Determinants of Mother to Child Transmission of HIV in Public Hospitals of West Shewa Zone, Oromiya Region: Mixed Method Study.

Abstract

Background Mother-to-child transmission of HIV (MTCT) occurs when a mother infected with the human immunodeficiency virus (HIV) passes the virus to her child. Without intervention, the transmission rate of HIV ranges from 15% to 45%. With effective interventions, this rate can be reduced to below 5%. Ethiopia aimed to reduce transmission to lower than 5% by 2020, but their final MTCT rate was 15% in 2016. The aim of this study was to identify the determinants of HIV transmission from mother to child in the West Shoa Zone of the Oromiya region. Methods: This study employs mixed methods, including an unmatched case-control study among children who tested HIV positive and negative at the end of Prevention of Mother-to-Child Transmission (PMTCT) follow-up and one -on - one interview. Additionally, one-on-one interviews with mothers of positive infants were conducted. Variables of interest were collected using structured and semi-structured questionnaires and data abstraction forms from mothers of exposed infants, medical records of mothers, and children. Results: The majority of cases (70.8%) were not included in the Option B+ program. Home delivery increases the chance of HIV transmission by six times, AOR=6.0; CI (1.5–29.2). None-inclusion in the Option B+ program increases the chance of transmission by 18 times, AOR=18.0; CI (5.0–68.1). Partner non-involvement in HIV care increases the chance of transmission by 7.3 times, AOR=7.3; CI (1.1–37.4). The mother-to-mother support program decreases the chance of transmission by 86.5%, AOR=0.13; CI (0.11–0.39). Poor antenatal care (ANC) awareness and practices among rural residents, and unstable marriage in urban residents, contribute to unaware MTCT of HIV. Conclusion: ART clinics should focus on and strengthen the mother-to-mother support program, create space for partner involvement in HIV care, and provide training for Health Extension Workers (HEWs). Health education and awareness creation should be implemented by HEWs to improve ANC practices, reduce home delivery, and increase voluntary counseling and testing among residents.