A systematic review and meta-analysis of vertical transmission route of HIV in Ethiopia

Abstract

Background: The burden of mother-to-child transmission rate of HIV is high and risk factors are common in Ethiopia. This systematic review and meta-analysis intended to provide the pooled estimation of mother-to-child transmission rate and its risk factors in Ethiopia.

Methods: We searched PubMed, Google Scholar, EMBASE and Web of Science electronic databases for all available references. We included observational studies including case-control, cohort, and cross-sectional studies. The search was further limited to studies conducted in Ethiopia and publish in English. Heterogeneity was checked using the I² statistic. Egger's test and the funnel plot were used to assess publication bias. A meta-analysis using a weighted inverse variance random-effects model was performed.

Results: A total of 18 studies with 6253 individuals were included in this systematic review and meta-analysis. Of these, 14 studies with 4624 individuals were used to estimate the prevalence. The estimated pooled prevalence of mother-to-child transmission of HIV was 11.4% (95% CI = 9.1-13.7). The pooled adjusted odds ratio (AOR) of mother-to-child transmission of HIV for the infants from rural area was 3.8 (95% CI = 1.4 to 6.3), infants delivered at home was 3.2 (95% CI = 1.2 to 5.2), infant didn't take antiretroviral prophylaxis was 5.8 (95% CI = 1.5 to 10.3), mother didn't take antiretroviral prophylaxis was 6.1 (95% CI = 2.5 to 9.6), mothers didn't receive PMTCT intervention was 5.1 (95% CI = 1.6, 8.6), and on mixed feeding was 4.3 (95% CI = 1.8 to 6.7).

Conclusions: This systematic review and meta-analysis showed that mother-to-child transmission rate of HIV was high in Ethiopia. Being from the rural residence, home delivery, not taking antiretroviral prophylaxis, the absence of PMTCT intervention, and mixed infant feeding practices increased the risk of HIV transmission.

Trial registration: It is registered in the Prospero database: (PROSPERO 2017: CRD42017078232 ).

Keywords: Ethiopia; HIV transmission; HIV-exposed infants; Infants; Meta-analysis; Mothers.

Fig. 1

Studies selection process flow chart for the studies included in the analyses

Fig. 2

Funnel plot before adjustment (a) and after adjustment (b) for publication bias, Logprop or LNP (log of proportion) represented in the x-axis and standard error of log proportion in the y-axis

Fig. 3

Forest plot of the prevalence with corresponding 95% CIs of the fourteen studies on MTCT of HIV. The midpoint and the length of each segment indicated prevalence and a 95% CI whereas the diamond shape showed the combined prevalence of all studies

Fig. 4

Forest plot of the prevalence with corresponding 95% CIs of the subgroup analysis based on the regions, where the studies done. The midpoint and the length of each segment indicated prevalence and a 95% CI whereas the diamond shape showed the combined prevalence

Fig. 5

Forest plot of the prevalence with corresponding 95% CIs of the study design. The midpoint and the length of each segment indicated prevalence and a 95% CI whereas the diamond shape showed the combined prevalence

Fig. 6

Forest plot of the adjusted odds ratios with corresponding 95% CIs of studies on the association of rural residence and MTCT of HIV. The midpoint and the length of each segment indicated an AOR and a 95% CI; the arrow showed the widest CI; and the diamond shape showed the combined AOR of all studies

Fig. 7

Forest plot of the adjusted odds ratios with corresponding 95% CIs of studies on the association of home delivery and mixed infant feeding with MTCT of HIV. The midpoint and the length of each segment indicated an AOR and a 95% CI; the arrow showed widest CI; and the diamond shape showed the combined AOR of all studies for each variable

Fig. 8

Forest plot of the adjusted odds ratios with corresponding 95% CIs of studies on the association of absence of mother ARV prophylaxis, absence of infant ARV prophylaxis, and absence of PMTCT intervention with MTCT of HIV. The midpoint and the length of each segment indicated an AOR and a 95% CI; the arrow showed widest CI; and the diamond shape showed the combined AOR of all studies for each variable