Determinants of Mother-to-Child Transmission of HIV in Public Hospitals of West Shewa Zone, Central Ethiopia: Case-Control Study

BACKGROUND: Mother-to-child transmission (MTCT) of human immune deficiency virus (HIV) is the infection of baby by HIV that originated from an HIV-positive mother during pregnancy and breast feeding. Without intervention, the transmission rate of HIV ranges from 15–45%, which can be reduced to below 5% with effective intervention. In Ethiopia, the final mother-to-child transmission rate was 15% in 2016, which was much higher than the target of the country to reduce transmission to lower than 5% by 2020. The study aims to identify determinants of transmission of HIV from mother to child in the West Shewa Zone. METHODS: An unmatched case–control study, among children less than 5 years who tested HIV positive and negative, at the end of PMTC follow-up, N=96 (24 cases, 72 controls) was conducted during June to August 2019, focusing on PCR done during the last 2 years (June 2017 to July 2019), in public hospitals. Data were collected using a structured questionnaire and data abstraction forms from mothers of exposed infants, medical records of mothers and children. RESULTS: The majority of cases (17, 70.8%) were not included in the option B+ program, but only 11.1% of controls were not included. Home delivery (adjusted odds ratio (AOR)=6.047, confidence interval (CI)=1.549–29.230), non-inclusion into option B+ (AOR=18.0, 95% CI=5.0–68.1), and partner non-involvement to HIV care (AOR=7.3, 95% CI=1.14–37.459) had higher odds of transmitting HIV, while a mother-to-mother support program decreases the chance of transmission by 86.5% (AOR=0.135, 95% CI=0.11–0.396) when compared to their counterparts. CONCLUSION: Mother-to-mother support programs have a protective effect, while non-inclusion to option B+, partner non-involvement in HIV care, home delivery, and poor antenatal care (ANC) practices were determinant factors of HIV transmission from mother to child.