Reduction in mother-to-child transmission of HIV following an integrated couple-community intervention in Mbandaka (DRC)
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In Central Africa, the effectiveness of programs to prevent mother-to-child transmission (PMTCT) remains limited. This study evaluates the impact of an integrated couple-community approach on the PMTCT care cascade in Mbandaka, Democratic Republic of Congo. A mixed-methods study was conducted. The quasi-experimental quantitative component compared a pre-intervention group (2022–2023, n=450) with a post-intervention group (2024–2025, n=384). The intervention included virological reinforcement, male involvement, community support, and postnatal reminders. The qualitative component explored the perceptions of 30 participants through interviews and focus groups. The intervention significantly improved key indicators. Early initiation of treatment (<20 weeks of gestation) increased from 31.8% to 71.1% (p<0.001), and viral load suppression at delivery increased from 55.1% to 94.0% (RR=5.79). The rate of vertical transmission decreased from 8.4% to 2.6% (p<0.001). Partner involvement in prenatal care increased from 27.8% to 78.9%. Multivariate analysis confirms that early initiation reduces the risk of transmission by 88% (ORa=0.121). Qualitatively, participants reported increased spousal support, reduced stigma, and greater trust in the healthcare system. The integrated couple-community approach drastically reduces vertical HIV transmission. These results argue for decentralizing virological monitoring and institutionalizing male and community involvement in national PMTCT policies.
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