Magnitude and risk factors of mother-to-child transmission of HIV among HIV-exposed infants after Option B+ implementation in Ethiopia: a systematic review and meta-analysis

Abstract

Background: Mother-to-child transmission (MTCT) of the human immunodeficiency virus (HIV) remains a major public health challenge in Ethiopia. The objective of this review was to assess the pooled magnitude of MTCT of HIV and its risk factors among mother-infant pairs who initiated antiretroviral therapy (ART) after Option B+ in Ethiopia.

Methods: A systematic search of literature from PubMed, Hinari, African Journals Online (AJOL), Science Direct, and Google Scholar databases was conducted from June 11, 2013 to August 1, 2023. The authors used the Preferred Reporting Items for Systematic Reviews and Meta-Analysis (PRISMA) guidelines to guide the article selection process and reporting. Observational studies that reported the magnitude and/or risk factors on MTCT of HIV among mother-infant pairs who initiated ART after the implementation of Option B+ in Ethiopia were included. We applied a random-effect model meta-analysis to estimate the overall pooled magnitude and risk factors of MTCT of HIV. A funnel plot and Egger's regression test were employed to check publication bias, and heterogeneity was assessed using I² statistics. The protocol was registered in the PROSPERO database with registration ID number CRD42022325938.

Result: Eighteen published articles on the magnitude of MTCT and 16 published articles on its risk factors were included in this review. The pooled magnitude of MTCT of HIV after the Option B+ program in Ethiopia was 4.05% (95% CI 3.09, 5.01). Mothers who delivered their infants at home [OR: 9.74; (95% CI: 6.89-13.77)], had not been on ART intervention [OR: 19.39; (95% CI: 3.91-96.18)], had poor adherence to ART [OR: 7.47; (95% CI: 3.40-16.45)], initiated ART during pregnancy [OR: 5.09; (95% CI: 1.73-14.97)], had WHO clinical stage 2 and above [OR: 4.95; (95% CI: 1.65-14.88]], had a CD4 count below 350 at enrolment [OR: 5.78; (95% CI: 1.97-16.98], had no or low male partner involvement [OR: 5.92; (95% CI: 3.61-9.71]] and whose partner was not on ART [OR: 8.08; (95% CI: 3.27-19.93]] had higher odds of transmitting HIV to their infants than their counterparts.

Conclusion: This review showed that the pooled magnitude of MTCT of HIV among mother-infant pairs who initiated ART after the Option B + program in Ethiopia is at the desired target of the WHO, which is less than 5% in breastfeeding women. Home delivery, lack of male partner involvement, advanced HIV-related disease, lack of PMTCT intervention, and poor ARV adherence were significant risk factors for MTCT of HIV in Ethiopia.

Keywords: Ethiopia; HIV-exposed infant; MTCT; Meta-analysis; Mother-to-child transmission; PMTCT; Systematic review.

Fig. 1

Forest plot of the magnitude of MTCT of HIV after Option B + in Ethiopia. Dots represent the magnitude reports with confidence intervals (CIs) from primary studies. The diamond shape represents the pooled estimation, and the width of the diamond shows the width of the 95% CI of the pooled estimate

Fig. 2

Subgroup analysis of the magnitude of MTCT of HIV after Option B + in Ethiopia by study region. Dots represent the magnitude with 95% confidence intervals from primary studies, and the diamond shape stands for the pooled estimation

Fig. 3

Subgroup analysis on the magnitude of MTCT of HIV after Option B + in Ethiopia by study design. Dots represent the magnitude reports with confidence intervals from primary studies, and the diamond shape stands for the pooled estimation

Fig. 4

Funnel plot for the magnitude of MTCT of HIV after Option B+ in Ethiopia logpr, logarithm of the prevalence; se, standard error of the logarithm of prevalence.

Fig. 5

PRISMA 2020 flow diagram for studies included in the review, 2023