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      Positivity rate, trend and associated risk factors of mother-to-child transmission of HIV among HIV-exposed infants

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          Abstract

          Background

          Mother-To-Child-Transmission (MTCT) of Human Immunodeficiency Virus (HIV) occurs during pregnancy, delivery and breastfeeding, and cause infection among several new-borns. However, there is limited recent evidence on the burden of MTCT of HIV in Ethiopia from a large-scale data. Thus, this study aimed to determine the positivity rate, trend and associated risk factors of MTCT among HIV-exposed infants.

          Methodology

          A cross-sectional study was conducted among 5,679 infants whose specimen referred to Ethiopian Public Health Institute HIV referral laboratory for Early Infant Diagnosis (EID) from January 01, 2016, to December 31, 2020. Data were extracted from the national EID database. Frequencies and percentages were used to summarize the data on characteristics of infants. Logistic regression analysis was employed to identify factors associated with positivity rate of MTCT of HIV. Level of significance was set at 5%.

          Results

          The mean age of the infants was 12.6 (± 14.6) weeks with an age range of 4 to 72 weeks. Half of the infants (51.4%) were female. The positivity rate of MTCT decreased from 2.9% in 2016 to 0.9% in 2020 with five-year average positivity rate of 2.6%. HIV test after six weeks (Adjusted odds ratio (AOR) = 2.7; 95% confidence interval (CI): (1.8–4.0,)); p <  0.001), absence of prevention of mother-to-child-transmission (PMTCT) service (AOR = 4.6; 95% CI: (2.9–7.4)); p =  0.001), nevirapine prophylaxis not received (AOR = 2.0; 95% CI: (1.3–3.2)); p <  0.001), and unknown ART status of the mother at delivery (AOR = 11; 95% CI: (5.5–22.1)); p <  0.001) were significantly associated with MTCT of HIV.

          Conclusion

          The positivity rate of MTCT of HIV was showing declining tendency gradually in the study period. Strengthening PMTCT service, early HIV screening and starting ART for pregnant women, and early infant diagnosis are required to reduce the burden of HIV infection among infants exposed to HIV.

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          Mother-to-child transmission of HIV infection and its associated factors in Ethiopia: a systematic review and meta-analysis

          Getachew Kassa (2018)
          Background Mother-to-child transmission (MTCT) is the main mode of HIV transmission in children under 15 years old. This problem is significant in the Sub-Saharan African countries, where more than 80% of children living with HIV are found. Previous studies in Ethiopia present inconsistent and inconclusive findings on the prevalence and associated factors of MTCT of HIV. Therefore, this study was conducted to determine the pooled prevalence of MTCT of HIV and its associated factors in Ethiopia. Methods Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guideline was followed. All published studies were retrieved using relevant search terms in MEDLINE, PUBMED, Cochrane Library, EMBASE, Google Scholar, CINAHL, and African Journals Online databases. Joanna Briggs Institute Meta-Analysis of Statistics Assessment and Review Instrument (JBI-MAStARI) was used to critically appraise articles. STATA version 14 software was used to perform the Meta-analysis. The I 2 statistics was used to test heterogeneity and publication bias was assessed using Begg’s and Egger’s tests. Odds ratio (OR) with 95% confidence interval (CI) was presented using forest plots. Results A total of nine studies, 3688 mother-baby pairs, were included in this meta-analysis. The pooled prevalence of MTCT of HIV in Ethiopia was 9.93% (95% CI: 7.29, 12.56). The subgroup analysis showed a higher prevalence of MTCT of HIV in Dire Dawa City Administration (15.7%) and lowest in Southern Nations, Nationality and Peoples Region (SNNPR) (4.16%). Associated factors with MTCT of HIV include: mixed feeding, OR = 7.46 (95%CI: 4.71, 11.81), absence of infant ARV prophylaxis, OR = 7.89 (95%CI: 4.32, 14.42), home delivery, OR = 5.08 (95%CI: 2.32, 11.15), and absence of maternal PMTCT intervention, OR = 7.13 (95% CI: 3.31, 15.35). Conclusions Almost one in ten HIV exposed infants become HIV positive in Ethiopia. Factors like: mixed feeding, the absence of infant ARV prophylaxis, home delivery and absence of mother’s PMTCT intervention were significantly associated with MTCT of HIV. Therefore, the governmental and non-governmental organizations need to focus on the identified factors and work towards improving the prevention of mother to child transmission of HIV (PMTCT) program.
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            Risk of HIV and associated factors among infants born to HIV positive women in Amhara region, Ethiopia: a facility based retrospective study

            Zelalem Berhan, Fantu Abebe, Molla Gedefaw … (2014)
            Background The estimated HIV prevalence among pregnant women in Ethiopia is 1.2 percent and unfortunately one of every 3 children born to these women gets infected with HIV. Elimination of these mother-to-child transmissions (MTCT) of HIV is possible through HIV testing during pregnancy and taking antiretroviral medications. However, only 24 percent of the pregnant women living with HIV have yet received the medication needed to prevent the transmission of HIV. Hence, there exists a concern that the rate of HIV infection among infants born to HIV positive mothers is increasing. This study assessed the prevalence of HIV infection and associated factors among infants born to women living with HIV, in South Gondar zone, Amhara region, Ethiopia. Methods Facility based document review was conducted upon 434 charts. The study participants were HIV exposed infants enrolled from January to December 2012. The data were reviewed from all the 17 health facilities which were providing PMTCT services in the zone. The study included 434 HIV exposed infants having an HIV Deoxyribonucleic Acid (DNA) Polymerase Chain Reaction (PCR) test result. The data were collected using structured data extraction tool. Binary logistic regression analysis was employed to assess the putative association of independent variables with the outcome variable. Significance was taken at a P value <0.05 and 95% confidence level. Result The prevalence of HIV among HIV exposed infants was 10.1% (95% CI = 7.3 - 13%). Delayed diagnosis (AOR = 2.7, 95% CI = 1.3, 29.4), mixed infant feeding (AOR = 8.8, 95% CI = 4.5, 22.8), failure to receive either antiretroviral therapy or prophylaxis during pregnancy or breast feeding (AOR = 21.6, 95% CI = 14.5, 39.8) and shorter duration of HIV treatment (AOR = 12, 95% CI = (4.2, 45.0) were the factors that increase the risk of mother- to- child transmission of HIV. Conclusion The prevalence of HIV infection among HIV exposed infants is strikingly high. Inadequate use of antiretroviral therapy and skilled delivery care were the factors that enhance mother-to-child transmission of HIV. Integrated and audience specific education and promotion for seeking obstetric care and HIV services is instrumental to curb the devastating consequences of HIV on pregnant women and their newborns
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              Mother to Child Transmission of HIV and Associated Factors Among HIV Exposed Infants at Public Health Facilities, Dessie Town, Ethiopia

              Yibeltal Asmamaw Yitayew, Daniel Mengistu Bekele, Birhanu Wondimeneh Demissie … (2019)
              Background Vertical transmission of Human Immunodeficiency Virus (HIV) is the primary route of infection among children. Ethiopia is among the top ten countries in the world with the highest burden of HIV infections among children. Therefore we aimed to assess mother to child transmission (MTCT) of HIV and associated factors among HIV exposed infants (HEIs). Methods A cross-sectional study was conducted using retrospective data collected from HEIs paired with their mothers who had received the services in prevention of mother to child transmission (PMTCT) programs from January 2014 to December 2017 in public health facilities in Dessie town. Data of a total of 313 HEIs paired with their mothers were obtained by using semi-structured data extraction proforma from their medical records. The data were processed in Epi-info version 7.1.2.0 and analyzed using SPSS version 22. Crude and adjusted odds ratios with their 95% confidence intervals and p-value were used to identify significant factors. Results The prevalence of HIV among exposed infants was 3.8%. Absence of maternal antenatal care visit (AOR = 4.6, 95% CI: 1.17–17.99), home delivery (AOR = 4.2, 95% CI: 1.04 −16.76), absence of antiretroviral intervention to the mother (AOR= 5.7, 95% CI: 1.10–29.36), and failure to initiate nevirapine prophylaxis for the infant (AOR = 5.3, 95% CI: 1.11 −25.44) were significant factors of MTCT of HIV. Conclusion Prevalence of MTCT of HIV was low (3.8%) in Dessie town public health facilities. Having ANC visit, delivery at health facility, maternal ARV drug intake, and infant ARV prophylaxis were the significant protective factors against MTCT of HIV. Promoting ANC service utilization among pregnant women and providing counseling as well as setting up linkage with PMTCT and giving ARV intervention to all HIV positive pregnant women and timely initiation of NVP prophylaxis to all HEIs should be recommended by the minister of health and health facilities.
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                Author and article information

                Contributors
                Gadissa Gutema:
                ORCID: http://orcid.org/0000-0002-6117-1589
                gadissagutema@gmail.com
                Habteyes Hailu Tola: habtetola@gmail.com
                Dinka Fikadu: ejeta430@gmail.com
                Dereje Leta: letadereje2@gmail.com
                Birra Bejiga: birr4allephi@gmail.com
                Jaleta Bulti Tura: jaletatura@gmail.com
                Saro Abdella: helen_saro@yahoo.com
                Hassen Mamo: binmamo@yahoo.com , hassen.mamo@aau.edu.et
                Journal
                Journal ID (nlm-ta): BMC Pediatr
                Journal ID (iso-abbrev): BMC Pediatr
                Title: BMC Pediatrics
                Publisher: BioMed Central (London )
                ISSN (Electronic): 1471-2431
                Publication date (Electronic): 6 June 2023
                Publication date PMC-release: 6 June 2023
                Publication date Collection: 2023
                Volume: 23
                Electronic Location Identifier: 283
                Affiliations
                [1 ]GRID grid.452387.f, ISNI 0000 0001 0508 7211, HIV/AIDS Research Team, TB and HIV/AIDS Research Directorate, , Ethiopian Public Health Institute, ; PO Box 1242, Addis Ababa, Ethiopia
                [2 ]GRID grid.7123.7, ISNI 0000 0001 1250 5688, Department of Microbial, Cellular and Molecular Biology, College of Natural and Computational Sciences, , Addis Ababa University, ; PO Box 1176, Addis Ababa, Ethiopia
                [3 ]College of Health Sciences, Salale University, Fiche, Ethiopia
                [4 ]GRID grid.452387.f, ISNI 0000 0001 0508 7211, TB Research Team, TB and HIV/AIDS Research Directorate, , Ethiopian Public Health Institute, ; Addis Ababa, Ethiopia
                Author information
                http://orcid.org/0000-0002-6117-1589
                Article
                Publisher ID: 4074
                DOI: 10.1186/s12887-023-04074-2
                PMC ID: 10245613
                PubMed ID: 37280581
                SO-VID: 97986132-cb31-41a5-a93c-8c998145e55c
                Copyright © © The Author(s) 2023
                License:

                Open Access This article is licensed under a Creative Commons Attribution 4.0 International License, which permits use, sharing, adaptation, distribution and reproduction in any medium or format, as long as you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons licence, and indicate if changes were made. The images or other third party material in this article are included in the article's Creative Commons licence, unless indicated otherwise in a credit line to the material. If material is not included in the article's Creative Commons licence and your intended use is not permitted by statutory regulation or exceeds the permitted use, you will need to obtain permission directly from the copyright holder. To view a copy of this licence, visit http://creativecommons.org/licenses/by/4.0/. The Creative Commons Public Domain Dedication waiver ( http://creativecommons.org/publicdomain/zero/1.0/) applies to the data made available in this article, unless otherwise stated in a credit line to the data.

                History
                Date received : 23 June 2022
                Date accepted : 16 May 2023
                Categories
                Subject: Research
                Custom metadata
                issue-copyright-statement © BioMed Central Ltd., part of Springer Nature 2023

                ScienceOpen disciplines: Pediatrics
                Keywords: human immunodeficient virus,early infant diagnosis,mtct,hiv-exposed infants
                Data availability:
                ScienceOpen disciplines: Pediatrics
                Keywords: human immunodeficient virus, early infant diagnosis, mtct, hiv-exposed infants

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