Socio-Structural Factors Influencing the Prevention of Mother-to-Child Transmission of HIV in the Democratic Republic of the Congo: A Systematic Review

  • Guy-Lucien S. WhemboluaEmail author
  • Baraka Muvuka
  • Daudet Ilunga Tshiswaka
  • Donaldson F. Conserve
Review Paper


Introduction The Democratic Republic of the Congo (DRC) had the second-highest mother-to-child HIV transmission rate in Sub-Saharan Africa at 29% in 2013, however the uptake of preventive services for mother-to-child transmission of HIV (PMTCT) remains suboptimal. This systematic review explores socio-cultural and structural factors influencing PMTCT service uptake in the DRC. Methods We conducted a search of electronic databases. The PEN-3 model was used as a framework to synthesize factors influencing PMTCT service uptake into perceptions, enablers, and nurturers. Results Sixteen studies, 14 quantitative and two qualitative, were retained. Maternal, socio-economic, structural, and cultural factors were found to influence PMTCT service uptake in the DRC. Cost, accessibility, and quality of PMTCT services were key barriers to service uptake. Integration, male partner involvement, and evolving PMTCT policies improved PMTCT service delivery and uptake. This review also revealed several socio-cultural challenges in involving male partners in PMTCT programs. Discussion Findings highlight the need to address barriers and reinforce enablers of PMTCT uptake. Creating culturally appropriate, male-friendly, and family-oriented PMTCT programs will improve service uptake in the DRC.


Human Immunodeficiency Virus (HIV) Prevention of mother-to-child transmission (PMTCT) PEN-3 model Democratic Republic of Congo Male partner involvement 



  1. Airhihenbuwa, C. O., & Webster, J. D. (2004). Culture and African contexts of HIV/AIDS prevention, care and support. Sahara J: Journal of Social Aspects of HIV/AIDS, 1(1), 4–13. Scholar
  2. Armijo-Olivo, S., Stiles, C. R., Hagen, N. A., Biondo, P. D., & Cummings, G. G. (2012). Assessment of study quality for systematic reviews: A comparison of the Cochrane Collaboration Risk of Bias Tool and the Effective Public Health Practice Project Quality Assessment Tool: Methodological research. Journal of Evaluation in Clinical Practice, 18(1), 12–18. Scholar
  3. Behets, F., Edmonds, A., Kitenge, F., Crabbe, F., & Laga, M. (2010). Heterogeneous and decreasing HIV prevalence among women seeking antenatal care in Kinshasa, Democratic Republic of Congo. International Journal of Epidemiology, 39(4), 1066–1073. Scholar
  4. Behets, F., Mutombo, G. M., Edmonds, A., Dulli, L., Belting, M. T., Kapinga, M., Pantazis, A., Tomlin, H., & Okitolonda, E. (2009). Reducing vertical HIV transmission in Kinshasa, Democratic Republic of Congo: Trends in HIV prevalence and service delivery. AIDS Care, 21(5), 583–590. Scholar
  5. Behets, F. M., Matendo, R., Vaz, L. M., Kilese, N., Nanlele, D., Kokolomami, J., Okitolando, E. W., & Van Rie, A. (2006). Preventing vertical transmission of HIV in Kinshasa, Democratic Republic of the Congo: A baseline survey of 18 antenatal clinics. Bulletin of World Health Organanization, 84(12), 969–975. Retrieved July 25, 2017, from.
  6. Betancourt, T. S., Abrams, E. J., McBain, R., Fawzi, & Smith, M. C. (2010). Family-centred approaches to the prevention of mother to child transmission of HIV. Journal of the International AIDS Society, 13(2), 1. Scholar
  7. Ditekemena, J., Matendo, R., Colebunders, R., Koole, O., Bielen, G., Nkuna, M., Engmann, C., Tshefu, A., & Ryder, R. (2015). Health outcomes of infants in a PMTCT program in Kinshasa. Journal of the International Association of Providers of AIDS Care (JIAPAC), 14(5), 449–454. Scholar
  8. Dunlap, J., Foderingham, N., Bussell, S., Wester, C. W., Audet, C. M., & Aliyu, M. H. (2014). Male involvement for the prevention of mother-to-child HIV transmission: a brief review of initiatives in East, West, and Central Africa. Current HIV/AIDS Reports, 11(2), 109–118. Scholar
  9. Edmonds, A., Feinstein, L., Okitolonda, V., Thompson, D., Kawende, B., & Behets, F. (2015). Decentralization does not assure optimal delivery of PMTCT and HIV-exposed infant services in a low prevalence setting. Journal of Acquired Immune Deficiency Syndromes, 70(4), e130–e139. Scholar
  10. Feinstein, L., Dimomfu, B. L., Mupenda, B., Duvall, S., Chalachala, J. L., Edmonds, A., & Behets, F. (2013). Antenatal and delivery services in Kinshasa, Democratic Republic of Congo: care-seeking and experiences reported by women in a household-based survey. Tropical Medicine & International Health, 18(10), 1211–1221. Scholar
  11. Feinstein, L., Edmonds, A., Chalachala, J. L., Okitolonda, V., Lusiama, J., Van Rie, A., Chi, B. H., Cole, S. R., & Behets, F. (2014). Temporal changes in the outcomes of HIV-exposed infants in Kinshasa, Democratic Republic of Congo during a period of rapidly evolving guidelines for care (2007–2013). AIDS, 28(3), 301–311. Scholar
  12. Feinstein, L., Edmonds, A., Okitolonda, V., Cole, S. R., Van Rie, A., Chi, B. H., Ndjibu, P., Chalachala, J. L., & Behets, F. (2015). Implementation and operational research: Maternal combination antiretroviral therapy is associated with improved retention of HIV-exposed infants in Kinshasa, Democratic Republic of Congo. Journal of acquired immune deficiency syndromes, 69(3), e93–e99. Scholar
  13. Gourlay, A., Birdthistle, I., Mburu, G., Iorpenda, K., & Wringe, A. (2013). Barriers and facilitating factors to the uptake of antiretroviral drugs for prevention of mother-to-child transmission of HIV in sub-Saharan Africa: A systematic review. Journal of the International AIDS Society, 16(1).
  14. Hlarlaithe, M. O., Grede, N., de Pee, S., & Bloem, M. (2014). Economic and social factors are some of the most common barriers preventing women from accessing maternal and newborn child health (MNCH) and prevention of mother-to-child transmission (PMTCT) services: A literature review. AIDS Behaviour, 18(5), 516–530. Scholar
  15. Iwelunmor, J., Ezeanolue, E. E., Airhihenbuwa, C. O., Obiefune, M. C., Ezeanolue, C. O., & Ogedegbe, G. G. (2014a). Socio-cultural factors influencing the prevention of mother-to-child transmission of HIV in Nigeria: A synthesis of the literature. BMC Public Health, 14(1), 771. Scholar
  16. Iwelunmor, J., Newsome, V., & Airhihenbuwa, C. O. (2014b). Framing the impact of culture on health: A systematic review of the PEN-3 cultural model and its application in public health research and interventions. Ethnicity & Health, 19(1), 20–46. Scholar
  17. Joint United Nations Programme on HIV and AIDS (UNAIDS). (n.d.). Democratic Republic of Congo: HIV AIDS estimates 2015. Retrieved July 25, 2017, from
  18. Kabamba Mulongo, L., Schirvel, C., Mukalay wa Mukalay, A., & Dramaix Wilmet, M. (2010). HIV-1 test acceptance within the prevention of mother-to-child HIV-1 transmission program in Democratic Republic of Congo. Revue d’Epidemiologie et de Sante Publique, 58(5), 313–321. Scholar
  19. Kabamba Mulongo, L., Schirvel, C., Mukalay wa Mukalay, A., & Wilmet, D., M (2011). Understanding couples’ attitudes on prenatal HIV testing in the Democratic Republic of Congo. Revue d’Epidemiologie et de Sante Publique, 59(6), 379–383. Scholar
  20. Kirere Mathe, M., Sondag-Thull, D., & Lepage, P. (2008). Feasibility of prevention of perinatal HIV infection by nevirapine in rural areas of the northeast Democratic Republic of Congo, 2002–2004. Journal of Medical Virology, 80(5), 772–776. Scholar
  21. Maman, S., Cathcart, R., Burkhardt, G., Omba, S., Thompson, D., & Behets, F. (2012). The infant feeding choices and experiences of women living with HIV in Kinshasa, Democratic Republic of Congo. AIDS Care, 24(2), 259–265. Scholar
  22. Mathe, M. K., & Lepage, P. (2007). Feasibility of HIV prophylaxis with nevirapine in a northeastern rural area of the Democratic Republic of the Congo. Sante, 17(2), 97–101. Retrieved 15 July, 2018, from
  23. Ministère du Plan et Suivi de la Mise en œuvre de la Révolution de la Modernité (MPSMRM), Ministère de la Santé Publique (MSP), ICF International. (2014). Democratic Republic of Congo Demographic and Health Survey 2013-14: key findings. Maryland: MPSMRM, MSP et ICF International. Retrieved July 25, 2017, from
  24. Morfaw, F., Mbuagbaw, L., Thabane, L., Rodrigues, C., Wunderlich, A. P., Nana, P., & Kunda, J. (2013). Male involvement in prevention programs of mother to child transmission of HIV: A systematic review to identify barriers and facilitators. Systematic Reviews, 2(1), 5.
  25. Mwembo-Tambwe, A. N., Kalenga, M. K., Donnen, P., Humblet, P., Chenge, M., Dramaix, M., & Buekens, P. (2013). HIV testing among women in delivery rooms in Lubumbashi, Democratic Republic of the Congo: a catch-up strategy for prevention of mother-to-child transmission. Revue d’Epidemiologie et de Sante Publique, 61(1), 21–27. Scholar
  26. Ngwej, D. T., Mukuku, O., Mudekereza, R., Karaj, E., Odimba, E. B. F., Luboya, O. N., … Wembonyama, S. O. (2015). Etude de facteurs de risque de la transmission du VIH de la mère à l’enfant dans la stratégie « option A » à Lubumbashi, République Démocratique du Congo. The Pan African Medical Journal, 22, 18. Scholar
  27. Okoli, J. C., & Lansdown, G. E. (2014). Barriers to successful implementation of prevention-of-mother-to-child-transmission (PMTCT) of HIV programmes in Malawi and Nigeria: A critical literature review study. The Pan African Medical Journal, 19, 154. Scholar
  28. United Nations, A. I. D. S. P. (2014). 2014 progress report on the global plan towards the elimination of new HIV infections among children by 2015 and keeping their mothers alive. Retrieved July 25, 2017, from
  29. US President’s Emergency Plan for AIDS Relief (PEPFAR). (2014). Democratic Republic of the Congo operational plan report FY 2013. Retrieved July 25, 2017, from
  30. Van Rompaey, S., Kimfuta, J., Kimbondo, P., Monn, C., & Buve, A. (2011). Operational assessment of access to ART in rural Africa: The example of Kisantu in Democratic Republic of the Congo. AIDS Care, 23(6), 686–693. Scholar
  31. World Health Organization. (2015). Global health sector response to HIV, 2000–2015: focus on innovations in Africa: progress report. Retrieved July 25, 2017, from
  32. World Health Organization. (2016a). Prevention of mother-to-child transmission: data by country. Retrieved July 25, 2017, from
  33. World Health Organization. (2016b). Consolidated guidelines on the use of antiretroviral drugs for treating and preventing HIV infection: recommendations for a public health approach. Switzerland: World Health Organization. Retrieved July 25 2017, from

Copyright information

© Springer Science+Business Media, LLC, part of Springer Nature 2019

Authors and Affiliations

  • Guy-Lucien S. Whembolua
    • 1
    Email author
  • Baraka Muvuka
    • 2
  • Daudet Ilunga Tshiswaka
    • 3
  • Donaldson F. Conserve
    • 4
  1. 1.Department of Africana StudiesUniversity of CincinnatiCincinnatiUSA
  2. 2.Department of Health Promotion and Behavioral Sciences, School of Public Health and Information SciencesUniversity of LouisvilleLouisvilleUSA
  3. 3.Department of Public HealthUniversity of West FloridaPensacolaUSA
  4. 4.Department of Health Promotion, Education, and BehaviorArnold School of Public Health, University of South CarolinaColumbiaUSA

Personalised recommendations