Mother-to-Child-Transmission of HIV Infection, Trends and Determinants among HIV-Exposed Infants in Western Ethiopia: A cross-sectional study

Background: Despite the availability of lifelong anti-retroviral medication (ART) and improved prevention of mother-to-child transmission (PMTCT) activities, MTCT remains a major factor contributing to new pediatric infections. As a result of service gaps and time instability, the proportion of HIV-positive exposed children has persisted, even with a reduction in the overall incidence of the infection globally. It is important to evaluate the current rates of transmission to hasten the process of elimination, particularly through improved early infant diagnosis (EID). Methodology: A cross-sectional study was conducted in 2,868 infants whose specimens were submitted for EID at the Nekemte Public Health Research and Referral Laboratory Center from January 1, 2016, to December 31, 2025. Data were extracted from the EID database, entered into Epi Data version 4.6 and exported to Statistical Software for Social Sciences (SPSS) version 27. Descriptive statistics such as frequencies and percentages were used to characterize the study population. To identify factors associated with the rate of MTCT of HIV, logistic regression analysis was employed. Adjusted odds ratios (AORs) were calculated to assess the strength of associations, with statistical significance defined as a p-value of less than 0.05. Results: The mean age of the infants was 8.5 (±5.4), and 52% were male. The overall HIV positivity rate was 3.5%, increasing from 1.7% in 2016 to a peak of 6.3% in 2018, before declining to 1.9% by 2022 after a transient rise in 2021 (5.1%). Significant determinants of MTCT included being newly initiated to ART (AOR=5.603; 95% CI: 2.710-11.587), unknown maternal ART status (AOR=4.125; 95% CI: 2.143–7.941), absence of PMTCT intervention (AOR=2.334; 95% CI: 1.199–4.546), and absence of infant prophylaxis (AOR=7.062; 95% CI: 3.918–12.727). Conclusion: The study found fluctuating trends in MTCT of HIV over the ten years. Strengthening comprehensive PMTCT services and ensuring consistent ART coverage are critical to eliminating pediatric HIV.