Mother-to-child HIV transmission and its associations among exposed infants after Option B+ guidelines implementation in the Amhara regional state referral hospitals, Ethiopia

Mesfin Wudu Kassaw; Ayele Mamo Abebe; Biruk Beletew Abate; Kenean Getaneh Tlaye; Ayelign Mengesha Kassie

doi:10.1016/j.ijid.2020.03.006

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 Jun:95:268-275. doi: 10.1016/j.ijid.2020.03.006. Epub 2020 Apr 1.

Authors

Mesfin Wudu Kassaw¹, Ayele Mamo Abebe², Biruk Beletew Abate³, Kenean Getaneh Tlaye⁴, Ayelign Mengesha Kassie⁵

Affiliations

¹ Department of Nursing, College of Health Science, Woldia University, PO Box 400, Woldia, Ethiopia. Electronic address: mesfine12a@gmail.com.
² Department of Nursing, College of Health Science, Debre Berhan University, PO Box 400, Debre Berhan, Ethiopia. Electronic address: ayelemamo12@gmail.com.
³ Department of Nursing, College of Health Science, Woldia University, PO Box 400, Woldia, Ethiopia. Electronic address: birukkelemb@gmail.com.
⁴ Department of Nursing, College of Health Science, Woldia University, PO Box 400, Woldia, Ethiopia. Electronic address: kenyget@yahoo.com.
⁵ Department of Nursing, College of Health Science, Woldia University, PO Box 400, Woldia, Ethiopia. Electronic address: ayelignmengesha59@gmail.com.

PMID: 32247052
DOI: 10.1016/j.ijid.2020.03.006

Abstract

Background: Elimination of mother-to-child transmission of human immunodeficiency virus (HIV) has been a global public health priority. In 2013, the World Health Organization recommended antiretroviral therapy administration to all HIV-positive pregnant and breastfeeding women regardless of the CD4 cell count or clinical stage, referred to 'Option B+'. Ethiopia has had a high prevalence of mother-to-child transmission of HIV. The prevalence of transmission in breastfeeding mothers was 24% in 2012 and increased to more than 30% in 2015. Thus, the aim of this study was to determine the prevalence of HIV transmission and its associations among infants born to HIV-positive mothers who had enrolled with the five Amhara regional state referral hospitals' prevention of mother-to-child HIV transmission departments, Ethiopia.

Methods: The study used a retrospective single cohort design, and simple random sampling with proportional allocation to select the medical records of 217 exposed infants. The data collected from each hospital were documented from January 1, 2014 to May 30, 2017. The cumulative incidence and prevalence of HIV transmission among exposed infants in the region were presented using figures and tables.

Results: The prevalence of HIV transmission among exposed infants at enrollment to the program was 2.3% (five cases) (95% CI, 0.5-4.6%), whereas the prevalence of HIV transmission among exposed infants on completion of the program was 3.7% (8) (95% CI, 1.4-6.5%). The cumulative incidence of transmission on completing the program was 1.6% (3) (95% CI, 0.0-3.2%).

Conclusions: In contrast to the expected outcome of the World Health Organization's 'Option B+' guidelines regarding HIV transmission, this study found the cumulative incidence of HIV transmission on completing the program and the overall prevalence of HIV infection to be high. Although some studies have reported significant reductions in mother-to-child transmission of HIV, there are still considerable challenges in preventing this transmission in the Amhara region.

Keywords: Amhara region; Ethiopia; Exposed infants; Option B(+); Referral hospitals.

MeSH terms

Breast Feeding
CD4 Lymphocyte Count
Child, Preschool
Cohort Studies
Ethiopia / epidemiology
Female
Guideline Adherence
HIV Infections / epidemiology
HIV Infections / transmission*
Humans
Incidence
Infant
Infectious Disease Transmission, Vertical* / prevention & control
Male
Pregnancy
Pregnancy Complications, Infectious*
Prevalence
Retrospective Studies
World Health Organization