The transmission of HIV from a HIV-positive mother to her child during pregnancy, labour, delivery or breastfeeding is called mother-to-child transmission. In the absence of any intervention, transmission rates range from 15% to 45%. This rate can be reduced to below 5% with effective interventions during the periods of pregnancy, labour, delivery and breastfeeding 1.

Worldwide, Acquired Immunodeficiency Syndrome (AIDS) accounts for three per cent of deaths in children under five years of age, and six per cent of those in sub-Saharan Africa, where AIDS has become one of the major killers of young children. At least 1600 infants are infected with Human Immunodeficiency Virus (HIV) everyday and more than 600,000 infants are infected by the virus annually. About 90% of these infections occur in developing countries, mainly Sub-Saharan Africa 2.

The primary intervention to reduce MTCT of HIV is antiretroviral treatment for the mother and a short course of antiretroviral drugs for the baby. They also include measures to prevent HIV acquisition in the pregnant woman and appropriate breastfeeding practices. The new Sustainable Development Goals place heightened emphasis on prevention of mother-to-child transmission (PMTCT) in the context of better health for mothers and their children 1.

Most of HIV infected children were from sub-Saharan Africa and mother-to-child transmission during pregnancy, on delivery and during breastfeeding were the major route of infection. It is believed that about two thirds are infected during pregnancy and around the time of delivery, and about one third are infected through breastfeeding. Interventions have reduced MTCT of HIV to less than 2% in high income countries but this rate remains high in resource poor countries ranging between 20% and 45% 3.

In Rwanda, according to the data from Rwanda Biomedical Center, the prevalence of HIV transmission from mother to child is 1.56%. The child is infected during in utero (Trans placenta route) 5-10% due to free virus, infected cell or micro transfusion. Is also infected during delivery 10-20% by ingestion of vaginal secretion and contact with maternal blood. Then the child is infected during breastfeeding on 5-20% 4.

From 2014 up to 2017 the health facilities of Musanze District received 698 pregnant women HIV positive. Among these women, 14 children were infected with HIV infection 5. The use of Antiretroviral (ARV) drugs is one of the interventions available to prevent transmission of HIV from mother to child during pregnancy, labor and delivery and breastfeeding. ARV prophylaxis, elective caesarean section (CS) and avoidance of breastfeeding reduced risk of MTCT to less than 2 % 6.

The international recommendations on infant and young child feeding in the context of HIV had been last revised by the World Health Organization 7. Rwanda national protocol of HIV prevention when an HIV pregnant woman is well followed and was shown a good adherence on HIV treatment with Viral Lord suppression, she is supposed at 100% to have a child free from HIV infection 8.

It is recommended that when the pregnant women have been tested HIV positive, she should immediately start the ART. However some women still resisting on starting ART or poor adherence to HIV drugs due to different factors such negative health seeking behavior, lower education level, socio economic condition and cultural aspects 8. Therefore, there was a need to assess prevalence and risk factors of HIV infection among children born from HIV positive women in Musanze district of Rwanda.

The main objective of this study was to determine the Prevalence and Risk Factors of HIV Infection among Children born from HIV Positive Women in Musanze District. Mother to child transmission of HIV infection occurs when HIV positive women passes the virus to her baby during pregnancy, delivery and breastfeeding period. Of 420 children born from HIV positive mother 12 (2.9%) were HIV positive. The prevalence of HIV infections among children born from HIV positive mother in Musanze District was 2.9%.

In the research conducted by UNAID in 2017 in worldwide founded that the route of HIV infection from mother to child is during pregnancy period, delivery period and breastfeeding period. It is believed that about 2/3 are infected during pregnancy and around the time of delivery, and about 1/3 are infected through breastfeeding period.

A lower HIV prevalence among children born from HIV mother was observed in Musanze District. In contrast the higher prevalence was reported in the study conducted in Ethiopia. The study conducted in Amhara region, Ethiopia showed that the prevalence of HIV infection among HIV exposed infants was 10.1% 10. In Ethiopia an estimated 1.2 % of pregnant women are living with HIV. Consequently, one of every 3 (33.3%) children born to these women is being infected with HIV 11.

The higher prevalence as also reported in the study conducted in Zimbabwe where mother-to-child HIV transmission is between 15–25%. In Zimbabwe like any other country in sub-Saharan Africa, breastfeeding is the norm with 97% of children reported as ever breastfed 12. In Tanzania, a study showed that, the overall rate of transmission can go up to 20% if an HIV infected mother breastfeeds for 18–24 months 13. Similarly to these findings, a research conduct by Rwanda Biomedical Center in 2018 revealed that the prevalence of HIV transmission from mother to child is 1.56% 8. From 2012, the Government of Rwanda has opted for the WHO option in which all HIV positive pregnant women got engaged in ART regardless of the CD4 count. The process excluded breast feeding protected by ART and women continuing ART as a lifelong treatment. Implementation of WHO option resulted in the reduction of MTCT rate at 18 months. Recent data concluded that MTCT rate dropped to 1.8% in a cohort of exposed infants 9.

Factors such as working in private sector, maternal poor adherence to ART, advanced stage of HIV, poor ANC visits were associated with HIV infection among mothers born from HIV positive mothers.

Rwanda Government continue to work together with partners to ensure full implementation of national standards for HIV prevention, care and treatment for pregnant women, mothers and their children; and to develop evidence-based strategies and define baselines and indicators that promote the integration of PMTCT into maternal, newborn and child health services, thus strengthening Rwanda health systems.

The prevalence of HIV infection among children born from HIV positive women in Musanze District was 2.9% this is higher compared to national prevalence (1.5%). Factors such as working in private sector, maternal poor adherence to ART, unsuppressed viral load, and lack of ART drug during PMTCT period, lack of ART prophylaxis for the infant, advanced stage of HIV, poor ANC visits were associated with HIV infection among children born from HIV positive mothers. Effective strategies to promote safe infant feeding practices such as, avoidance of mixed feeding beyond 26 weeks among HIV infected mothers are recommended. This study releases some recommendations such as; early introduction of ART for all HIV positive pregnant women; to provide ARVs prophylaxis for all children born from HIV positive women; enhance cancelling on ART treatment in term of increasing good adherence and encourage HIV positive pregnant women to follow antenatal care program.