This study has some limitations. The self-reporting as an approach to provide survey data is likely to introduce specific biases for factors such as infant feeding practices, mutual disclosure of HIV status and individual socioeconomic characteristics. Although Muhima study findings corroborate those from existing literature selleck inhibitor about major risk factors for mother-to-child transmission of HIV-1 in breastfeeding populations, it was only conducted in one of the 30 Rwanda districts and located in urban area. For the results to be generalizable to the entire country there would be need for larger studies. Conclusion In 679 mother �C infant pairs followed at Muhima health Centre (Rwanda), the most relevant factors independently associated with increased risk of mother �C to �C child transmission of HIV-1 included non-disclosure of HIV status to partner and high HIV-1 RNA.

Members of this cohort also showed socioeconomic inequalities, with unmarried status carrying higher risk of undisclosed HIV status that, as a mediator, was associated with higher risk of MTCT. Such findings suggest that HIV status disclosure to partner & HIV-1 RNA level are key entry points for reducing HIV-1 mother-to-child transmission in Rwanda. And more specifically, the monitoring of HIV-1 RNA level might be considered as a routinely used test to assess the risk of transmission with the goal of achieving viral suppression as critical for elimination of transmission, particularly in breastfeeding populations. In addition, further research is needed to identify most effective interventions to get optimal mutual disclosure of HIV status for Rwanda PMTCT services & clients.

Abbreviations AIDS: Acquired immunodeficiency syndrome; ARV: Antiretroviral; CD4: T-helper cells; CI: Confidence interval; DNA: Deoxyribonucleic Acid; HAART: Highly active antiretroviral therapy; HIV: Human immunodeficiency virus; OR: Odds ratio; PCR: Polymerase chain reaction; PMTCT: Prevention of mother-to-child transmission; RNA: Ribonucleic acid; WHO: World Health Organization Competing interests Authors declare no competing interests. Authors�� contributions MB supervised the study and wrote the paper. JDDB & JM assisted with data collection, entry and analysis. CPH contributed to the study design, data analysis and reviewed the manuscript critically for important intellectual content.

All authors read and approved the final manuscript. Acknowledgements The authors thank the teams from the Rwanda Ministry of Health and Muhima health centre who have provided support for data collection as well as The National Reference Laboratory of Rwanda that conducted viral load tests with the financial support from EGPAF-Rwanda.
Life Brefeldin_A expectancy at birth has steadily increased during the last decade in the EU27, by more than 3 years for men and 2 years for women, leading to accelerated population ageing.