Background: In the Democratic Republic of Congo, the use of Prevention of Transmission of Human Immunodeficiency Virus infection from mother to child is still very low. Objective: The objective of this study was to estimate the prevalence of infants born from HIV-positive mother in different centers in Kinshasa. Methods: This study is a retrospective cohort of at least 2 years on the records of mother-child couple followed in 8 centers of Kinshasa. Based on a sample survey form with specific criteria, some files were selected. Results: The record keeping of all centers was estimated at 70% on average; the most represe nted age group was from 26 to 35 years with 102 women (54%) out of 190. Forty-five percent (45%) of pregnant women started pre-natal consultation (CPN) in the 2nd trimester of pregnancy. All mothers had been diagnosed with 3 Rapid Diagnostic Tests (RDT). The majority of women were under: AZT 3TC NVP and CTX and 139 (73%) women were diagnosed at stage 1 of HIV infection according to WHO’s standard. One hundred new born were male. Seventy-eight newborns weighed between 2.01 and 3.00 kg at birth. Ninety seven percent of newborns were treated at birth. Ninety-one children who were on Nevirapine syrup; six of them were not put on treatment. Ninety five percent of newborns were diagnosed HIV-negative 9 months after birth by PCR; 2% of children were undiagnosed as a result of refusal and 3% of children had undetermined serology. This gives a mother-to-child transmission rate of 2% at 9 months of birth for the centers of Kinshasa. Conclusion: Despite the insufficient coverage of the PMTCT service in our community, the centers in Kinshasa respond to the PMTCT approach and the transmission rate in the 8 centers of 4 districts of Kinshasa is 2%.
Acquired Immune Deficiency Syndrome (AIDS) is a condition that causes a fall in the natural immune defenses caused by the Human Immunodeficiency Virus (HIV). Since 1981, HIV and AIDS have been a major public health problem in the world, particularly in sub-Saharan Africa [
According to the World Health Organization (WHO) in its protocol on PMTCT the adoption of a single scheme (option A) for ART in pregnant women would not be enough. The arrival of the third, option B+, would strengthen links to achieve a better result [
The present study is a 2-year retrospective cohort based on the records of mother-child pairs in 8 different centers in Kinshasa. It was composed of 309 files, of which 190 mother-child pairs were selected.
Based on a modeled survey form and on very specific criteria: 1) monitoring centers with a maternity unit organizing and offering PMTCT services for at least 2 years; 2) records of any patient up to 18 years of age, diagnosed HIV-positive at the follow-up center confirmed by at least 2 Rapid Diagnostic Tests (RDT-Determines, Unigold, and/or Double Check); with confirmation with a 3rd RDT in case of doubt according to WHO recommendation [
The record keeping in all the centers was estimated at 70% on average. It was estimated at 100% for the Maternity of Kintambo, 92% for the Mother and Child Center of Bumbu (MCCB), 82% for the Saint Gabriel Center, 79% for Pilot Maternity of Masina, 71% for the Mother and Child Center of Ngaba (MCCN), 67% for the Emerald Center, 41% for the Kasa-Vubu Trinity Center and 29% for the Binza Maternity Center. Of the 190 selected cases of HIV-positive pregnant women, the most represented age group was that of 26 to 35 years with 102 mothers (54%), followed by those of 36 to 45 with 58 mothers (31%), as shown in
Sixteen mothers (8%) started Prenatal Consultation (PNC) in the first trimester of pregnancy, 88 mothers (45%) started PNC in the second trimester of pregnancy and 50 mothers (26%) in the third trimester of pregnancy. All mothers were diagnosed with the 3 RDT according to the national program recommendations. One hundred and thirty-nine mothers (73%) were diagnosed at stage 1 of HIV infection, 45 mothers (24%) diagnosed at stage 2 and 6 mothers (3%) had been diagnosed at stage 3. All mothers were on first-line anti-retroviral drugs (ARVs). The majority of women (71%) were on AZT + 3TC + NVP plus cotrimoxazole (CTX), 13% of women on TDF + 3TC + EVP, 8% on AZT + CTX, 3% on AZT + EFV, 0.5% on AZT + FN and AZT + L each, 0.5% under B + and 0.5% had refused treatment.
For the newborns, the male gender was the most represented, with 100 boys (52%) compared to 48% girls, while at birth 78 newborns (41%) weighed between 2.01 and 3.00 kg weight, followed by those weighing between 3.01 and 4.00 kg (34%), 2% weighed between 1.00 and 2.00 kg and those weighing more than 4.00 kg were 3 (2%). One hundred eighty five newborns (97%) were being treated at birth, 49% were on Nevirapine syrup, 45% had Nevirapine syrup and CTX, and 6% under CTX only. Six children were not put on treatment. Ninety five percent of newborns born from HIV-positive mothers were diagnosed HIV negative 9 months after birth by PCR, 2% of newborns were undiagnosed as a
Characteristics | Districts | Total | |||||||||||||
---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
Funa | Lukunga | Mont Amba | Tshangu | ||||||||||||
KTC | MCCB | Sub-Total | Maternity of Binza | Maternity of Kintambo | Sub-Total | St Gabriel | MCCN | Sub-Total | Emerald | PMM | Sub-Total | ||||
Groups of age (years) | |||||||||||||||
18 - 25 | 2 | 1 | 3 | 2 | 5 | 7 | 6 | 0 | 6 | - | - | - | 16 | ||
26 - 35 | 8 | 40 | 48 | 21 | 19 | 40 | 10 | 4 | 14 | - | - | - | 102 | ||
36 - 45 | 1 | 27 | 28 | 13 | 14 | 27 | 2 | 1 | 3 | - | - | - | 58 | ||
Over 45 | 0 | 1 | 1 | 0 | 0 | 0 | 0 | 0 | 0 | - | - | - | 1 | ||
1st Prenatal consultation | |||||||||||||||
1st trimester | 1 | 3 | 4 | -- | 6 | 6 | 0 | 0 | 0 | 1 | 5 | 6 | 16 | ||
2nd trimester | 6 | 47 | 53 | -- | 19 | 19 | 8 | 3 | 11 | 0 | 5 | 5 | 88 | ||
3rd trimester | 4 | 19 | 23 | -- | 13 | 13 | 10 | 2 | 12 | 1 | 1 | 2 | 50 | ||
Methods of diagnosis (RDT) | |||||||||||||||
Determine | 11 | 69 | 80 | 36 | 38 | 74 | 18 | 5 | 23 | 2 | 11 | 13 | 190 | ||
Unigold | 11 | 69 | 80 | 36 | 38 | 74 | 18 | 5 | 23 | 1 | 11 | 12 | 189 | ||
Double check | 0 | 69 | 69 | 36 | 38 | 74 | 18 | 0 | 18 | 0 | 0 | 0 | 161 | ||
Clinical stage according to WHO’s recommendations | |||||||||||||||
Stage 1 | 4 | 67 | 71 | 27 | 19 | 46 | 17 | 3 | 20 | 2 | 0 | 2 | 139 | ||
Stage 2 | 6 | 2 | 8 | 6 | 19 | 25 | 0 | 1 | 1 | 0 | 11 | 11 | 45 | ||
Stage 3 | 1 | 0 | 1 | 3 | 0 | 3 | 1 | 1 | 2 | 0 | 0 | 0 | 6 | ||
Stage 4 | 0 | 0 | 0 | 0 | 0 | 0 | 0 | 0 | 0 | 0 | 0 | 0 | 0 | ||
Type of ARV used | |||||||||||||||
AZT + 3TC + NVP + CTX | 8 | 57 | 65 | 27 | 18 | 45 | 14 | 1 | 15 | 0 | 10 | 10 | 135 | ||
TDF + 3TC + EFV | 0 | 12 | 12 | 1 | 5 | 6 | 0 | 4 | 4 | 2 | 0 | 2 | 24 | ||
CTX | 3 | 0 | 3 | 0 | 0 | 0 | 3 | 0 | 3 | 0 | 0 | 0 | 6 | ||
AZT + EFV | 0 | 0 | 0 | 6 | 0 | 6 | 0 | 0 | 0 | 0 | 0 | 0 | 6 | ||
ZFN/1Z 3L | 0 | 0 | 0 | 2 | 0 | 2 | 0 | 0 | 0 | 0 | 0 | 0 | 2 | ||
AZT + CTX | 0 | 0 | 0 | 0 | 15 | 15 | 0 | 0 | 0 | 0 | 0 | 0 | 15 | ||
B+ | 0 | 0 | 0 | 0 | 0 | 0 | 1 | 0 | 1 | 0 | 0 | 0 | 1 | ||
None | 0 | 0 | 0 | 0 | 0 | 0 | 0 | 0 | 0 | 0 | 1 | 1 | 1 | ||
Total per Centers | 11 | 69 | 80 | 36 | 38 | 74 | 18 | 5 | 23 | 2 | 11 | 13 | 190 | ||
KTC: Kasavubu Trinity Center, MCCB: Mother and Child Center of Bumbu, MCCN: Mother and Child Center of Ngaba, PMM: Pilote Maternity of Masina, AZT: Zidovudine, 3TC: Lamivudine, NVP: Nevirapine, CTX: Cotrimoxazole, TDF: Tenofovir, EFV: Efavirenz.
result of parental refusal and 3% of newborns had indeterminate serology for HIV.
The objective of this study was to evaluate PMTCT and to estimate the prevalence of mother-to-child transmission of HIV infection in different centers in Kinshasa. Record keeping in all centers was estimated at 70% on average; 100% for the Maternity of Kintambo, 92% for Mother and Child Center of Bumbu, 82% for Saint Gabriel center, 79% for Pilot Maternity in Masina, 71% for Mother and Child Center of Ngaba, 67% for the Emerald center, 41% for the Kasa-Vubu Trinity Center and 29% for the Binza Maternity Center. This corroborates data from the literature reported in our community that states poor record keeping in the centers [
The most represented age group was of 26 to 35 years with 102 mothers (54%). This could be explained by the fact that this age group is one that has a high sexual activity [
Sixteen mothers (8%) attended the Prenatal Clinic (PNC) in the first trimester of pregnancy, 86 mothers (45%) in the second trimester of pregnancy and 50 mothers (26%) in the third trimester of pregnancy. While 45% of mothers presented to PNC in the 2nd trimester of pregnancy, national guidelines recommend the first PNC visit during the 1st trimester of pregnancy for better medical management of pregnancy, so that women benefit from the benefits associated with options to reduce Maternal-Fetal Transmission, as they need to be aware of their HIV status and accept it for proper management [
All mothers had been diagnosed with 2 or 3 RDT (190 with Determine, 189 with Unigold and 162 with Double Check) as recommended by national guidelines [
For newborns, the male gender was more represented with more boys (52%) than girls. Contrary to the study made in Lubumbashi by Mwemba et al. who made known that the female sex was the most dominant than boys (62.5% against 37.5%) [
However, the United Nations program in charge of the AIDS (UNAIDS) stated in its progress report on the Global Plan that most of the priority countries still had a long way to go; Cameroon, Chad, Ivory Coast, the Democratic Republic of Congo and Ethiopia, which provided treatment to less than 10% of their Children Living with HIV (CLHIV) [
Ninety five percent (95%) of children born to HIV-positive mothers were diagnosed HIV negative 9 months after birth by PCR and 2% were not diagnosed as a result of their parents’ refusal. This confirms that the acceptability of this diagnosis is often low. In accordance with the panel’s recommendations that this test should be used in children under 18 months of age with perinatal exposure and at 14 to 21 days, 1 to 2 months to 4 to 6 months and 2 to 4 weeks after discontinuation of ARV prophylaxis. Bukongo NR, in his dissertation, stated that the guide to the management of HIV infection in children in the DRC recommends screening of HIV infection by PCR from 0 to 24 months and a second confirmation test by ELISA [
Despite the structural shortcomings encountered, the results obtained from this study indicate that the management of HIV-positive pregnant women in the centers of Kinshasa responds to the approach of PMTCT and that the monitoring of mother-child couples is done correctly. The vertical transmission rate is of 2%.
The authors declare that there is no conflict of interest.
Chuga, D., Bulanda, B.I., Kabasele, J.Y.D., Okonda, M.O., Bongenya, B.I. and Kamangu, E.N. (2018) Vertical Transmission Rate of HIV from Seropositive Mothers Followed in the Different Care Centers in Kinshasa from 2010 to 2015. Open Access Library Journal, 5: e4769. https://doi.org/10.4236/oalib.1104769