HIV Sero-status Outcomes and Associated Factors Among HIV-Exposed Children at Four Public Hospitals in Addis Ababa,Ethiopia (2018-2023): A Cross-Sectional Study

Abstract

Background

Human immunodeficiency virus (HIV)/Acquired immunodeficiency syndrome Acquired immunodeficiency syndrome can affect any age group, and it is the major cause of pediatric morbidity and mortality worldwide; challenges persist in identifying and linking all HIV-exposed infants to early infant diagnosis and care.

Methods

A cross-sectional study was done using secondary data extracted from the medical records of 244 HIV-exposed children from HIV-infected mothers who were on follow-up from January 2018 to December 2023 and enrolled in four public hospitals. Data were collected and imported into Epi-Data and exported to SPSS version 26.0 for analysis. A binary logistic regression model was used to fit each variable.

Results

Among 244 HIV-exposed infants, 10 (4.1%) were diagnosed as HIV positive. Children who received cotrimoxazole preventive therapy {AOR 0.89 = 95% CI (0.02-0.79)} and children born at a health facility 91.2% {AOR 0.088 = 95% CI (0.01-0.58)} were associated with positive HIV sero-status.

Conclusion

The level of HIV infection among infants was relatively high compared with the global goal of less than 2% for 2030.

Keywords

HIV exposed infant prevention of mother-to-child transmission

Introduction

Acquired immunodeficiency syndrome (AIDS) is the most severe form of human immunodeficiency virus (HIV), which impairs the body's immune system.¹ IV/AIDS continues to be a major global cause of pediatric illness and mortality, affecting individuals of all ages. Globally, an estimated 1.3 million women with HIV become pregnant each year.¹ Every year, about 1.3 million women living with HIV become pregnant worldwide.²

In any absence of intervention, an HIV-positive mother has a 15% to 45% probability of transmitting the virus to her unborn child during pregnancy, labor, delivery, or the breastfeeding period. In 2022, anti-retroviral therapy (ART) was accessible to 85% of women and girls global.³

Approximately 70% of infections with HIV globally are located in this region, with women responsible for 60 per cent of infections, and gaps in clinical treatment of women and newborns suffering from HIV-related problems in urban as well as rural areas.⁴ Compared to women in other locations, in sub-Saharan Africa have a disproportionately burden of HIV in women.⁵ HIV-exposed children mean that your baby has been in contact with the HIV virus, but we do not know whether he/she is HIV-infected.

Mother-to-child transmissions of HIV in children remain a serious worldwide health concern, particularly in Sub-Saharan Africa, since they accounted for 90% of all new pediatric HIV infections globally in 2020.⁶ In Sub-Saharan Africa, with over 700,000 people currently living with HIV including 57,000 children.⁴ HIV-exposed newborns are more likely than their HIV-unexposed peers to experience poor growth, developmental delays, and mortality, according to recent research in sub-Saharan African nations such as South Africa, even in cases where prevention of mother-to-child transmission (PMTCT) intervention uptake is high.⁷

Ethiopia has an HIV/AIDS burden, with an estimated number of women affected by HIV of more than 245,000 in 2018.⁸ As a result, a significant percentage of HIV-exposed newborns in the country are at risk of acquiring the infection themselves.⁹ A substantial number of children are exposed to the virus through vertical transmission from their HIV-positive mothers. The widespread implementation of PMTCT programs has reduced MTCT rates, yet challenges remain. In Ethiopia, MTCT rates were estimated at 9.93% in 2018, demonstrating the ongoing need to identify and address barriers to successful PMTCs.¹⁰

Considerable progress has been made in preventing PMTCT nationwide, reducing transmission rates from 27% in 2011% to 8% in 2020.¹¹ However, an estimated 57% of pregnant women still do not access ART.⁸ There has been progress in preventing MTCT in Ethiopia through expanded ART programs. However, Identifying and linking HIV-exposed early infants diagnosis and care services without intervention remains challenging.³

The majority of HIV infections in children under the age of 15 are transmitted from mother to child.¹² In 2009, before the implementation of the global strategy, the total transmission of HIV from mother to child rate was 28% in 21 target nations, including Ethiopia, and it was decreased to 14% by 2014.²

MTCT of HIV is a critical public health concern in Sub-Saharan African countries.¹³ The spread of HIV remains a serious public health problem, especially in Sub-Saharan Africa. HIV-exposed infants—those delivered from HIV-positive mothers—face particular challenges that can impair their health outcomes during the critical early months of life.

MTCT is responsible for 95% of pediatrics HIV infections, and the risk of transmission increases significantly if the mother is not treated.¹⁴ Mother-to-child transmission of HIV remains one of the greatest challenges in the country's response to HIV.¹⁰ Despite attempts to eliminate pediatrics HIV in Ethiopia, transmission from mother to child of HIV remains a challenge, and HIV-exposed newborns suffer an increased risk of poor health outcomes in their early years of life.³

The main aim of the study was to assess the HIV sero-status outcomes and associated factors among HIV-exposed children from four public hospitals in Addis Ababa, Ethiopia, 2024. This study contributes to improved education and health professionals’ skills and knowledge on PMTCT, identifies factors independently associated with HIV MTCT, provides input for interventional planning, and allows researchers to assess the impact of various interventions, such as early initiation of ART, prophylaxis against opportunistic infection, and nutritional support.

Methods

Study Area and Period

The study was conducted in Addis Ababa, the city and founding headquarters of Ethiopia's African Union. The central statistics office estimates that the city will have 11 sub-cities and 3.6 million residents by 2020.¹⁵ In total, there are 14 hospitals in the city; out of these, six of them are controlled by the federal government, six of them are governed by the Addis Ababa City Health Bureau, one is owned by the police force, and one is owned by the defense army. This investigation was conducted in four randomly selected public hospitals in Addis, and this study was conducted in the city of Addis Ababa at four public hospitals that were selected at random. These are St Paul's Hospital Millennium Medical College, Gandhi Memorial Hospital, Zewditu Memorial Hospital, and Tikur Anbessa Specialised Hospital. The study period was from March 10 to March 30, 2024.

Study Design

An institutional- retrospective cross-sectional study was done.

Source Population and Study Population

Source Population

HIV-exposed children who were followed-up at public hospitals in Addis Ababa whose age was less than 18 months.

Study Population

The study population comprised all HIV-exposed children who had follow-up in randomly selected public hospitals in Addis Ababa whose age was less than 18 months.

Inclusion and Exclusion Criteria

Inclusion Criteria

All HIV-exposed children who have undergone a deoxyribonucleic acid-polymerase chain reaction test (DNA-PCR) prior to 18 months of age were included.

Additionally children who had undergone rapid antibody tests had done during follow-up 6 weeks after cessation of breastfeeding and who had been registered were be included in this study.

Exclusion Criteria

HIV-exposed children transferred in or transferred out from health facility, HIV-exposed children with incomplete data, and HIV-exposed children mother not enrolled in PMTCT were excluded.

Sample Size Determination and Procedure

Sample Size Determination

For the first objective, HIV Sero-Status of HIV exposed children, a single population proportion formula used by considering the following statistical assumptions CI = confidence interval among exposed children.

(Z α/2 = Z score of 95% CI,

d = margin of error, 5%).

P = Population proportion of HIV transmission among exposed children, 17.5% in Dire Derwa¹⁰ City, Ethiopia.

\frac{{(Z \propto / 2)}^{2} P (1 - P)}{d^{2}}

(1.96) ² *0.175*0.825/ (0.05) ²; thus, 3.84*0.175*0.825/0.0025 = 222

After adding a non-response rate of 10%, the total sample size was 244.

Sampling Technique

For this study, simple random sampling technique was used to select study participants as shows in the figure below (figure 1).

Figure 1.

Schematic diagram for sampling procedure for HIV-exposed children who were followed-up at public hospitals in Addis Ababa, 2024. HIV, human immunodeficiency virus.

Operational Definitions

Mother-to-child transmission: the passage of HIV from mother to her child during pregnancy, labor, delivery or breastfeeding.¹⁶

Pre-exposure prophylaxis: medication used by people who do not have HIV but are at high risk of being exposed.¹⁷

Anti-Retroviral Therapy Adherence

ART adherence was calculated based on missed doses. There were three grades Out of 60 doses,

Good: if fewer than 3 of the 60 doses were missed.

Fair: 3-9 doses out of 60 doses were missed.

Bad: more than 9 of the 60 doses were missed.¹⁴

Vertical transmission: The HIV virus passes from an HIV-positive mother to her baby during pregnancy.¹⁸

HIV-exposed infants: Infants born to HIV-infected mothers or HIV antibody-positive infants.¹⁴

ARV prophylaxis: short-term use of ARV drugs in mothers and/or infants to reduce MTCT.¹⁷

Outcome of HIV-exposed infants. The final HIV status of exposed infants after antibody testing or DNA-PCR results.

For non-breastfed infants: HIV DNA/PCR result for children aged <18 months or HIV antibody test results for children aged ≥ 18 months.¹⁴

For breastfed infants: HIV DNA/PCR results for children aged <18 months after cessation of breastfeeding or HIV antibody test results for children aged ≥ 18 months’ 6 weeks after cessation of breastfeeding.¹⁸

Study Variables

Dependent Variable

HIV sero-status outcomes of HIV exposed children.

Independent Variable

Socio-demographic factors (age, educational level of the mother, marital status, parity, residence, religion, and economic status).

Maternal factors (ANC visit, ARV initiation, place of delivery, mode of delivery, CD4 count).

Children factor (Birth weight, feeding practice, follow-up, and ARV prophylaxis intake, premature).

Data Collection Instrument and Procedure

Data extraction sheets were used to obtain the data. Data extract sheets were generated from the national standard HIV-exposed children follow-up chart and the PMTCT registration book, including socio-demographic characteristics (mother age, marital status, level of education, infant age, sex of children, birth weight); PMTCT interventions provided to the mother and her children, antibody body, DNA/PCR tests, test results, and the first 6 months of feeding. The data were gathered by hospital nurses working in the PMTCT department using structured data extraction forms. Following 2 days of training, the data collectors began collecting data. The data were gathered at the PMTCT clinic from the treatment and follow-up records of exposed children as well as their mothers’ PMTCT.

Data Quality Control

The data were gathered at the PMTCT clinic through reviewing mothers’ PMTCT and exposed children's care integrated register books. The primary investigator was closely monitoring the process. The data collectors received training for 2 days before and 1 day following the pretest. The training included how to gather data, the overall goal, the significance of the study, and the confidentiality of the information. The training was provided in the form of a discussion using the data extraction sheet. To ensure data quality, the primary investigator worked with the data collectors throughout the data collection process to ensure that they were correctly doing so.

Furthermore, during data management, storage, and analysis, the lead investigator ensured that all acquired data was complete, consistent, and clear. Five per cent of the pretests were completed before the actual data collection began at the selected public hospital. The reporting of this study conforms to the STROBE Statement of cross-sectional study (SF 1).

Data Processing and Analysis

The data were collected, coded, and entered into Epi-Data 4.6. The data was then exported to SPSS Version 26 statistical software for further analysis. For continuous variables, descriptive statistics are reported as mean and standard deviation, as well as a measure of dispersion. In addition, descriptive summaries for categorical variables were presented using tables, figures, and charts. The variance inflation factor was used to determine whether there were outliers or multicollinearity among the independent variables. Both the bivariate and multivariate binary logistic regression models were fitted. Variables having P-values <0.25 from the bivariable analysis were included in the multivariable analysis.

The Hosmer-Lemeshow goodness of fit test was used to check model fitness. Variables with P-values < 0.05 were found to be statistically significant predictors of positive outcomes in HIV-exposed infants, with an adjusted odds ratio of 95%.

Results

Socio-Demographic Characteristics of the Study Population

A total of 244 study participants were included with a response rate of 100%. From a total study participant of 93 (38.1%), the mothers were aged between 25 and 30 years. Regarding educational level, 78 (32.0%) had attained secondary school. Regarding marital status, 109 (44.7%) participants were married, and 147 (60.2%) of the women were multiparous. The majority of 175 (72%) lived in urban areas (Table 1).

Table 1.

Socio-Demographic Characteristics of Mothers of HIV-Exposed Children in Addis Ababa, Ethiopia, 2024 (n = 244).

Variable	Category	Frequency(n)	Percent (%)
Age of the mother	15–24	41	16.8
	25–30	93	38.1
	30–34	54	22.1
	35–39	48	19.6
	40–44	8	3.2
Level of education of the mother	Cannot read and write	20	8.2
	Read and write	45	18.4
	Primary	46	18.9
	Secondary	78	32.0
	Tertiary	55	22.5
Place of residence	Rural	69	28
Place of residence	Urban	175	72
Marital status of the mother	Single	84	34.4
	Married	109	44.7
	Separated/divorced/ widowed	51	20.9
Parity of the mother	Multi parity	147	60.2
Parity of the mother	Prim parity	97	39.8

PMTCT Interventions for the Mother

Regarding the CD4 counts of the mother taken before the last pregnancy, 35.3% were less than 350 mm³, while 64.7% were greater than 500 mm³. The CD4 counts of the mothers prior to the before last pregnancy were 35.3% less than 350 mm³ and 64.7% larger than 500 mm³. The majority of mothers who participated in the study, 213 (87.3%), were on ARV prior to this pregnancy. The majority of mothers had ANC flow of 216 (88.5%), and approximately 204 (83.6%) had attended more than 4 antenatal care visits during pregnancy. For 206 (84.4%) of the mothers, ART was initiated during this pregnancy, and those whose ART drugs were initiated for the mother (206, 84.4%) had good adherence. Of the mothers who delivered at the health facility, 132 (54.1%) had a normal delivery, whereas 112 (46.9%) had a cesarean section. Because the viral load 196 (80.6) was less than 1000 ml/copy, approximately 56 (23%) patients experienced illness during pregnancy. Regarding the AIDS stage of mothers about to give birth, 34 (13.9%) were classified as Stage 1, 93 (38.1%) were classified as Stage 2, 103 (42.2%) were classified as Stage 3, and 14 (5.7%) were classified as Stage 4 (Table 2).

Table 2.

PMTCT Intervention for Mothers of HIV-Exposed Infants in Addis Ababa, Ethiopia, 2024 (n = 244).

Variable	Category	Frequency(n)	Percent (%)
Mother have CD4 counts taken before last pregnancy	Yes	244	100
Mother have CD4 counts taken before last pregnancy	No	0	0
Mother CD4 count	0–350	86	35.3
Mother CD4 count	>351	158	64.7
Mother viral load	0–1000	196	80.3
Mother viral load	>1000	48	19.7
Antenatal care clinic attend	Yes	216	88.5
Antenatal care clinic attend	No	28	11.5
If yes number of ANC visits	1–4	40	16.4
If yes number of ANC visits	>4	204	83.6
Mothers on ARVs prior to pregnancy	Yes	213	87.3
Mothers on ARVs prior to pregnancy	No	31	12.7
ART drugs initiated for the mother	during pregnancy	206	84.4
	during labor/delivery	34	13.9
	after delivery	4	1.6
Mothers adherence status	Good	213	87.3
	Fair	16	6.6
	Poor	15	6.1
Illness during pregnancy	Yes	56	23
Illness during pregnancy	No	188	77
WHO stage of the mother	I	34	13.9
	II	93	38.1
	III	103	42.2
	IV	14	5.7
Place mother deliver	Health facility	227	93
Place mother deliver	Home	17	7
Mode of delivery	SVD	132	54.1
	Elective C/S	71	29.1
	Emergency C/S	41	16.8

PMTCT Interventions for the Infant

Among the total children who were enrolled in the study, 138 (56.6%) were males. With reference to birth weight, 187 (76.6%) of the infants had a weight greater than 2500 grams. According to the findings, 224 (91.8%) of the infants received prophylaxis, whereas 20 (8.2%) did not. Accordingly, those infants received prophylaxis 223 (91.4%) AZT + NVP, 12 (4.9%) received NVP syrup, and the others did not. The majority of exposed children, 223 (91.4%), received cotrimoxazole preventive therapy. Out of the total number of study subjects, 104 (42.6%) experienced exclusive breastfeeding for the first 6 months of life, although 110 (45.1%) of the exposed infants received exclusive formula replacement, and 30 (12.3%) had mixed feeding. The HIV test was done on all 228 children (100%) (Table 3).

Table 3.

PMTCT Intervention for Exposed Infants in Addis Ababa, Ethiopia, 2024 (n = 244).

Variable	Category	Frequency	Percent
Sex of children	Male	138	56.6
Sex of children	Female	106	43.4
Children birth weight	0–2500	57	23.4
Children birth weight	>2500	187	76.6
Infant feeding practice during the first six months of life	Exclusive breastfeeding	104	42.6
	Mixed feeding	30	12.3
	Exclusive infant formula milk	110	45.1
Did child receive ARV prophylaxis	Yes	224	91.8
Did child receive ARV prophylaxis	No	20	8.2
Drugs given for the child	NVP syrup	12	4.9
	AZT syrup	4	1.6
	AZT + NVP	223	91.4
	None	5	2
Child Cotrimoxazole preventive therapy	Received	223	91.4
Child Cotrimoxazole preventive therapy	not Received	21	8.6
Child has been tested for HIV	Yes	244	100
Child has been tested for HIV	NO	0	0
Child antibody HIV test result	Negative	234	95.9
Child antibody HIV test result	Positive	10	4.1
Age was DBS (DNA/ PCR) done	0–6 months	197	80.7
Age was DBS (DNA/ PCR) done	>6 months	47	19.3

Outcomes of HIV-Exposed Infants

From the total populations in this study, 10 (4.1%) of the exposed infants tested positive for HIV (figure 2).

Figure 2.

HIV sero-status outcomes of exposed children at selected public hospitals in Addis Ababa, Ethiopia, 2024 (n = 244). HIV, human immunodeficiency virus.

Factors Associated with HIV Status Among HIV Exposed Infants

Bivariate and multivariate variable analysis was performed between HIV sero-status outcomes (dependent variable) and each independent variable. The factors that showed a P-value of 0.25 and less were added to the multivariable regression model. In multivariable logistic regression analysis, P-values of less than 0.05 were considered for association and initiation. Cotrimoxazole preventive therapy and the delivery place of the mother were significantly associated with HIV status. The odds of receiving cotrimoxazole preventive therapy are 89% {AOR 0.89, 95% CI (0.02-0.79)} less likely to be HIV positive compared to children who did not receive cotrimoxazole preventive therapy (table 4).

Table 4.

Factors Associated with: HIV Sero-status Outcomes of Exposed Children at Selected Public Hospitals in Addis Ababa, Ethiopia, 2024 (n = 244).

Variable	Category	Negative	Positive	COR(95%CI)	AOR(95%CI)	P-Value
Antenatal care clinic attend	Yes	209	7	3.5(0.87,14.74)	0.46(0.09,2.32)	0.46
Antenatal care clinic attend	No	25	3	1	1
Mothers on ARVs prior to pregnancy with this infant	Yes	207	6	0.19(0.05,0.73)	0.39(0.08,1.19)	0.24
Mothers on ARVs prior to pregnancy with this infant	No	27	4	1	1
Mothers adherence status	Good	206	7	0.2290.04,1,17)	0.43(0.35,5.34)	0.12
	Fair	15	1	0.18(0.22,1.59)	0.74(0.41,13.72)	0.84
	Poor	13	2	1	1
Place mother deliver	Health facility	221	6	11.33(2.84,45.19)	0.088(0.01,0.58)	0.01*
Place mother deliver	Home	13	4	1	1
Cotrimoxazole preventive therapy	Received	217	6	8.51(2.18,33.09)	0.11(0.02,0.79)	0.025*
Cotrimoxazole preventive therapy	not Received	17	4	1	1

NB 1 reference *P < 0.05 significance level. COR, crude odd ratio; AOR, adjusted odd ratio; HIV, human immunodeficiency virus.

Discussion

The results of HIV-exposed children who received follow-up care at a particular government hospital in Addis Ababa, Ethiopia, were assessed in an institutionally based retrospective study. The results demonstrated that during the follow-up period, 4.1% of the youngsters acquired HIV. This outcome is still much above the national goals established by the nation, suggesting that further work is required to bridge the gap.

The national objective of MTCT is to reduce HIV transmission to less than 2% by 2030.¹⁹ This finding was lower than that of a study performed in Vietnam that reported an 8.9% transmission rate among children exposed to MTCT; another study conducted in India indicated that the prevalence of HIV due to MTCT is 8.76%.²⁰ In East Africa, the prevalence of vertical HIV infection among HIV-exposed infants was 7.68%.²¹ A study conducted in Eastern Ethiopia revealed that maternal-to-child HIV transmission was 15.7%,²² additionally, also lower than study conducted in Gondar reported that the prevalence of HIV-positive infants born to HIV-positive mothers was 5.5%.²³ In another study conducted in Addis Ababa, the prevalence rate of HIV-positive mother-to-child transmission was 5.1%²³ and study conducted in Addis Ababa indicate the prevalence rate of HIV-positive mother-to-child transmission was 5.1%²⁴ The difference in the results might be due to differences in the study design, study location and time of study.

Compared to a study done in Brazil, where the rate of HIV transmission from mother to child among children exposed to the virus was 2.0%, the prevalence revealed in this study was greater²⁵ and a study conducted in South Africa showed a 2.1% MTCT rate,²⁶ a study conducted in Ethiopia indicated that the overall MTCT rate in Gonder of HIV infection among exposed children was 3.6%,²⁷ and a study conducted in Dessie reported that the transmission rate was 3.8 among HIV-exposed infants.²⁸ This difference may be due to differences in the study population, study design, study area, and period.

The factors associated with positive HIV sero-status outcomes among HIV-exposed infants were receiving cotrimoxazole preventive therapy and the place of delivery.

Children who were received cotrimoxazole preventive therapy were 89% {AOR 0.89=, 95%CI (0.02-0.79)} less likely to be HIV positive compared to children who were not received cotrimoxazole preventive therapy. A study conducted in Oromia, Ethiopia, revealed that children who did not receive cotrimoxazole therapy were seven times more likely to acquire HIV than were children who did receive cotrimoxazole.²⁹ Cotrimoxazole is relatively inexpensive and cost-effective; with the use of logistically feasible interventions to reduce morbidity in HIV-exposed infants but lacking an adequate supply of cotrimoxazole in health facilities, the factors causing poor implementation of cotrimoxazole prophylaxis and treatment cannot be provided regularly without interruption. Additionally, poor communication and inadequate counseling for the mothers; they may not be motivated to take their child for follow-up or to take the medication and care services, and interestingly, mothers/caretakers of HIV-exposed infants who had knowledge of the benefits of cotrimoxazole prophylaxis

Children born at a health facility 91.2% {AOR 0.088=, 95% CI (0.01-0.58)} less likely to be HIV positive compared to children born at home. This result is consistent with studies in which Gondar infants born at home were three times more likely to be infected with HIV than infants born to women who delivered in health facilities,³⁰ because women getting professional delivery services are offered ART or anti-retroviral prophylaxis to avoid maternal-to-child HIV transmission during labor and delivery. Even HIV-exposed infants may have an opportunity to get ARV prophylaxis immediately, hence decreasing the risk of acquiring HIV infection during labor and delivery, as the majority of newborns are infected at this time, however, in this study, an appreciable number of pregnant. Women did not obtain skilled birth care, leading to the catastrophic effects of HIV on their infants. Additionally, infants who were delivered at home were more prone to many harmful traditional practices that increase the HIV infection rate, such as cord-cutting by blade, placental blood contamination, unplanned circumcision, pre-lacteal feeding, and breastfeeding from unexamined nipples.

Strengths and Limitations of the Study

Strength

✓ This study had a high response rate and provides information on the outcomes of infants exposed to HIV mothers.

✓ Sources for future investigators

Limitations

First, this was a retrospective study in which some data were incomplete. Hence, some independent variables that could affect the outcome of HIV-exposed infants were not registered in the document and were excluded from the analysis. Second, this study could identify only associated risk factors for which causal inference may be difficult because of the nature of the study. Second, the limited sample size may potentially have an impact on the test's power. As a result, the findings may not be generalizable. Although this study might suffer from its lower precision, this study provides useful evidence for evaluating program efficacy and establishing the groundwork for future interventions. Finally, data collection errors may have had an impact on retrospective data collection.

Conclusion

The study revealed a higher risk of HIV infection among children born to HIV-positive mothers in the study area. Infants who did not receive cotrimoxazole and delivery at home increased the risk of HIV transmission from mother to child. Therefore, education and promotion for seeking obstetric care and HIV services during pregnancy, institutional delivery counseling and promotion, and early initiation of cotrimoxazole prophylaxis for HIV-exposed infants are recommended to eliminate the devastating consequences of HIV in pregnant women and their newborns.

Recommendations

According to the study's findings, following necessary suggestions is offered to reduce MTCT in HIV patients and researchers working in this field. Therefore, this study suggests:

Policy makers: To improve maternal and child health, government health institutions and non-governmental organizations should provide inexpensive availability of cotrimoxazole for families with low incomes in developing countries.

Health care providers: To reduce HIV transmission from mother to child, health care practitioners should give mothers high-quality integrated information on the timely starting of cotrimoxazole, birth preparation, institutional delivery, and postnatal care.

Other researchers: Other research should be done to identify the time of mother-to-child transmission (pre-partum, intrapartum or postpartum period) in order to focus on the specific intervention that will have a positive impact on the PMTCT of HIV.

Footnotes

Acknowledgements

Thank you all hospital staff for helping us during data collection period.

ORCID iDs

Habtamu Walle

Habtamu Abera

Mekonen Adimasu

Addisu Simachew Asgai

Ethical Consideration

Ethical approval for this study was obtained from the ethical committee of Addis Ababa University College of health science school of nursing and midwifery (AAU-CHS-school of nursing and midwife) protocol number SNM/27/2024. In addition, the Addis Ababa Public Health Research and Emergency Management Core Process provided an ethical approval letter. The authors didn’t take informed consent, since the data was taken from patient's charts retrospectively. However, institutional permission letters were requested and secured for reviewing information of HIV-positive mothers and their infants. In accordance with the Declaration of Helsinki to maintain patient confidentiality, no names or identifying numbers were included in the data extraction format, had been stored in password protected computer.

Consent to Publication

Consent to publish is not applicable.

Author Contributions

H.W, H.A, M.A., and A.S. contributed to data analysis, drafting or revising the article, have agreed on the journal to which the article will be submitted, gave final approval to the version to be published, and agree to be accountable for all aspects of the work.

Funding

The authors received no financial support for the research, authorship, and/or publication of this article.

Declaration of Conflicting Interests

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

Availability of Data and Materials

All the data include in the manuscript can be accessed from the Corresponding author with an email: addisusimachew29@gmail.com

References

UNAIDS. UNAIDS data 2021. UNAIDS. UNAIDS Data 2021. Geneva: Joint United Nations Programme on HIV/AIDS; 2021.

UNAIDS. Progress Report on the Global Plan: Towards the Elimination of New HIV Infections Among Children and Keeping Their Mothers Alive . 2016;11(1):18-20.

Tadewos

Adimasu

Tachbele

. Mother-to-child transmission of HIV and associated factors among exposed infants in pastoralist health facilities, South Omo zone, Ethiopia, 2020 – A retrospective cross-sectional study. HIV/AIDS - Res Palliat Care. 2021;13:1015-1023. 10.2147/HIV.S332904

Astawesegn

Stulz

Conroy

Mannan

. Trends and effects of antiretroviral therapy coverage during pregnancy on mother-to-child transmission of HIV in Sub-Saharan Africa. Evidence from panel data analysis. BMC Infect Dis [Internet]. 2022;22(1):1-13. Available from. 10.1186/s12879-022-07119-6

Kharsany ABM, Karim QA. HIV infection and AIDS in Sub-Saharan Africa: current status, challenges and opportunities. Open AIDS J A. 2016;10:34-48. doi:10.2174/1874613601610010034

Vrazo

Sullivan

Phelps

. Eliminating mother-to-child transmission of HIV by 2030: 5 strategies to ensure continued progress. Glob Heal Sci Pract. 2018;6(2):249-256. 10.9745/GHSP-D-17-00097

Jalbert

Williamson

Kroehl

, et al. HIV-exposed uninfected infants have increased regulatory T cells that correlate with decreased T cell function. Front Immunol. 2019;10(MAR):1-9. 10.3389/fimmu.2019.00595

Assefa

Soares

Assefa

. International journal of infectious diseases spatial clustering and socio-demographic determinants of HIV infection in Ethiopia, 2015–2017. Int J Infect Dis. 2020;82(2019):33-39.

Worku Dagnew

Belachew Asresie

Abeje Fekadu

, et al. Draft 0. PLoS One. 2021;15(5):1-11.

10.

Kassa

. Mother-to-child transmission of HIV infection and its associated factors in Ethiopia: A systematic review and meta-analysis. BMC Infect Dis. 2018;18(1):1-9. 10.1186/s12879-018-3126-5

11.

Gebremedhin

Alamneh

Hagos

Desalegn

Worku

. A multilevel analysis of determinants of PMTCT service utilisation among women during the antepartum, intrapartum and postpartum period in Ethiopia. BMC Pregnancy Childbirth. 2021;1:1–10. doi:10.1186/s12884-021-03896-1

12.

2021 World AIDS Day Report: Unequal, Unprepared, Under Threat—Why Bold Action Against Inequalities Is Needed to End AIDS, Stop COVID-19 and Prepare for Future Pandemics.. Geneva, Switzerland: Joint United Nations Programme on HIV/AIDS (UNAIDS); 2021.

13.

Hampanda

. Vertical transmission of HIV in Sub-Saharan Africa: Applying theoretical frameworks to understand social barriers to PMTCT. ISRN Infect Dis. 2013;2013:1-5. doi:10.5402/2013/420361

14.

FMoH. National Guideline for Prevention of Mother-to-child Transmission of HIV, Syphilis and Hepatitis B Virus የዜጎች ጤና ለሃገር ብልጽግና! 2021.

15.

Weldeghebrael

. Addis Ababa: City scoping study. African Cities Res Consertium. 2021; (June):1-10.

16.

Sakondhavat

Kosalaraksa

Thinkhamrop

, et al. Prevention of HIV transmission from mother-to-child in srinagarind hospital. J Med Assoc Thail. 2001;84(10):1460-1466.

17.

World Health Organization. Differentiated and simplified Pre-exposure prophylaxis for HIV prevention. Update to WHO Implementation Guidance. [Internet]. 2022;1-46 p. Available from: https://creativecommons.org/licenses/by-nc-sa/3.0/igo.

18.

FMoH. National guideline for prevention of mother-to-child transmission of HIV. Syphilis and Hepatitis B Virus. 2021;1:1-120.

19.

Worku Dagnew

Belachew Asresie

Abeje Fekadu

, et al. Draft 0. PLoS One [Internet]. 2021;15(5):1-11. Available from: 10.1371/journal.pone.0232793.

20.

Bhatta

Dutta

Nandi

Dutta

Saha

. Mother-to-child HIV transmission and its correlates in India: Systematic review and meta-analysis. BMC Pregnancy Childbirth. 2020;20(1):1-16. 10.1186/s12884-020-03193-3

21.

Belachew

Tewabe

Malede

. Prevalence of vertical HIV infection and its risk factors among HIV exposed infants in East Africa: a systematic review and meta-analysis. Trop Med Health. 2020;48(1):1-11. doi:10.1186/s41182-020-00273-0

22.

Wudineh

Damtew

. Mother-to-child transmission of HIV infection and its determinants among exposed infants on care and follow-up in Dire Dawa City, Eastern Ethiopia. AIDS Res Treat. 2016;2016:1-6. doi:10.1155/2016/3262746

23.

Kassie

Bogale

Addisu

. The prevalence of HIV-positive infants born to HIV-positive mothers attended at the University of Gondar specialized hospital anti-retroviral therapy services, Northwest Ethiopia, 2018. HIV/AIDS - Res Palliat Care. 2020;12:135-140. 10.2147/HIV.S238315

24.

Sebsibie Teshome

Maud Modiba

. Determinants of mother to child transmission of HIV in Addis Ababa, Ethiopia. Int J Africa Nurs Sci. 2021;15:100348. 10.1016/j.ijans.2021.100348

25.

Domingues

RMSM

Saraceni

Do Carmo Leal

. Mother to child transmission of HIV in Brazil: Data from the “Birth in Brazil study”, a national hospital-based study. PLoS One. 2018;13(2):1-14. 10.1371/journal.pone.0192985

26.

Naidoo

Hoque

Buckus

Hoque

Jagernath

. Prevention-of-mother-to-child-transmission (PMTCT) program outcomes in South Africa in the pre-COVID and COVID eras. BMC Public Health [Internet]. 2023;23(1):1-9. Available from. 10.1186/s12889-023-16214-5

27.

Kassaw

Abebe

Abate

Tlaye

Kassie

. Mother-to-child HIV transmission and its associations among exposed infants after option B+ guidelines implementation in the Amhara regional state referral hospitals, Ethiopia. Int J Infect Dis. 2020;95:268-275. 10.1016/j.ijid.2020.03.006

28.

Yitayew

Bekele

Wondimeneh

Menji

DZA

. Mother to child transmission of HIV and associated factors among HIV exposed infants at public health facilities, Dessie town, Ethiopia. HIV/AIDS - Res Palliat Care. 2019;11:343-350.

29.

Obsa

Dabsu

Ejeta

. Rate of mother to child transmission of HIV and factors associated among HIV exposed infants in Oromia regional state, Ethiopia: Retrospective study. Egypt Pediatr Assoc Gaz [Internet]. 2018;66(3):61-65. Available from. 10.1016/j.epag.2018.07.002

30.

Tiruneh

Dagnew

. Prevalence of HIV infection and associated factors among infants born to HIV-positive mothers in health institutions, northwest Ethiopia, 2021. Women’s Heal. 2022;18. 10.1177/17455057221117407