specific targets were defined at global level: overall transmission rate < 5% at the population level (<2% in the absence of breastfeeding or measured at 6 weeks) and the reduction of new pediatric HIV infections by 90% from the estimated baseline .
In developed countries, the rate of HIV transmission from the mother to the child has been significantly reduced to 1%, through the use of antiretroviral triple therapy for HIV-infected mother, caesarean delivery and formula feeding for the child. In Rwanda, the mother-to-child transmission of HIV-1 before the era of antiretroviral medicines, has affected more than one in four children (25.7%) born to HIV-1 positive mothers .
During the decade of 2000s, the use of antiretroviral drugs allowed for significant advance in the reduction of HIV mother-to-child transmission. However, feeding practices for exposed children still represent a major challenge for populations with breastfeeding as the only feeding alternative for child survival. Nearly all Rwandan children are breastfed through the first year of life, with about 70% of them receiving complementary foods by age of 6 to 9 months .
Several studies support the role of socioeconomic, clinical and biological risk factors for HIV-1 transmission [8–12]. Based on this background, we initiated this study to assess the role of socioeconomic, clinical and biological factors in mother-to-child transmission of HIV-1 at Muhima health centre (Kigali/Rwanda), where this type of study has never been conducted. The site of the study includes Muhima health centre & hospital, located in the district of Nyarugenge (Kigali), with a population of about 287,529 inhabitants (2010).
This study is specifically expected to allow for better understanding of risk factors, likely to limit the effectiveness of the national strategy for elimination of mother-to-child transmission of HIV-1. The knowledge generated from this study in Muhima will guide the national evidence-based response towards a multisectoral approach, with both more effective health interventions and specific socioeconomic strategies to address the HIV pandemic in Rwanda [1, 9, 13].