This was a 6-month descriptive cross-sectional study from July 1 to December 31, 2023, conducted in the Obstetrics and Gynecology Department of the Ignace Deen National Hospital in Conakry, focusing on HIV-positive women who gave birth in the department during the study period.

All HIV-positive women who gave birth in the department and agreed to participate were included in this study.

Women who delivered a stillbirth or whose newborns died within hours of delivery were excluded from this study.

- All HIV-positive parturients who did not agree to participate in the study;

- All parturients who gave birth outside the ward and were referred for complications.

We have carried out a exhaustive recruitment of all pregnant and parturient women who met the inclusion criteria.

They were sociodemographic, obstetric, HIV screening, therapeutic and neonatal.

The data were entered using Excel software from the Office 2016 package and then analyzed using SPSS software in its version 26.0.

Informed consent was obtained from participants, confidentiality and anonymity were required.

In this work, we attempted to study the practice of PMTCT in the Gynecology-Obstetrics Department of the Ignace Deen National Hospital. These results show a significant frequency of HIV infection during pregnancy (2.52%) ( Figure 1 ). However, we encountered some difficulties, including the failure to perform the viral load and the CD4 lymphocyte rate and the discontinuation of ARVs for antiretroviral prophylaxis. However, this study remains of interest because it allowed us to know the frequency of HIV infection during pregnancy, the vertical transmission rate and the maternal and neonatal care provided in the department.

This frequency observed in this series is lower than that of Diallo MH et al. [14] who in 2016 found a rate of 6.71% of pregnant women infected with HIV in a level II maternity hospital in Guinea. This difference could be explained by the presence in this center of the NGO Doctors Without Borders which has significantly improved the attendance of the center in terms of monitoring and care of pregnant women infected with HIV.

Young pregnant women were the most represented in our sample with an average age of 28.30 years ( Table 1 ). A similar observation was reported in the study by Diallo MH et al. Mentioning a predominance of the 20 - 29 age group (78%) [14] . On the other hand, Izudi J et al. in Uganda in 2018 reported that 89% of pregnant women infected with HIV were over 30 years old [15] . For some authors, this predominance of young age could be explained by the precocity of marriage and sexuality [12] [16] .

This work shows that the sample was dominated by pregnant women in the informal sector worker ( Table 1 ). This observation is similar to that found in a study carried out in Conakry in 2016. with more than half of HIV-positive pregnant women working in the liberal profession (55.56%) [14] . This could be explained by the fact that in Guinea, apart from studies and lack of employment, women engage in remunerative activities to be able to provide for the family. Married women were the most numerous in this series (85.8%) ( Table 1 ). This finding corroborates with the results of Cissé Z et al. in Mali in 2020 who reported a proportion of 85.4% of married women [17] . On the other hand, Ngo Nyee A et al. in Cameroon in 2018 found that 79% of pregnant women infected with HIV were single [18] . This difference could be explained by the fact that conception outside of marriage is poorly accepted in our country because of religious and cultural constraints.

It emerges from this study that uneducated women were the majority of the most represented in the sample ( Table 1 ). This result is close to that of Kyba A et al. in Burkina Faso in 2017 who found a proportion of 47.8% of uneducated women [19] . On the other hand, a conclusion contrary to ours was reported by Ngo Nyee A et al. in Cameroon in 2018, i.e. 100% of parturients were educated. This difference could be explained by the low rate of schooling of young girls in our country [18] .

We identified 23.9% of HIV-positive pregnant women with premature rupture of membranes ( Table 2 ). A higher proportion of premature rupture of membranes in HIV-positive women was found by some authors (80%) [20] . It is described in the literature that HIV infection significantly increases the risk of premature delivery, which would explain this high rate of premature rupture of membranes [21] .

RPM: Premature rupture of membranes; AFS: Acute fetal distress; AFM: Active fetal movements; PES: Severe preeclampsia.

We found that multigravida and pauciparous women were the most numerous among pregnant women infected with HIV ( Table 3 ). An identical finding to ours was reported in Malian series in 2020 and 2021 [17] [22] .

In this study, the majority of HIV-positive pregnant women admitted to the department had completed fewer than 4 ANCs ( Table 4 ). Our conclusion corroborates that of Mwembo A et al. in the DRC in 2012 [23] . On the other hand, Cissé Z et al. found that 1 in 3 HIV-positive patients (33.3%) had not undergone ANC [17] . More than 1/3 of patients discovered their HIV status in the labor and delivery room ( Table 5 ). This finding is different from that observed by Ouedraogo-Yugbaré SO et al., i.e. 19.75% of pregnant women who discovered their HIV status in the labor and delivery room [24] . This late discovery of HIV infection could be explained, on the one hand, by the low rate of prenatal consultations and, on the other hand, by a low rate of counseling for screening for HIV infection during pregnancy. According to literature data, the timing of screening is very useful in PMTCT and the earlier the woman is screened, the more chance her child has of being spared from HIV infection [17] .

ATS: Technical health agent; CS: Health center; CMC: Municipal medical center; PTME: Prevention of mother-to-child transmission; CPN: Prenatal consultation.

In this study, all the parturients screened had HIV type 1 (HIV1) ( Table 5 ). Our result is similar to those of Diallo MH in Guinea in 2016 and Ouedraogo-yugbaré SO in Burkina Faso in 2015 who found respectively 97.53% and 95.38% of HIV type 1 [14] [24] . The fact that HIV type 1 is the most widespread throughout the world, the most virulent and more sexually transmissible would explain its higher proportion in our context [20] . We observed that more than 2/3 of the study population received triple ARV therapy, more than half of whom were put on treatment before and during pregnancy ( Table 6 ). This observation is different from that of Ngwej DT et al. who reported that only 25% of HIV-positive women received ARV treatment before and during pregnancy [20] . Data from the literature show that a well-monitored HIV-positive pregnant woman on ARV treatment significantly reduces the risk of HIV transmission, unlike those not subjected to treatment [25] .

This work shows a low rate of achievement of the CD4 count and viral load ( Table 6 ). Different results were recorded in the study by Takassi OE et al. who reported that all of their patients had their viral load and CD4 count performed with a proportion of 73.4% of women having an undetectable viral load at the time of delivery and a median CD4 count of 348 cells/mm³ [26] . The low rate of these tests in our context could be explained on the one hand by poor prenatal monitoring and on the other hand by the high cost of the latter.

ARV: Antiretroviral. The majority of pregnancies were at term (89.1%) and in 55.4 % of cases membrane rupture occurred before complete dilation. Vaginal delivery was 38.0% compared to 62.0 % cesarean section. More than 9 out of 10 women gave birth without soft tissue tear and episiotomy was performed in 17.4 % of deliveries.

In this series, more than 2 out of 10 patients had experienced PROM and early rupture of membranes. Our results are lower than those of Ngwej DT et al. in the DRC in 2015 who reported 40% PROM and 60% early rupture of membranes respectively [20] . They found that prolonged rupture of membranes before delivery would promote HIV transmission during labor and delivery [20] .

Regarding the mode of delivery, we noted that more than 6 out of 10 HIV-positive parturients had given birth by Cesarean section. Contrary results have been reported in the literature [26] . This difference could be explained by the fact that, in our series, it was most often parturients evacuated from secondary structures presenting maternal and/or fetal complications requiring caesarean section. Our study site is the only level 3 structure in the city of Conakry handling the majority of obstetric emergencies coming from the capital and its outskirts. However, the literature shows that an elective cesarean section is a protective factor and would lead to a significant reduction in the risk of MTCT compared to vaginal delivery [20] . The majority of newborns received an antiseptic wash using chlorhexidine or Dakin Cooper within 30 minutes of delivery ( Table 7 ). This practice helps limit MTCT due to the newborn’s contact with various fluids that may contain human immunodeficiency virus. We observed high rates of low birth weight and prematurity. Ngwej DT et al. in DRC in 2015 reported a rate of 33% of newborns with low birth weight [20] . While Ouedraogo-yugbaré SO et al. found lower proportions of low birth weight (7.89%) and prematurity (16.10%). However, the literature reports that HIV infection on pregnancy significantly increases the risk of premature delivery and intrauterine growth retardation. This is the consequence of an infectious syndrome and anemic syndrome caused or maintained by immunosuppression but also of the direct effect of ARVs on fetal growth [21] .

*The ARV used was Nevirapine. The vertical transmission rate of HIV infection was 9.5%.

According to literature data, ARV prophylaxis at birth (0 to 6 weeks) is an alternative that better protects them against HIV infection [25] . In our study, 86 newborns, or 91%, received Nevirapine within 24 hours of delivery ( Table 6 ). Our result corroborates that of Diallo MH et al. in Guinea in 2016 reported 91.25% of newborns receiving Nevirapine at birth [14] . However, this finding is different from that of Cissé Z et al. in Mali in 2020 reported 22.9% of newborns receiving ARV prophylaxis [17] . This indicates good practice in the prevention of MTCT of HIV in our department.

After counseling on the advantages and disadvantages of each method of breastfeeding, the majority of women preferred exclusive breastfeeding ( Table 6 ). This result is similar to that of Diallo MH et al. who reported a rate of 87.5% in their series [14] . A study carried out in Togo in 2017 had shown the superiority of protected breastfeeding compared to artificial breastfeeding in developing countries [26] . Thus, Alvarez-uria G et al. in India demonstrated that the risk of infant death was 14 times higher in the group of children on artificial feeding after 12 months. They also showed that bottle-fed children were at greater risk of developing severe malnutrition after the age of two months [27] . This rate could be explained by the fact that women understood the importance of breast milk in the growth and well-being of their infants.

In this study, PCR was performed for 84 newborns, including eight positive cases, with a vertical transmission rate of 9.5% ( Table 6 ). This finding is intermediate to those of Ngwej in the DRC in 2015 and Izudi in Uganda in 2018, which found 8.5% and 12% respectively [20] [28] . A lower rate was reported in Togo in 2017 (0.46%) [26] . This difference could be explained by the quality of monitoring of women during pregnancy. In the Togolese study, all patients and their newborns were regularly monitored and all had PCR and viral load tests performed. They also administered antiretroviral prophylaxis during labor, which would explain this low vertical transmission of HIV infection in their context.

The analysis of the results of this work shows that the rate of HIV infection during pregnancy is not negligible in our context. Counseling on HIV testing during ANC remains low, and the majority of patients were tested during pregnancy, labor, and postpartum. HIV-1 was the only type encountered in this study. The rate of non-treatment of ARVs was high, as was the rate of vertical transmission. The majority of newborns received nevirapine within minutes of delivery.

Strengthening HIV screening in all pregnant women during prenatal consultations or in the delivery room, systematically starting ARV treatment on HIV-positive pregnant women and performing viral load testing in these patients could further reduce the rate of vertical transmission of HIV infection and improve maternal and neonatal prognosis.