Continuous quality improvement, linkage to peer supporters in prevention of mother-to-child human immunodeficiency virus transmission programs in Rwanda

doi:10.5501/wjv.v15.i2.120310

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World Journal of Virology

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2220-3249

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Baishideng Publishing Group Inc, 7041 Koll Center Parkway, Suite 160, Pleasanton, CA 94566, USA

Retrospective Study

Copyright: ©Author(s) 2026. This article is an open access article distributed under the terms and conditions of the Creative Commons Attribution-NonCommercial (CC BY-NC 4.0) license. No commercial re-use. See permissions. Published by Baishideng Publishing Group Inc.

World J Virol. Jun 25, 2026; 15(2): 120310
Published online Jun 25, 2026. doi: 10.5501/wjv.v15.i2.120310

Continuous quality improvement, linkage to peer supporters in prevention of mother-to-child human immunodeficiency virus transmission programs in Rwanda

Jackson Sebeza, Peter Memiah, Mariam Salim Mbwana, Hassan Fredrick Fussi, Hafidha Mhando Bakari, Upendo Kayeke Chenya, Beatrice Kelvin Mpimo, Haji Mbwana Ally, Basile Ikuzo, Habib Omari Ramadhani

Jackson Sebeza, School of Public Health, College of Medicine and Health Sciences, University of Rwanda, Kigali 3286, Rwanda

Peter Memiah, Department of Global Health, Graduate School, University of Maryland, Baltimore, MD 21201, United States

Mariam Salim Mbwana, Department of Medicine, Primary Health Care Institute, Iringa 51108, Tanzania

Hassan Fredrick Fussi, Department of Medicine, District Hospital, Dar es Salaam 35091, Tanzania

Hafidha Mhando Bakari, Department of Literature, Communication and Publishing, University of Dar es Salaam, Dar es Salaam 35091, Tanzania

Upendo Kayeke Chenya, Department of Prevention and Treatment, Drug Control and Enforcement Authority, Dar es Salaam 15103, Tanzania

Beatrice Kelvin Mpimo, Department of Research, Lincoln University, Oakland, CA 94612, United States

Haji Mbwana Ally, Department of Medicine, Kilimanjaro Christian Medical Center, Moshi 25116, Kilimanjaro, Tanzania

Basile Ikuzo, Division of Human Immunodeficiency Virus, Rwanda Biomedical Center, Institute of Human Immunodeficiency Virus Disease Prevention and Control, Kigali 4285, Rwanda

Habib Omari Ramadhani, Department of Medicine, Institute of Human Virology, University of Maryland School of Medicine, Baltimore, MD 21201, United States

Author contributions: Sebeza J, Mbwana MS, Memiah P, and Ramadhani HO contributed to conceptualization; Mbwana MS, Sebeza J, Ally ZM, Ally HM, and Ramadhani HO contributed to data curation; Ally HM, and Ramadhani HO contributed to formal analysis; Ally HM, Fussi HF, and Ramadhani HO contributed to methodology; Fussi HF, Memiah P, and Ramadhani HO contributed to validation; Sebeza J and Mbwana MS, contributed to writing original draft; Bakari HM, Sebeza J, Chenya UK and Mpimo BK contributed to visualization. All authors reviewed this manuscript, provided feedback, and approved the manuscript in its final form.

Institutional review board statement: The original study was approved by the Rwanda National Ethics Committee with approval certificate number 104/RNEC/2022.

Informed consent statement: This was a retrospective review of routinely collected clinical data. The study did not involve direct patient interviews and therefor no consent was sought.

Conflict-of-interest statement: All the authors report no relevant conflicts of interest for this article.

Data sharing statement: The data that support the findings of this study are available from the corresponding author upon reasonable request.

Corresponding author: Habib Omari Ramadhani, PhD, Senior Researcher, Department of Medicine, Institute of Human Virology, University of Maryland School of Medicine, 725 West Lombard Street, Baltimore, MD 21201, United States. homari@ihv.umaryland.edu

Received: February 24, 2026
Revised: March 10, 2026
Accepted: April 13, 2026
Published online: June 25, 2026
Processing time: 115 Days and 14.8 Hours

Abstract

BACKGROUND

Peer supporters are instrumental for the successful navigation of prevention of mother-to-child human immunodeficiency virus (HIV) transmission services, including maternal viral load suppression and early infant HIV diagnosis. These outcomes are critical for the elimination of mother-to-child HIV transmission. We assessed the impact of continuous quality improvement (CQI) services on assignment to peer supporters and undetection of the viruses among pregnant women living with HIV (WLHIV) and mother-to-child transmission of HIV (MTCT) rates among HIV exposed babies in Rwanda.

AIM

To assess the impact of CQI services on assignment to peer supporters and undetection of the viruses among pregnant WLHIV and MTCT rates among HIV exposed babies in Rwanda.

METHODS

Between 2021 and 2022, CQI services were implemented in 18 of the 38 healthcare facilities included in this analysis. Healthcare workers in 18 facilities used CQI approaches to key predictors of, and contributors related to, the implementation of the prevention of MTCT (PMTCT) program to improve maternal and infant outcomes. This was a secondary data analysis that explored the association between CQI and assignment to peer supporters, undetection of the virus, and MTCT rates. To assess the impact of CQI on these outcomes, a multivariable logistic regression model was used to compute adjusted odds ratios (aOR) and corresponding 95% confidence intervals (CI).

RESULTS

A total of 1145 mother-baby pairs were included, of whom 558 (48.7%) were from facilities that implemented CQI. At the end of evaluation, 1043 (91.0%) either completed 24-months of follow-up or remained in care in the same facilities. Of 102 not available at the evaluation, 84 were transferred out, and 18 were dead or lost to follow-up. Overall, 405 (35.4%) women were assigned to peer supporters, 1004 (87.7%) had undetectable viruses, and 8 (0.7%) infants were infected with HIV. Compared to women from non-CQI facilities, those from CQI implementing facilities had 32% higher odds of being assigned to peer supporters (aOR = 1.32; 95%CI: 1.02-1.71). Similarly, disclosing HIV status (aOR = 1.53; 95%CI: 1.10-2.14) and a higher number of health care workers per 1000 active patients (> 4 vs ≤ 4) (aOR = 1.34; 95%CI: 1.05-1.75) were associated with higher odds of being linked to peer supporters. Having a formal education was associated with reduced odds of being linked to peer supporters compared to those with no education. Compared to women from non-CQI facilities, those from CQI implementing facilities had 51% higher odds of having undetectable viruses (aOR = 1.51; 95%CI: 1.05-2.18). CQI was associated with fewer transferred out compared to non-CQI facilities (6.0% vs 8.8%; P = 0.07).

CONCLUSION

Nearly 3 in 10 pregnant WLHIV in Rwanda were linked to peer support to support the successful navigation of PMTCT services, and CQI increased this linkage and aided the achievement of undetectable viruses. Implementing CQI and promoting HIV status disclosure is critical to facilitate peer support linkage and improve maternal and infant outcomes.

Keywords: Continuous quality improvement; Peer support, mother to child transmission of human immunodeficiency virus; Pregnant women living with human immunodeficiency virus; Human immunodeficiency virus; Rwanda

Core Tip: Peer supporters are instrumental for the successful navigation of prevention of mother-to-child human immunodeficiency virus (HIV) transmission services, including maternal viral load suppression and early infant HIV diagnosis. This retrospective cohort study assessed the effect of continuous quality improvement on the assignment of peer supporters, achievement of undetectable viruses among pregnant women living with HIV, and mother-to-child transmission rates among HIV exposed infants in Rwanda. The findings showed that compared to healthcare facilities that did not employ continuous quality improvement approaches, those that did improved assignment of peer supporters and achievement of undetectable viruses.