Assessment of Mother-to-Child HIV Transmission Program in Cameroon: A Three-Year Study Using Statistical Models

Abstract

Background

In Cameroon, Prevention of Mother-to-Child Transmission (PMTCT) program has been implemented for over two decades, yet persistent challenges hinder their effectiveness. This study evaluates the effectiveness of PMTCT program between 2021 and 2023 throughout the national territory.

Methods

This was a retrospective analysis of data from Cameroon's PMTCT program with data sourced from the national health records and analyzed using advance statistic technics.

Results

The findings indicate a slight upward trend in transmission prevalence from 0.98% in 2021 to 1.06% in 2023. Maternal human immunodeficiency virus (HIV) status during pregnancy emerged as a major driver of transmission, highlighting gaps in repeated HIV testing. We note a national wide decline of first antenatal attendances and HIV testing coverage. Male partner involvement remained low and retention in care varied overtime inline to specific indicators.

Conclusion

While Cameroon's PMTCT program has made progress, challenges persist with mother-to-child transmission-related program indicators.

Keywords

HIV evaluation mother-to-child transmission Cameroon modeling

Introduction

The Prevention of Mother-to-Child Transmission (PMTCT) of human immunodeficiency virus (HIV) remains a pivotal public health challenge, especially in sub-Saharan Africa, where the burden of HIV is disproportionately high.¹ In Cameroon, significant strides have been made to curb vertical transmission, yet the effectiveness and sustainability of these interventions warrant continuous evaluation.² Among West and Central African countries, Cameroon ranks third with the highest burden of HIV, after Nigeria and the Democratic Republic of Congo.³ According to the latest 2022 Cameroon Demographic and Health Survey, the national prevalence of HIV is 2.6%:3.3% in women and 1.7% in men.⁴ In response, the country has developed a National Strategic Plan for HIV/AIDS and Sexually Transmissible Infections which major objectives included the reduction of new infections among newborns, adolescents, adults, elimination of Mother-to-Child Transmission (MTCT) of HIV and reduction of HIV-associated mortality.⁵ Accordingly, Cameroon has defined numerous strategies and priority interventions including the prevention of MTCT of HIV extensively described in its National Guidelines released in 2015 and later revised in 2019.^6,7

Still in Cameroon, a study conducted in Douala assessed the impact of maternal Antiretroviral Therapy (ART), infant prophylaxis, and feeding practices on HIV transmission rates. The findings revealed a 5% transmission rate at nine months postpartum, with notable variations based on ART adherence and infant prophylaxis protocols. Specifically, mothers on ART had a transmission rate of 3%, whereas those without ART experienced a 100% transmission rate. Similarly, infants on nevirapine prophylaxis had a 2.6% transmission rate, contrasting sharply with a 60% rate in those without prophylaxis.¹ In the Adamawa region, a mixed-methods analysis highlighted challenges in PMTCT service delivery. Despite the implementation of strategies such as task-shifting and integration of services, gaps persisted due to inadequate training and coordination among healthcare providers. Additionally, over 60% of HIV-positive breastfeeding women exhibited insufficient knowledge and practices related to PMTCT, underscoring the need for enhanced education and support systems.²

Some studies reported a pooled MTCT prevalence of approximately 7%, with notable geographical disparities across regions. The study highlighted that poor coverage of PMTCT services and suboptimal interventions for both mothers and children are associated with increased MTCT rates.⁸ Results from this study confirms that conducted at Tiko Health District between 2018 and 2020 where MTCT rate was 7.14% among infants born to HIV-positive mothers. Factors such as late attendance to antenatal care (ANC), late maternal HIV diagnosis, and maternal nonadherence to antiretroviral drugs were associated with higher transmission rates.⁹ While existing studies have provided valuable insights into the challenges of PMTCT in Cameroon, there are notable gaps as many studies utilize data from periods before the widespread adoption of current PMTCT guidelines. For instance, a study at Bamenda Regional Hospital analyzed data from 2008 to 2014¹⁰ and given the evolving nature of HIV treatment protocols, there is a need to assess the effectiveness of PMTCT programs using more recent data. Also, previous research has often focused on specific regions or factors without employing advanced statistical modeling to comprehensively assess transmission rates and retention probabilities within PMTCT programs.

Our study aims to address these gaps by evaluating the effectiveness of Cameroon's PMTCT program from 2021 to 2023 using national data and advanced statistics methods. Employing advanced statistical modeling, we will analyze transmission rates and retention probabilities within the program, providing insights to inform policy and optimize intervention strategies.

Methods

Study Design and Setting

This study employed a cross-sectional descriptive design with a retrospective approach, aimed at evaluating the effectiveness of the PMTCT program in Cameroon over a three-year period (2021-2023). The data collection and analysis phase was carried out between January and December 2024, focusing on the assessment of key programmatic indicators across three domains: process indicators (eg, ANC attendance, HIV testing uptake), results indicators (eg, ART initiation and adherence, infant prophylaxis), and impact indicators (eg, MTCT rates, retention in care). A quantitative methodology was adopted, relying on secondary data extracted from PMTCT program reports and national health databases containing data from HIV/AIDS monitoring facility-level registers in all health districts across the national territory. The study utilized statistical modeling techniques, including logistic regression and survival analysis, to estimate HIV transmission probabilities and evaluate retention rates across different stages of the PMTCT cascade. The retrospective design allowed for the inclusion of data from a defined historical period (2021-2023), providing an opportunity to assess trends, identify gaps, and quantify the effectiveness of implemented strategies under the national PMTCT guidelines.

The National AIDS Control Committee (NACC) is the central body responsible for coordinating and managing Cameroon's National AIDS Control Program. Established in 1998, the NACC operates under the leadership of the Minister of Public Health and under the coordination of a Permanent Secretary. The committee's primary mission is to define and implement national policies to combat HIV/AIDS, ensuring a comprehensive and coordinated response across the country within the 10 regions of Cameroon. It is also responsible for the overall management of HIV and MTCT data across these regions and compiles it yearly to produce a report. As of 2022, Cameroon reported approximately 480,228 people living with HIV, with 9898 new infections recorded that year. Notably, there has been a significant decline in HIV prevalence among individuals aged 15 to 64 over the past 14 years, decreasing from 5.4% in 2004 to 2.7% in 2018. This progress is attributed to focused strategies and the collaborative efforts of the NACC and its partners.¹¹ The reporting of this study conforms to the template for Strengthening the Reporting of Observational Studies in Epidemiology (STROBE) Statement: guidelines for reporting observational studies provided by the Equator Network for cross sectional studies (Supplemental Table 1).

Study Population

The study population comprised of pregnant women enrolled in the PMTCT program in Cameroon across the 12 regions covering 181 health districts from 2021 to 2023. These women were either newly diagnosed with HIV during ANC visits or already aware of their HIV-positive status prior to pregnancy and had been on ART before their first ANC contact. No initial sample size was calculated for this study but a total number of 2,350,179 pregnant women were received at their first ANC across the national territory. This was the key indicator from which other studied indicators were derived from inline to the secondary data put at our disposal and was adopted as the sample size for this study.

Inclusion and Exclusion Criteria

The inclusion criteria for this study were women who had attended at least one ANC visit between 2021 and 2023 in any health facilities under legal conformity with the state across all regions of the national territory, with data sources demonstrating completeness of information on the indicators of interest considered eligible. Exclusion criteria included women who did not attend any ANC visit during the study period, records with incomplete or missing data on key study indicators, as well as health facilities with insufficient or inconsistent data reporting or under irregularity with the state.

Ethical Approval and Informed Consent

This study utilized secondary patient data, which were fully anonymized prior to access and analysis. Ethical approval for the study was granted by Cameroon Centre Ethics Committee of Research for Human Health, with reference number 0677/CRERSHC/2024. No inform consent was needed for this study and all procedures complied with relevant institutional guidelines and national regulations on research ethics. No direct contact with patients occurred, and no identifiable personal information was used, ensuring the confidentiality and privacy of all individuals included in the dataset. In addition to this, administrative authorization was obtained from the Regional Delegation of Public Health for the Centre and from the NACC to assess data.

Data Collection

This study focused on secondary data and was collected from the NACC using a predesigned excel sheet with key indicators of interest from already available monthly data compiled from 2021 to 2023. The indicators of interest were: Process indictors focusing on measuring activities and service delivery within the PMTCT program, Result indicators focusing on measuring immediate results or outputs of program actions, including HIV status and ART, and Impact indicators measuring long-term outcomes, such as HIV transmission rates and ART initiation among HIV-positive infants.

Data Synthesis and Bias Minimization

The data collected were structured by regions (the 10 regions of Cameroon) and aligned with the indicators of interest during the study. The dataset was cleaned and organized to ensure completeness and comparability across regions before analysis.

To minimize bias, this study used secondary data compiled by the NACC across all 10 regions of Cameroon, ensuring national representativeness and reducing selection bias. Only records meeting strict completeness criteria were included, while inconsistent reports were excluded, and data were cleaned to improve accuracy. Analytical bias was addressed through Kaplan-Meier survival curves, Cox proportional hazards models, generalized linear models (GLMs), and Auto-Regressive Integrated Moving Average (ARIMA) forecasting, adjusting for confounders and sample size variations. Weighting with Ptme_25 corrected unequal distributions. The retrospective design reduced observer bias, and anonymization safeguarded confidentiality, while STROBE guidelines enhanced transparency and reproducibility.

Statistical Analysis

Data analysis was conducted using R software for both descriptive and advanced statistical techniques. A survival analysis was performed to evaluate the retention duration of women and children in care after being tested HIV-positive and initiated on ART. The Kaplan-Meier survival curve was used to estimate retention probabilities over time for different indicators, while the Cox proportional hazards model assessed the effect of selected predictors (those found significant in the Kaplan-Meier analysis, presented in Table 1) on retention duration.

Table 1.

Indicators Associated With Retention Within MTCT Program.

Coef	exp(coef)	se(coef)	z Pr(>\|z\|)
Ptme_10 −0.014584	0.985522	0.003019	−4.830 1.36e-06^a
Ptme_11 −0.001424	0.998577	0.003064	−0.465 0.642
Ptme_27 −0.003574	0.996433	0.002510	−1.424 0.154
Ptme_31 0.001777	1.001779	0.002750	0.646 0.518

Statistically significant, P < .05.

To assess HIV transmission risks among pregnant women and newborns, 10 key variables were examined, with transmission proportion converted into a binary outcome. A GLM with binomial logistic regression was applied, using Ptme_25 (HIV-positive women who gave birth at a health facility) as a weighting variable to adjust for sample size variations. The model demonstrated good fit with a residual deviance of 527.78 (compared to a null deviance of 627.06) and an Akaike Information Criterion (AIC) value of 1529.2. Stepwise regression (bidirectional forward and backward selection) was subsequently performed to optimize model fit, systematically removing nonsignificant predictors. The initial model had an AIC of 1511.84, which was reduced to 1505.9 in the final model, retaining five significant predictors.

Finally, an ARIMA time series model was employed to forecast key indicators, namely HIV-positive cases at first ANC visit (Ptme_04), later HIV detection (Ptme_07), ART initiation (Ptme_11), retesting during labor (Ptme_22), and facility-based deliveries (Ptme_25) for a 12-month period. The final regression model obtained from stepwise regression was then used to predict the transmission proportion for the same 12-month period by incorporating the forecasted values of Ptme_04, Ptme_07, Ptme_11, Ptme_22, and Ptme_25 (see list of indicators in the annex).

Results

National Wide Characterization of the Data

Process indicators: 2.350.179 pregnant women were received at their first antenatal visit (ANC1) irrespective of the age of the pregnancy. 20% of the pregnant women were tested negative at ANC1 and were retested at ANC3 or ANC4. 8.4% of pregnant women took their first HIV test during labor and delivery, of which 2903 were tested positive. 4.884 HIV+ women who delivered outside health facilities and brought their babies within 72 h and 3.217 pregnant women were tested HIV+ in the delivery room and were initiated on ART.

Result indicators: 1.229 pregnant women were tested negative at ANC1 but later tested HIV+ at ANC2, ANC3, or ANC4; 1.437 male partners of pregnant women were tested HIV+, 27.799 infants born to HIV+ mothers who underwent polymerase chain reaction (PCR) testing between 6 and 8 weeks, 10.342 at 8 weeks, 14.166 at 9 months, and 12.384 serology testing at 18 months.

Impact indicators: 36.625 infants were born to HIV+ mothers in health facilities; 431 infants were tested HIV+ by PCR after 8 weeks, 241 at 9 months, 236 by serology at 18 months.

Mother-to-Child Transmission Prevalence and HIV+ Cases During Labor/Delivery from 2021 to 2023

Figure 1 highlights a slight upward trend in the prevalence of MTCT of HIV in Cameroon over the past three years, with rates increasing from 0.98% in 2021 to 1.06% in 2023, resulting in a combined prevalence of 1.01%. A key observation is that all children who tested HIV-positive by PCR at 6 to 8 weeks remained HIV-positive during follow-up tests at 9 months (PCR) and 18 months (serology). Notably, these cases involved mothers who initially tested HIV-negative during ANC but were later diagnosed as HIV-positive at delivery. Moreso, Figure 2 shows a high frequency of pregnant women screened during labor and delivery with 2903 positive cases.

Figure 1.

Nationalwide Prevalence of MTCT Rates from 2021 to 2023.

Figure 2.

Frequency of Pregnant Women Human Immunodeficiency Virus (HIV) Screened and Positive Cases During Labor and Delivery.

Antenatal Care Attendances and Frequency of HIV Screening

Figure 3 presents data on the number of pregnant women attending first ANC and HIV testing between 2021 and 2023. It shows a significant nationwide decline in the number of women attending their first ANC visit, with a total decrease of 47,771 women. The regions experiencing the largest declines are North (19,409), Littoral (7500), East (7308), Centre (4783), and North-West (4268). Similarly, it also illustrates a nationwide decline in the number of women attending their first HIV test during pregnancy, with a decrease of 20,370 cases over the past three years. The regions with the highest reductions in HIV testing rates are North, East, Littoral, North-West, Adamaoua, and Centre.

Figure 3.

Frequency of First Antenatal Care (ANC) Attendance and Human Immunodeficiency Virus (HIV) Screening from 2021 to 2023 Across the 10 Regions of Cameroon.

Figure 4 highlights the disparity in HIV screening between pregnant women and their male partners during the 2021 to 2023 period. It shows the number of pregnant women who underwent HIV screening during their first ANC visit compared to the number of male partners who participated in HIV testing. Despite the recent increase in the number of male partners tested, a clear gap remains in the participation rates between pregnant women and their male counterparts.

Figure 4.

Comparison of Human Immunodeficiency Virus (HIV) Screening Rates Between Pregnant Women and Their Male Partners (2021-2023).

Modeling MTCT Factors Associated With Retention Probability Within the PMTCT Program National Wide

Table 1 shows that HIV+ pregnant women initiated on ART on site (Ptme10) was a statistically significant predictor with a hazard ratio of 0.986, meaning that a one-unit increase in Ptme 10 reduced the hazard of leaving care by 1.4%. This finding suggests that higher levels of Ptme 10 are associated with better retention. In contrast, the other predictors, including HIV+ pregnant women already on ART at ANC1 (Ptme 11), exposed children on nevirapine within 72 h (Ptme 27), and exposed children on cotrimoxazole at 6 weeks (Ptme 31), were not statistically significant, indicating that their effect on retention could not be confirmed within the scope of this analysis.

After conducting the Kaplan-Meier survival and Cox proportional hazards analysis, the curves on Figure 5 reveals a steady decline in retention as time progressed, indicating that individuals exited care or were lost to follow-up over the observed period.

Figure 5.

Kaplan-Meier Survival Curve and Cox Proportional Hazards Survival Curve for Retention Probability Within the MTCT program.

Modeling Mother-to-Child HIV Transmission Risk During Pregnancy and Delivery National Wide

The GLM results highlight significant predictors as shown in Table 2: HIV-positive at first ANC visit (Ptme_04): Positive and highly significant (P < .001), suggesting higher transmission risk. Seroconversion during pregnancy (Ptme_07): Negative and significant (P < .01), indicating that later detection may allow for interventions reducing transmission. HIV+ pregnant women already on ART at first ANC visit (Ptme_11): Negative and significant (P < .05), reinforcing ART's protective role. Other predictors, such as HIV-positive women initiated on ART or INH prophylaxis, and those diagnosed in the delivery room, did not show statistically significant associations with transmission.

Table 2.

Indicators Associated With MTCT Probability Within the Program.

Coefficients:
Estimate Std. Error z value Pr(>\|z\|)
(Intercept)	−3.449e + 00	7.943e-02	−43.424	<2e-16
Ptme_04	9.533e-03	2.373e-03	4.017	5.89e-05^a
Ptme_05	4.409e-04	2.135e-03	0.207	0.83639
Ptme_07	−1.387e-02	4.535e-03	−3.059	0.00222^a
Ptme_10	3.677e-03	2.503e-03	1.469	0.14181
Ptme_11	−5.252e-03	2.137e-03	−2.457	0.01399^a
Ptme_15	−6.110e-03	4.192e-03	−1.458	0.14495
Ptme_21	−7.471e-03	6.279e-03	−1.190	0.23409
Ptme_22	−1.460e-05	7.421e-05	−0.197	0.84405
Ptme_24	−2.834e-03	6.501e-03	−0.436	0.66286

Statistically significant, P < .05.

Stepwise Model Selection

The finding showed HIV-positive at first ANC visit (Ptme_04): Strong positive effect (P < .001), indicating higher transmission risk. seroconversion during pregnancy (Ptme_07): Negative effect (P < .01), suggesting earlier interventions may reduce transmission. HIV+ pregnant women on ART at first ANC visit (Ptme_11): Negative effect (P < .01), confirming ART's role in lowering transmission. HIV-negative at ANC, retested during labor (Ptme_22): Not statistically significant (P = .10), indicating uncertain impact. Facility-based deliveries by HIV-positive women (Ptme_25): Strong negative effect (P < .001), highlighting the protective role of institutional deliveries.

Forecasting

The predicted values using ARIMA for the next 12 months suggest that the probability of HIV transmission remains relatively stable, fluctuating between 0.026 and 0.03 (Table 3).

Table 3.

Forecasting Transmission Variables and Proportion for 12 Months.

Forecasted data
months	Ptme_04	Ptme_07	Ptme_11	Ptme_22	Ptme_25	TP
1	361 23.05903	5.462222	47.419080	1008.0619	82.30506	0.0290
2	362 26.43349	5.462222	68.904989	972.0965	95.59537	0.0267
3	363 22.89520	5.462222	29.553658	1078.5854	106.67336	0.0285
4	364 15.28837	5.462222	−2.713464	665.7543	83.32609	0.0302
5	365 22.26377	5.462222	41.658647	1070.5164	106.68889	0.0273
6	366 23.34573	5.462222	46.208453	1022.6709	101.11329	0.0275
7	367 22.40780	5.462222	28.215130	977.9485	98.09012	0.0290
8	368 27.01832	5.462222	76.290994	936.5387	108.22285	0.0250
9	369 28.97740	5.462222	43.116369	1156.6891	103.07505	0.0295
10	370 30.97942	5.462222	49.893483	1246.5671	126.66450	0.0276
11	371 33.63636	5.462222	59.578323	1335.2396	116.86562	0.0286
12	372 34.04752	5.462222	52.313237	1175.2915	114.37221	0.0290

Abbreviation: TP, transmission proportion.

Discussion

This study provides a three-year evaluation (2021-2023) of the PMTCT program in Cameroon using a statistical modeling approach. The findings indicate a slight upward trend in MTCT prevalence from 0.98% in 2021 to 1.06% in 2023, with a combined prevalence of 1.01%. This increase, although relatively small underscores persistent gaps in early HIV detection and maternal follow-up that contribute to late maternal seroconversion and subsequent vertical transmission. This analysis used a retrospective cross-sectional design with national data aggregated from health facilities, and statistical modeling techniques were applied to examine retention probabilities and transmission rates within the PMTCT cascade. This methodological approach enabled identification of key predictors while controlling for temporal patterns. However, the cross-sectional nature limits the capacity to establish causality.

Trends in MTCT and Implications for PMTCT Programs

The upward trend in MTCT prevalence, though modest, highlights the continued challenges in fully eliminating vertical HIV transmission. All infants who tested HIV-positive by PCR at 6 to 8 weeks remained HIV-positive throughout subsequent follow-up tests at 9 months and 18 months. Notably, these cases predominantly involved mothers who tested HIV-negative at their initial ANC visit but later seroconverted during pregnancy or at delivery. Similar findings have been reported in sub-Saharan Africa, where maternal seroconversion during pregnancy remains a significant risk factor for MTCT, reinforcing the importance of repeat HIV testing in late pregnancy.^12,13 Cameroon's national PMTCT guidelines recommend retesting at ANC3 or ANC4, yet data show that many women who initially tested negative were diagnosed HIV-positive only at delivery. This suggests a potential gap in adherence to repeat testing protocols, a finding consistent with reports from other high-burden settings where late maternal HIV diagnosis remains a challenge.¹⁴ Improving provider compliance with national retesting guidelines and scaling up point-of-care testing in later ANC visits could mitigate these missed opportunities.

Predictors of Mother-to-Child HIV Transmission

The findings from this study highlight significant factors influencing mother-to-child HIV transmission. The positive association between HIV-positive status at the first ANC visit (Ptme_04) and increased transmission risk (P < .001) aligns with previous research that emphasizes the importance of early treatment and detection.¹⁵ Additionally, early initiation of ART, particularly at the first ANC visit (Ptme_11), demonstrated a protective role, reducing transmission risk.¹⁶ This result supports the growing body of evidence emphasizing ART's effectiveness in reducing vertical transmission.¹⁷ The negative association with seroconversion during pregnancy (Ptme_07) suggests that timely intervention after HIV detection can mitigate risks, as corroborated by other studies on late diagnosis.¹⁸ Furthermore, the strong negative impact of facility-based deliveries (Ptme_25) reinforces institutional care's protective role, consistent with findings that facility delivery reduces transmission risk.¹⁹ These results emphasize the need for quality ANC services, including prompt ART initiation and institutional delivery promotion.

Decline in ANC Attendance and HIV Testing Coverage

Another critical observation is the decline in first ANC attendance and HIV testing rates among pregnant women over the study period. From 2021 to 2023, the total number of women attending their first ANC visit decreased by 47,771, with the largest declines observed in the North, Littoral, East, Centre, and North-West regions. A similar downward trend was seen in HIV testing coverage, with 20,370 fewer pregnant women undergoing initial HIV screening over three years. This decline could be attributed to multiple factors, including healthcare access barriers, the impact of sociopolitical instability in some regions, and possible disruptions in service delivery.²⁰ ANC visits serve as a primary entry point for PMTCT services, and reduced attendance may contribute to missed opportunities for early HIV diagnosis and timely initiation of ART. Previous studies have shown that late ANC attendance and delayed HIV testing are associated with higher MTCT rates.^21,22 Therefore, future PMTCT strategies should integrate demand-generation approaches, mobile testing units, and community-level awareness campaigns to promote early ANC engagement, particularly in underserved and conflict-affected zones.

Male Partner Involvement in PMTCT

The study also highlights significant disparities in HIV testing rates between pregnant women and their male partners, despite a slight increase in male partner testing over the years. Male involvement has been widely recognized as a key determinant of PMTCT success, as it enhances maternal ART adherence and infant HIV-free survival.^23,24 The persistent gap in male partner engagement observed in this study aligns with findings from other African countries, where cultural barriers, stigma, and limited health system strategies for male inclusion hinder their participation in PMTCT programs.²⁵ To enhance male involvement, policies should promote couple-based counseling, provide flexible clinic hours, and offer targeted incentives or compensations to encourage partner testing and follow-up.

Prevention of MTCT Outcomes: Retention in Care and Transmission Proportion

Survival analysis in this study demonstrated that retention in care among HIV-positive pregnant women and their infants significantly improved when ART was initiated on-site (Ptme 10), reducing the hazard of leaving care by 1.4% per unit increase. This finding underscores the importance of early ART initiation and continuous follow-up to ensure long-term retention. Previous studies have similarly reported that decentralized ART initiation at maternal and child health clinics enhances retention and reduces MTCT risk.²⁶ The model result for the transmission proportion suggests significant predictors such as HIV-positive at first ANC visit, seroconversion during pregnancy, and already on ART at first ANC visit. These findings emphasize early detection, ART adherence, and facility-based care as critical factors in reducing mother-to-child HIV transmission. The forecasting results indicate that HIV transmission risk is projected to remain low, with slight variations over time. The forecasted values for Ptme_04 and Ptme_11 suggest changes in HIV detection and ART coverage, which may influence transmission rates. The ARIMA model for the next 12 months indicates a relatively stable trend, with values ranging between 0.026 and 0.03. This stability suggests that, if current programmatic efforts and interventions in the PMTCT continuum are maintained, the risk of MTCT is unlikely to significantly increase in the short term. Therefore, ongoing surveillance and adaptive programming are essential to sustain low transmission levels and respond to emerging gaps.

This study's strengths include the use of comprehensive, nationally representative data from Cameroon's PMTCT program over a three-year period (2021-2023), allowing for robust analysis of trends and regional variations. The integration of both process and outcome indicators alongside advanced statistical modeling provided a thorough evaluation of program effectiveness, offering actionable insights for policymakers. However, several limitations may have influenced the study outcomes. First, reliance on routine program data may introduce reporting biases or misclassification. Second, information on ART stock outs, loss to follow-up, and socioeconomic barriers where not mentioned in the data provided which might continue to affect transmission rates as equally highlighted by UNAIDS.²⁰ The cross-sectional nature of the design limits causal inference, though associations provide valuable programmatic insights.

Strength and Limitation of the Study

This study presents several strengths and limitations. On the strength side, it utilized nationally representative secondary data covering all 10 regions of Cameroon, enhancing the generalizability of findings compared to studies restricted to specific facilities or regions. The large sample size of over 2.3 million pregnant women increased statistical power and reliability of estimates. Advanced statistical approaches, including survival analysis, Cox proportional hazards modeling, GLMs, and ARIMA forecasting, enabled a comprehensive analysis of retention in care, HIV transmission risks, and prediction of future trends. The inclusion of process, result, and impact indicators provided a multidimensional assessment of PMTCT program effectiveness, moving beyond simple prevalence reporting. Additionally, alignment with STROBE guidelines strengthened methodological rigor and transparency. However, limitations exist. The reliance on secondary routine program data introduced risks of underreporting, misclassification, and missing information, potentially affecting results. Regional variations in reporting practices may bias interregional comparisons. The retrospective cross-sectional design restricts causal inference, and important confounders such as maternal socioeconomic status, facility access, counseling quality, and cultural factors were not captured. Forecasts from ARIMA and other models remain limited by underlying assumptions and data quality, affecting real-world applicability. Moreover, the study's scope, restricted to 2021 to 2023, while recent, does not reflect longer-term trends or impacts of future changes in national HIV guidelines and health system dynamics.

Conclusion

This study underscores the critical role of early HIV detection, timely ART initiation, and facility-based deliveries in reducing MTCT of HIV. Though also highlighting persistent gaps and regional disparities in the implementation of the PMTCT program in Cameroon, despite overall progress being HIV-positive at the first ANC visit was strongly associated with transmission risk, highlighting the need for prompt screening and ART coverage during pregnancy. Conversely, early ART initiation and institutional deliveries demonstrated protective effects, supporting the integration of PMTCT within routine maternal and child health services. Although retesting during labor did not show statistical significance in this study, its potential programmatic value warrants further exploration. Strengthening adherence to national PMTCT guidelines, particularly regarding repeat testing and male partner involvement, could further reduce transmission risks and improve maternal–infant outcomes in Cameroon. These findings therefore, serve as a call to action for policymakers and stakeholders to reinforce monitoring systems and adopt evidence-based strategies that address contextual barriers, ultimately accelerating progress toward the elimination of pediatric HIV in Cameroon.

Supplemental Material

sj-docx-1-jia-10.1177_23259582251382267 - Supplemental material for Assessment of Mother-to-Child HIV Transmission Program in Cameroon: A Three-Year Study Using Statistical Models

Supplemental material, sj-docx-1-jia-10.1177_23259582251382267 for Assessment of Mother-to-Child HIV Transmission Program in Cameroon: A Three-Year Study Using Statistical Models by Misonge Kapnang Ivan, Fokam Joseph, Esoh Rene Tanwieh, Charles Kouanfack and Donatien Gatsing in Journal of the International Association of Providers of AIDS Care (JIAPAC)

Supplemental Material

sj-docx-2-jia-10.1177_23259582251382267 - Supplemental material for Assessment of Mother-to-Child HIV Transmission Program in Cameroon: A Three-Year Study Using Statistical Models

Supplemental material, sj-docx-2-jia-10.1177_23259582251382267 for Assessment of Mother-to-Child HIV Transmission Program in Cameroon: A Three-Year Study Using Statistical Models by Misonge Kapnang Ivan, Fokam Joseph, Esoh Rene Tanwieh, Charles Kouanfack and Donatien Gatsing in Journal of the International Association of Providers of AIDS Care (JIAPAC)

Footnotes

Acknowledgments

The authors acknowledge Health Organisation Welfare for supporting the research implementation and providing technical assistance.

ORCID iDs

Misonge Kapnang Ivan

Esoh Rene Tanwieh

Ethical Approval and Informed Consent

This study was approved by Cameroon Centre Ethics Committee of Research for Human Health (approved number 0677/CRERSHC/2024), and no study participant inform consent is required from studies utilizing secondary data according to the ethics committee and NACC.

Ethical Statement

This study utilized secondary patient data, which were fully anonymized prior to access and analysis. Ethical approval for the use of these data was granted by Cameroon Centre Ethics Committee of Research for Human Health, reference number 0677/CRERSHC/2024. All procedures complied with relevant institutional guidelines and national regulations on research ethics. No direct contact with patients occurred, and no identifiable personal information was used, ensuring the confidentiality and privacy of all individuals included in the dataset.

Informed Consent

Informed consent was not required for this study as it did not involve direct interaction with human participants. However, authorization to access nationwide programmatic data was obtained from the Cameroon National AIDS Control Committee.

Authors’ Contributions

Misonge Kapnang Ivan and Charles Kouanfacks conceived the original idea. Esoh Rene Tanwieh and Misonge Kapnang Ivan wrote the initial draft. Charles Kouanfack, Fokam Joseph, and Donatien Gatsing contributed to the subsequent drafts. All authors edited and approved the final manuscript.

Funding

The author(s) received no financial support for the research, authorship, and/or publication of this article.

Declaration of Conflicting Interests

The author(s) declared no potential conflicts of interest with respect to the research, authorship, and/or publication of this article.

Supplemental Material

Supplemental material for this article is available online.

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