# Determinants of HIV infection among infants born to HIV positive women receiving option B + prevention of mother to child transmission of HIV in Tigray, north Ethiopia: a case control study

## TL;DR

This study identifies factors that increase the risk of HIV transmission from HIV-positive mothers to their infants in Tigray, Ethiopia, despite using the Option B+ treatment strategy.

## Contribution

The study identifies specific risk factors for mother-to-child HIV transmission in the context of Option B+ implementation in Tigray, Ethiopia.

## Key findings

- Rural residence and advanced WHO disease stages in mothers significantly increase the risk of HIV transmission.
- Late initiation of antiretroviral therapy and lack of follow-up for HIV-exposed infants are associated with higher transmission rates.
- A child's mouth ulcer during exclusive breastfeeding is a significant risk factor for HIV transmission.

## Abstract

The option B+ prevention of mother to child transmission of human immunodeficiency virus is the lifelong provision of antiretroviral therapy for all human immunodeficiency virus positive pregnant and breastfeeding women regardless of immune status. In Ethiopia, the overall mother-to-child transmission rate of human immunodeficiency virus was 15.9%. This study assessed determinants of human immunodeficiency virus infection among infants born to human immunodeficiency virus positive women on option B + prevention of mother to child transmission of human immunodeficiency virus in Tigray, north Ethiopia.

Unmatched case-control study was conducted in Tigray region from October 2023 to April 2024. A total of 43 cases and 129 controls were selected using simple random sampling technique. Multivariable logistic regression analysis was fitted to identify the factors associated with mother to child transmission of human immunodeficiency virus at P < 0.05. Multicolinearity was checked among predictor variables using Variance Inflation Factor and Tolerance test. Furthermore, the goodness of fit of the logistic model was tested using Hosmer-Lemshow test.

This study showed that rural residence (Adjusted Odds ratio: 33.3, 95% CI: 1.02–87.05), World Health Organization disease stage III (Adjusted Odds ratio: 57.4, CI: 9.25– 297.54) and IV (Adjusted Odds ratio: 78.9, CI: 12.64–345.62) during initiation of antiretroviral therapy and a child with mouth ulcer during exclusive breastfeeding (Adjusted Odds ratio: 65, IC: 6.39–456.23) were the factors significantly associated with mother to child transmission of human immunodeficiency virus. Besides, mothers’ educational status (Adjusted Odds ratio: 0.2, CI: 0.04, 0.35), late time of antiretroviral therapy initiation after human immunodeficiency virus diagnosis (Adjusted Odds ratio: 0.14, CI: 0.02–0.18) and absence of human immunodeficiency virus exposed infant follow up visit (Adjusted Odds ratio: 0.04, IC: 0.005–0.09) had significant association with the mother to child transmission of human immunodeficiency virus.

The determinant factors significantly associated with mother to child transmission of human immunodeficiency virus were identified. Health care providers should strengthen option B + prevention mother to child transmission of human immunodeficiency virus services to reduce the mother to child transmission of human immunodeficiency virus.