Submission ID 118250
| Issue/Objective | In Rwanda, HIV negative pregnant and breastfeeding women require routine HIV retesting as part of elimination of mother-to-child transmission (EMTCT). Pregnant women attending antenatal are retested during these visits. After delivery, however, postnatal mothers often elude HIV retesting. In such settings, maternal postpartum HIV acquisition contributes to a significant proportion of infants with HIV. Pre-exposure prophylaxis (PrEP) is a safe and effective prevention strategy to reduce women's risk of HIV in pregnancy and postpartum. We will describe and assess the utility of PrEP in averting seroconversion among infants born from breastfeeding mothers testing HIV negative at delivery in Eastern Province, Rwanda. |
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| Methodology/Approach | This retrospective review utilized 2021 program data from SmartCare. The data included counts of HIV negative breastfeeding women (BFW) which we categorized into two subgroups: those receiving PrEP and those not receiving PrEP. Descriptive statistics were used to summarize the demographic characteristics of the BFW and the mother-infant HIV status outcomes at 24 months postnatal. Chi-square test was employed to assess differences in the mother-infant HIV status outcomes between the two subgroups. Statistical significance was set at p<0.05. |
| Results | In December 2021, 261 (27%) BFW were receiving PrEP, while 704 (73%) were not. Among the PrEP cohort, 95% had status outcomes, of which 98.8% were negative. All children (100%) from the 2 BFW who seroconverted remained HIV negative. From the no PrEP cohort, 86% had documented outcomes. 4% (24) had a seropositive outcome, of whom 21% had a concordant maternal-infant serostatus. Maternal seroconversion was significantly lower among the PrEP cohort at 0.8%, compared to those not on PrEP (4%) (p< 0.001). Similarly, infant seroconversion was not observed in the infants of seroconverted mothers from the PrEP cohort, but was significant (21%) among infants from mothers who seroconverted and not receiving PrEP (p< 0.001). |
| Discussion/Conclusion | Though only 27% of PBW during the review period were receiving PrEP, this analysis shows low postnatal maternal incident HIV and vertical transmission outcomes. In contrast, unfavourable HIV serostatus outcomes persisted among BFW not receiving PrEP and their infants. These findings underscore the critical role of PrEP services in complementing other interventions to optimize EMTCT efforts |
| Presenters and affiliations | Munana Steven Centre for Impact, Innovation and Capacity building for Health Information Systems and Nutrition (CIIC-HIN), Kigali, Rwanda uwase Nkusi Diana society for Family Health (SFH), Kigali, Rwanda |
