# Predictors of HIV Vertical Transmission in Exposed Infants in Northwest, Ethiopia: A Retrospective Cohort Study

## TL;DR

This study identifies factors that increase or reduce the risk of HIV transmission from mothers to infants in Ethiopia, aiming to improve prevention strategies.

## Contribution

The study identifies specific predictors of HIV vertical transmission in Northwest Ethiopia and provides targeted recommendations for prevention.

## Key findings

- The HIV vertical transmission rate was 3.6% among exposed infants.
- Mothers not receiving ART had 6.82 times higher odds of transmitting HIV.
- Early maternal HIV diagnosis and facility delivery significantly reduced transmission risk.

## Abstract

Although the global plan aimed to eliminate mother‐to‐child transmission of HIV by 2015, an estimated 130,000 children were newly infected, and 84,000 children died from HIV related causes in 2022. In Ethiopia, 3200 children became newly infected and 1,900 children died from HIV related causes in 2022. A new target has now been set for 2030. Vertical transmission remains the predominant route of pediatric HIV infection. This study aimed to assess HIV vertical transmission and its predictors among HIV‐exposed infants in Northwest Ethiopia.

A retrospective cohort study was conducted among 480 mother–infant pairs enrolled in the PMTCT program. Data were analyzed using R version 4.3.2. To account for missing values, multiple imputations were performed prior to bivariate and multivariable logistic regression analyses. Associations with a p‐value < 0.05 were considered statistically significant.

The rate of vertical transmission of HIV was 3.6%. Mothers residing outside the catchment area (AOR = 4.74; 95% CI: 1.17–20.63) and those not receiving antiretroviral therapy (AOR = 6.82; 95% CI: 1.33–38.73) had significantly higher odds of vertical HIV transmission. Conversely, maternal HIV diagnosis prior to pregnancy (AOR = 0.08; 95% CI: 0.009–0.84), receiving Nevirapine prophylaxis (AOR = 0.14; 95% CI: 0.03–0.65), and delivery at a health facility (AOR = 0.08; 95% CI: 0.01–0.66) were significantly protective against mother‐to‐child transmission.

The rate of vertical HIV transmission was found to be high. Therefore, we recommend further PMTCT service expansion; focus on maternal HIV diagnosis in the preconception period; improve provision of infant Nevirapine prophylaxis and maternal ART help to minimize HIV vertical transmission. Reduce home delivery also helps to decrease HIV vertical transmission.