Socio-Behavioral Factors Mediating Mother-To-Child Transmission of HIV in Selected PMTCT Clinics in Rwanda

Background: Mother-To-Child Transmission (MTCT) of HIV-1 and associated mortality remain unacceptably high despite extensive implementation of Prevention of Mother-To-Child Transmission (PMTCT) of HIV in Rwanda. Socio-behavioral factors sustaining MTCT in Rwanda remain inconclusively explored. This study aimed to identify the mediating effects of socio-behavioral factors on the MTCT of HIV-1 in PMTCT clinics in Rwanda. The goal of this study is to inform the refinement of PMTCT interventions to ensure they are effectively tailored to the specific context and dynamics of Rwanda’s HIV epidemic. Methods: A prospective cohort study was conducted in Rwanda’s PMTCT clinics to investigate the socio-behavioral factors associated with MTCT of HIV. HIV deoxyribonucleic acid-polymerase chain reaction (DNA PCR) was done immediately at birth and at 18 months together with HIV-antibody testing to establish HIV status. Quantitative socio-behavioral data were collected by questionnaire, and Structural Equation Modeling (SEM) using Smart PLS V4.0 was done to test hypotheses. Results: Fewer Antenatal Care (ANC) visits had significant negative correlational scores with low mothers’ knowledge of MTCT of HIV (p-value of 0.008 and 0.041, respectively). However, neither the number of ANC visits nor adherence to Antiretroviral Therapy (ART) significantly mediated the relationship between maternal occupation or income and mother-to-child transmission (MTCT) of HIV, as indicated by 95% confidence intervals (CIs) that included zero. Conclusion: While maternal occupation and income socio-behavioral factors significantly influenced MTCT of HIV, adherence to ART and to ANC did not mediate the relationship between socio-behavioral factors and MTCT of HIV. These results justify targeted interventions to address maternal health risk behavior and accessibility of care facilities (PMTCT).