{"paper_id":"20b2e4ee-c0dc-4cd4-b236-a52695aba1a7","body_text":"1\n1 Prevalence of HIV1 Infection and Its Associated Factors among Exposed \n2 Infants at Shegaw Motta General Hospital, Ethiopia\n3 Destaw Kebede Nigusie 1, 2 * Fantahun Getaneh Damitew  1 , Kirubel Endalamaw Melsew 1, \n4 Girma Zerefaw 3 , Abebe Feneta Nigusie4 \n5 1 Department of Diagnostic Medical Laboratory Science at Shegaw Motta General Hospital, \n6 East Gojjam, Motta Town, Ethiopia, \n7 2 Department of Bacteriology and Mycology Reference Laboratory, Amhara Public Health \n8 Institute (APHI)- Debre Markos Branch, Debre Markos Town, Ethiopia \n9 3 Department of Molecular Biology and Virology Reference Laboratory, Amhara Public Health \n10 Institute (APHI), Bahir Dar Town, Ethiopia\n11 4 Department of Medical Laboratory science, College or Medicine and Health science, Debre \n12 Markos University, Debre Markos Town, Ethiopia\n13\n14 *Correspondence Author, amaueldestaw@gmail.com\n15\n16\n17\n18\n19\n . CC-BY 4.0 International licenseIt is made available under a \n is the author/funder, who has granted medRxiv a license to display the preprint in perpetuity. (which was not certified by peer review)\nThe copyright holder for this preprintthis version posted September 2, 2024. ; https://doi.org/10.1101/2024.09.01.24312902doi: medRxiv preprint \nNOTE: This preprint reports new research that has not been certified by peer review and should not be used to guide clinical practice.\n\n2\n20 Abstract \n21 Background: Human immunodeficiency virus (HIV)/acquired immunodeficiency syndrome is a \n22 leading cause of death and disease burden. Following this, vertical transmission is the main \n23 source of HIV infection on children globally. Morbidity and mortality among HIV-exposed \n24 infants are still the main health challenges in Ethiopia. Therefore, the aim of this study was to \n25 determine the prevalence of HIV1infection and its associated factors among exposed infants at \n26 Shegaw Motta General Hospital, Ethiopia.\n27 Methods: Hospital-based cross-sectional study was conducted on exposed infants at Shegaw \n28 Motta General Hospital from September 1, 2022 to July 30, 2023. The consecutive convenience \n29 sampling technique was used to select study participants. Whole blood sample was collected \n30 from mothers and infants. Laboratory tests like early infant diagnosis, cluster of differentiation 4 \n31 counts and viral load were performed using standard operating procedure. Then, the data were \n32 entered into EpiData version 3.1 and analyzed by SPSS version 20. Finally, bivariable and \n33 multivariable logistic regressions were carried out to identify factors significantly associated \n34 (P<0.05).\n35 Results: Out of 155 infants, about 79(50.9%) infants were females and87(56.1%) was urban \n36 resident. Furthermore, majority of infants were born from mothers who could not able to write \n37 and read 88(56.8%) and maternal ages range from 25-34years were 138(89.0%). The overall \n38 prevalence of HIV1 infection among exposed infants was6(3.87%) with (95%CI: 2.9-8.2). \n39 Pregnant women had not antennal care (AOR=7.281, P = 0.001), home delivery (AOR= 3.239, \n40 P=0.001), maternal not received antiretroviral prophylaxis (AOR = 9.213, P= 0.001), infants \n41 not intake nevirapine prophylaxis (AOR=2.560, P= 0.007) and maternal high viral load (AOR= \n42 5.120, P= 0.004) were the factors associated with HIV infection among exposed infants.\n . CC-BY 4.0 International licenseIt is made available under a \n is the author/funder, who has granted medRxiv a license to display the preprint in perpetuity. (which was not certified by peer review)\nThe copyright holder for this preprintthis version posted September 2, 2024. ; https://doi.org/10.1101/2024.09.01.24312902doi: medRxiv preprint \n\n3\n43 Conclusion: The HIV1 infection among exposed infants was still high (3.87%). Pregnant \n44 women had not antenatal care follow up, home delivery, maternal high viral load, and not \n45 receiving antiretroviral prophylaxis, infant not intake nevirapine prophylaxis increases the risk \n46 of HIV1 infection. Therefore, health facilities should strictly strengthen the PMTCT service by \n47 providing maternal antiretroviral prophylaxis, infant nevirapine prophylaxis, promoting \n48 antenatal care  service, early screening maternal viral load and scale up skilled delivery to \n49 eliminate HIV infection among exposed infants.\n50 Keywords:  HIV infection, associated factors, exposed infants, Ethiopia\n51 Introduction \n52 Human immunodeficiency virus (HIV)/acquired immunodeficiency syndrome (AIDS) is a \n53 leading cause of death and disease burden [1]. Following this, vertical transmission is the main \n54 source of HIV infection in children with an estimated 2000 vertically-acquired HIV infections \n55 occurring daily in global and mostly in Eastern Europe and Central Asia [2]. However, about \n56 330,000 children were infected with HIV in 2011 globally, with over 90% of these infections \n57 through mother-to-child transmission was illustrating in sub-Sahara Africa [3]. \n58 Ethiopia is one of these priority countries where every 3 children born to women living with HIV \n59 still gets infected with HIV [4, 5]. So, infants acquire infection with HIV-1 through mother-to-\n60 child transmission (MTCT) of the virus [6]. MTCT of HIV-1 can occur through intrauterine (IU), \n61 at the time of labor and delivery or intra-partum, and postpartum mainly through breastfeeding \n62 [7,8].In addition to prenatal antiretroviral therapies, public health strategies such as prevention of \n63 maternal nipple lesions, mastitis and infant thrush; reduction of breastfeeding duration by all \n . CC-BY 4.0 International licenseIt is made available under a \n is the author/funder, who has granted medRxiv a license to display the preprint in perpetuity. (which was not certified by peer review)\nThe copyright holder for this preprintthis version posted September 2, 2024. ; https://doi.org/10.1101/2024.09.01.24312902doi: medRxiv preprint \n\n4\n64 HIV-1-infected mothers; absolute avoidance of breastfeeding by those at high risk, and \n65 prevention of HIV-1 transmission to breastfeeding mothers should be addressed [9].\n66 HIV-1 infection in breastfed children born to infected mothers is associated with the presence of \n67 integrated viral deoxy- ribose nucleic acid (DNA) in the mothers' milk cells. IgM and IgA anti-\n68 HIV-1 in breastmilk may protect against postnatal transmission of the virus [10]. However, \n69 international guidance currently states that when replacement feeding is acceptable, feasible, \n70 affordable, sustainable and safe, the avoidance of all breastfeeding by HIV-infected mothers is \n71 recommended [11].\n72 Most of the deaths in children with HIV could have been avoided through early infant diagnosis \n73 (EID) and provision of effective care and treatment. Interventions like the use of antiretroviral \n74 (ART) drugs by infected pregnant women, safe delivery practices and safe infant feeding have \n75 helped to reduce the risk of transmission to infants by 40% to 50% [12]. Because of passively \n76 transferred maternal HIV-1 antibodies, which may be present in the child's bloodstream until 18 \n77 months of age, antibody tests are not reliable for diagnosing children less than 18 months of age \n78 [12, 13].Instead, polymerase chain reaction (PCR) such as EID provides a feasible method to \n79 assess prevention of mother- to child transmission (PMTCT) programs and early identify HIV-\n80 infected infants [14] the reason why its high sensitivity and specificity, PCR has been widely \n81 used for diagnosis of HIV amongst exposed infants as well as identification of infection from \n82 birth [15] \n83 Ethiopia is among the top ten countries in the world with the highest burden of HIV1 infections \n84 among children [16] with the average number of MTCT of HIV in Ethiopia was 18% [17]. So \n85 that, Child morbidity and mortality among HIV-exposed infants are still the main health \n . CC-BY 4.0 International licenseIt is made available under a \n is the author/funder, who has granted medRxiv a license to display the preprint in perpetuity. (which was not certified by peer review)\nThe copyright holder for this preprintthis version posted September 2, 2024. ; https://doi.org/10.1101/2024.09.01.24312902doi: medRxiv preprint \n\n5\n86 challenges in Ethiopia [18]. However, there need a further study beyond HIV 1 and its associated \n87 factors among infants born to HIV positive women. Therefore, the aim of this study was to \n88 determine the prevalence of HIV 1and its associated factors among infants born from HIV \n89 positive mothers at Shegaw Motta General Hospital, Ethiopia.\n90\n91\n92\n93\n94\n95\n96\n97\n98\n99\n100\n101\n102\n103\n104\n . CC-BY 4.0 International licenseIt is made available under a \n is the author/funder, who has granted medRxiv a license to display the preprint in perpetuity. (which was not certified by peer review)\nThe copyright holder for this preprintthis version posted September 2, 2024. ; https://doi.org/10.1101/2024.09.01.24312902doi: medRxiv preprint \n\n6\n105 Materials and Method \n106 Study design, area and period\n107 Hospital based cross sectional study was conducted at Shegaw Motta General Hospital (SMGH) \n108 which is found in East Gojjam zone, Amhara regional state. Shegaw Motta General Hospital is \n109 found in Amhara region, which is located at a distance of 120 Km from Bahir Dar and 370 Km \n110 away from the capital city of the Ethiopia, Addis Ababa. SMGH has provided service to more \n111 than 1.5 million total populations. Whenever, this study was conducted from September 1, 2022 \n112 to July 30, 2023.\n113 Study Population and participants \n114 All infants (ages < 12months) born from HIV positive mothers were the study population. While, \n115 all HIV exposed infants attending PMTCT clinic in Shegaw Motta General Hospital and \n116 providing a blood sample during the study period were study participants. \n117 Sample size and sampling technique\n118 The sample size was calculated by using single population proportion formula by taking the \n119 prevalence of HIV-positive infants born to HIV-positive mothers, 11.4% pooled prevalence in \n120 Ethiopia [19] using the assumption of 95% confidence level (Z= Z α/2=95%=1.96), margin of \n121 error (d= 5%=0.05), Then, sample size was determined as follows:\n122\n123 N= (Zα/2)2p (1-p)=155\n124 d2\n125 Therefore, the minimum of 155 study participants was selected by consecutive convenience \n126 sampling technique. \n . CC-BY 4.0 International licenseIt is made available under a \n is the author/funder, who has granted medRxiv a license to display the preprint in perpetuity. (which was not certified by peer review)\nThe copyright holder for this preprintthis version posted September 2, 2024. ; https://doi.org/10.1101/2024.09.01.24312902doi: medRxiv preprint \n\n7\n127 Eligibility criteria\n128 All infants born to HIV positive mother attending PMTCT clinic at Shegaw Motta General \n129 Hospital were included in this study.  While, exposed infants who were critically ill and whose \n130 parents were unwilling to give their consent were excluded from the study.\n131 Data collection and processing \n132 The data were collected by trained a midwifery and principal investigator. Thus, socio-\n133 demographic and associated factors were collected by semi-structured pre-tested Amharic \n134 version questionnaire using a face-to-face interview with parents of study participants directly \n135 after obtaining consents. At each data collection spot, sufficient explanation about the aim of the \n136 research was given to the parents before conducting the interview.\n137 Blood specimen collection, transportation and storage \n138 A minimum of 100µlwhole blood specimen was collected using ethylene diamine tetra acetylene \n139 (EDTA) test tube as per the manufacturer`s instruction at heal or toe site of the infants who born \n140 to HV positive mother [20]. The collected whole blood was transported immediately from \n141 PMTCT clinic to Shegaw Motta General Hospital, Microbiology laboratory for Examination. \n142 Due to the Cepheid was busy by which GeneXpert MTB/RIF tests were done and the sample was \n143 not done immediately, the samples were stored at 2-8oc, 15-30oc and 31-35oc for up to 72, 24 and \n144 8 hours, respectively [21]. Additionally, 5ml of whole blood was collected from mother with \n145 EDTA K3   plasma separating tube (PPT),wait for 4–12hoursand then centrifuged at 3000 \n146 rpm for 3minute to separate the 1-2ml plasma from red blood cells. Such separated \n147 plasma was stored at 2-8 oCfor a week due to not done immediately. After then, it was \n . CC-BY 4.0 International licenseIt is made available under a \n is the author/funder, who has granted medRxiv a license to display the preprint in perpetuity. (which was not certified by peer review)\nThe copyright holder for this preprintthis version posted September 2, 2024. ; https://doi.org/10.1101/2024.09.01.24312902doi: medRxiv preprint \n\n8\n148 transported to Debre Markos Comprehensive specialized hospital (DMCSH), Molecular \n149 biology laboratory at 2-8oC with triple packaging system to determine maternal viral load.\n150 Laboratory testing \n151 Early Infant diagnosis (EID) by GeneXpert HIV-1 Qual Assay\n152 In the newly updated algorithm, samples that are nonreactive or indeterminate in the \n153 differentiation assay are to be tested with an HIV-1 nucleic acid amplification (NAAT) test for \n154 resolution. Xpert HIV-1 Qual assay is a new NAAT assay approved for the identification of HIV \n155 infection in whole blood [21].\n156 GeneXpert HIV-1Qual assays were conducted according to manufacturer’s recommendations. \n157 EID could be done by the GeneXpert HIV-1 Qual Assay using GeneXpert system machine \n158 (Cepheid)[22] by trained laboratory personnel during the study period. The GeneXpert ® HIV-1 \n159 Qual is a molecular cartridge-based assay that detects total nucleic acid (DNA and RNA) and \n160 provides a qualitative result (HIV detectable or undetectable) [23]. As such, the GeneXpert HIV \n161 Qual cartridge was labeled with the identification collected blood sample. Then after it was \n162 opened and 750 µl of sample reagent was transferred in using provided /inserted pipette in the \n163 kit. Mix the whole blood as well by inverting the EDTA tube containing such blood at least \n164 seven times. About 100µl whole blood was transferred immediately using provided pipette in the \n165 kit or calibrated automatic pipette in to same sample chamber of GeneXpert HIV Qual cartridge \n166 soon after the lid was firmly closed. Finally, the prepared GeneXpert HIV Qual cartridge was run \n167 by starting the test on GeneXpert machine and interpreted the result output as “HIV-1 detected” \n168 or “HIV-1not detected” after 90 minutes [24].\n . CC-BY 4.0 International licenseIt is made available under a \n is the author/funder, who has granted medRxiv a license to display the preprint in perpetuity. (which was not certified by peer review)\nThe copyright holder for this preprintthis version posted September 2, 2024. ; https://doi.org/10.1101/2024.09.01.24312902doi: medRxiv preprint \n\n9\n169 Cluster of differentiation at 4 (CD4) Count \n170 Maternal CD4 was counted using FACS Presto Machine after incubating one drop (40µl) out of \n171 collected 5ml maternal blood for viral load samples on CD4 cartridge for 18 Minute. Then, \n172 assess its association with HIV infection among exposed infants.\n173 Maternal Viral Load determination \n174 5ml of whole blood was collected from mother with EDTA K3   plasma separating tube (PPT), \n175 wait for 4–12hoursand then centrifuged at 3000 rpm for 3minute to separate the 1-2ml \n176 plasma from red blood cells. Such separated plasma was stored at 2-8 oCfor a week due to \n177 not done immediately. After then, it was transported to Debre Markos Comprehensive \n178 specialized hospital, Molecular biology laboratory at 2-8 oC with triple packaging system to \n179 determine maternal viral load. Finally, the viral load level was determined by PCR \n180 technique(Roche Diagnostics GmbH, Mannheim, Germany), the high or low viral load results \n181 were recorded and assessed its association with HIV infection to infants.\n182 Quality control  \n183 The structured questionnaires were prepared in English and translated into Amharic language \n184 and then back translated to English to check inconsistencies of meaning of words. About 9 (5%) \n185 of structured questionnaire was pretested in Motta health center and training was also provided to \n186 one BSc midwifery how to collect the socio-demographic and clinical data. The expired date on \n187 the GeneXpert HIV-1Qual cartridges was cheeked and the GeneXpert system machine (Cepheid) \n188 was calibrated annual regularly. Quality control for CD4 was also done and printed out daily \n189 soon after start up the FACS Presto CD4 Machine and it was cross checked with its standard \n190 reference ranges. \n . CC-BY 4.0 International licenseIt is made available under a \n is the author/funder, who has granted medRxiv a license to display the preprint in perpetuity. (which was not certified by peer review)\nThe copyright holder for this preprintthis version posted September 2, 2024. ; https://doi.org/10.1101/2024.09.01.24312902doi: medRxiv preprint \n\n10\n191 Data analysis\n192 Data was entered by EpiData version 3.1 and data analysis was performed using statistical \n193 package for social sciences (SPSS) version 20. The prevalence of HIV-1 was determined by \n194 descriptive statistics. Multivariable logistic regression was done by entering the variables with \n195 p < 0.2 in the bivariable logistic regression to identify the factors associated with HIV-1 \n196 infection among exposed infants by considering the P value < 0.05 as a statistically significant \n197 association.\n198 Ethical Consideration\n199 Ethical clearance and permission letter were obtained from Shegaw Motta General Hospital \n200 administrative office with reference number (SMGH 534/94/72). Additionally, written consent \n201 was obtained from a parent and/or legal guardian of study participants in accordance with the \n202 Declaration of Helsinki. Furthermore, the participation of study participants was entirely \n203 volunteer based on parents and/or legal guardian and their confidentiality was kept by coding \n204 rather than naming for identification. Finally, all HIV positive infants were linked to ART \n205 clinic at this hospital for further management.\n206 Operational definitions\n207 GeneXpert HIV-1 Qual assays: GeneXpert® Instrument Systems, is a qualitative in vitro \n208 diagnostic test designed to detect human immunodeficiency virus Type 1 (HIV-1) total nucleic \n209 acids using human venous whole blood and capillary from individuals suspected of HIV-1 \n210 infection for infant.\n211 Infant: infants or babies whose age less than 12 months and cannot produce their own serological \n212 detectable antibodies against HIV.\n . CC-BY 4.0 International licenseIt is made available under a \n is the author/funder, who has granted medRxiv a license to display the preprint in perpetuity. (which was not certified by peer review)\nThe copyright holder for this preprintthis version posted September 2, 2024. ; https://doi.org/10.1101/2024.09.01.24312902doi: medRxiv preprint \n\n11\n213 HIV1 exposed infants: The infants who born from HIV positive mother or women.\n214 Results\n215 Socio-demographic characteristics of study participants \n216 A total of 155 infants were recruited to the current study from which almost more than half of \n217 infants 79(50.9%) were females and the rest males. Furthermore, the majority of 87(56.1%), \n218 87(56.1%), 123 (79.4%), 138(89.0%) and 148(95.5%) infants were born from mothers who \n219 could not able to write and read, urban residence, self-employed, ages range from 25-34years \n220 and married mother, respectively. About 90 (58.1%) infants were less than 6 months in their age \n221 and the rest 65 (41.9%) was 6- 12months in the current study (Table: 1). \n222 Table 1: Socio-demographic characteristics of study participants at Shegaw Motta General \n223 Hospital, 2023\nVariable Categories Frequency Percent (%)\nGender of infant Male \nFemale \n76\n79\n49.1\n50.9\nResidence Urban \nRural \n87\n68\n56.1\n43.9\nMaternal education Unable to read and write\nPrimary & above\n87\n68\n56.1\n43.9\nMaternal age (in years) < 25 \n25–34 \n≥35 \n6\n138\n11\n3.9\n89.0\n7.1\n . CC-BY 4.0 International licenseIt is made available under a \n is the author/funder, who has granted medRxiv a license to display the preprint in perpetuity. (which was not certified by peer review)\nThe copyright holder for this preprintthis version posted September 2, 2024. ; https://doi.org/10.1101/2024.09.01.24312902doi: medRxiv preprint \n\n12\nMaternal marital status Not married\nMarried\n7\n148\n4.5\n95.5\nMaternal occupation Housewife \nGovernment employee \nSelf-employed\n24\n8\n123\n15.4\n5.2\n79.4\nInfant age (in months) <6 months \n6- 12months \n90\n65\n58.1\n41.9\n224\n225\n226\n227 Prevalence HIV 1 among exposed infants \n228 One hundred fifty-seven HIV-exposed infants were tested for HIV infection by GenXpert HIV1 \n229 Qual assay (EID). This study revealed that the overall prevalence of HIV1 infection among \n230 exposed infants was 6 (3.87%) with 95% CI; 2.9 - 8.2 in the current study ( Fig 1).\n231 Factors Associated with HIV1 infection among exposed infants \n232 According to bivariable analysis, residence, maternal education level, antenatal care (ANC) \n233 follow up, maternal Antiretroviral therapy (ART) enrolment, place of delivery, infant’s age at \n234 enrollment, attendant of delivery, maternal Antiretroviral (ARV) prophylaxis, infant nevirapine \n235 (NVP) prophylaxis, maternal CD4+ (cell/mm3) and maternal viral load (p-value < 0.2) were \n236 entered to multivariable logistic regression analysis. Regarding to multivariable logistic \n237 regression analysis, pregnant women had not ANC follow up  (AOR=7.281,  95% CI: 2.53-\n238 20.96: P = 0.001), home delivery ( AOR = 3.239,  95% CI: (1.75-9.19, P= 0.001), maternal not \n . CC-BY 4.0 International licenseIt is made available under a \n is the author/funder, who has granted medRxiv a license to display the preprint in perpetuity. (which was not certified by peer review)\nThe copyright holder for this preprintthis version posted September 2, 2024. ; https://doi.org/10.1101/2024.09.01.24312902doi: medRxiv preprint \n\n13\n239 received ARV prophylaxis (AOR = 9.213,  95% CI: 2.95-10.11, P = 0.001) , infant not intake \n240 NVP prophylaxis ( AOR = 2.560,  95% CI: 1.98-10.24, P = 0.007)  and maternal high viral load \n241 (>1000 copies) ( AOR = 5.120,  95% CI: 2.75-11.18, P = 0.004) during pregnancy were the \n242 identified  factors significantly  associated with  HIV infection among  infants born to HIV \n243 positive mothers. As the result, infants born to HIV positive mother who had not ANC follow \n244 up, home delivery, maternal not received ARV prophylaxis, infant not intake NVP prophylaxis \n245 and maternal high viral load (>1000 copies) were 7.281, 3.239, 9.213, 2.560 and 5.120 times \n246 more likely to be infected by HIV in this study, respectively (Table 2). \n247 Table 2: Bivariable and multivariable logistic regression analysis of factors associated with \n248 HIV1 infection among exposed infants at Shegaw Motta General Hospital Town, Ethiopia, 2023\n HIV1 Variables Categories\nPositive \nN (%) \nNegative\nN(%)\nCOR(95%CI) P value AOR(95%CI) P value \nGender of infant Male \nFemale \n2(2.6)\n4(5.4)\n74(97.4)\n71(94.6)\n1\n2.324(0.69-5.61)0.720\nInfant age (in \nmonths)\n<6 months \n6- 12months \n6 (6.7)\n0(0)\n84 (93.3)\n65 (100)\n1.653(0.812-7.921)0.431\n1\nResidence Urban\nRural \n4(3.4)\n2(2.9)\n83(96.6)\n66(97.1)\n1\n3.12 (1.45-5.11)0.102*\n1\n2.51(0.69-4.67) 0.145\nMaternal \neducation\nUnable read and write\nPrimary & above\n3(3.4)\n3(4.5)\n85(96.6)\n64(95.5)\n1.78(2.14-4.76)0.019*\n1\n3.16(0.43-5.89)\n1\n0.205\nMaternal age (in \nyears)\n< 25 \n25–34 \n≥ 35 \n0 (0)\n4 (3.0)\n2 (18.2)\n6 (100)\n131 (97.0)\n9 (81.8)\n1\n0.729(0.31-1.73)0.473\n1.545(0.47-5.12)0.478\nMaternal marital \nstatus\nNot married\nMarried\n1(14.3)\n5 (3.4)\n6(85.7)\n143(96.6)\n1\n1.714(0.72-4.11)0.427\n . CC-BY 4.0 International licenseIt is made available under a \n is the author/funder, who has granted medRxiv a license to display the preprint in perpetuity. (which was not certified by peer review)\nThe copyright holder for this preprintthis version posted September 2, 2024. ; https://doi.org/10.1101/2024.09.01.24312902doi: medRxiv preprint \n\n14\n249 Key:* = variables entered to multivariate regression (P- value < 0.2),** = statistical significant association ;ANC: Antenatal care; \n250 AOR: Adjusted odd ratio; ART: antiretroviral therapy; ARV: Anti-retroviral; CD4- cluster of differentiation -4 ; CI: confidence \n251 interval ,COR: crude odd ratio: EBF: exclusive breast feeding ;   HIV: human immunodeficiency, MF: mixed feeding; NVP: \n252 Nevirapine , TBA: Traditional birth attendant\nMaternal \noccupation\nHousewife \nSelf-employed\nGovernment employee\n2(8.3)\n3 (2.5)\n1(12.5)\n22 (91.7)\n120 (97.5)\n7(87.5)\n0.857(0.31-2.43) 0.367\n1.6490.418-3.24) 0.771\n1\nANC follow up Yes\nNo\n2 (2.7)\n4 (5.0)\n73 (97.3)\n76 (95.0)\n1\n10.615(4.40-25.61)0.001*\n1\n7.281(2.53-20.96) 0.001**\nMaternal ART \nenrolment\nEnrolled \nNot enrolled\n2 (1.5)\n4 (23.3)\n135 (98.5)\n14 (77.7)\n1\n16.179(4.58-57.22)0.001*\n1\n6.985(0.61-28.91) 0.195\nPlace of delivery Home \nHealth facility \n2(3.9)\n4 (3.8)\n49 (96.1)\n100(96.2)\n4.681(1.78-12.29) 0.002*\n1\n3.239(1.75-9.19)\n1\n0.001**\nInfant Feeding \npattern\nEBF\nERF\nMF\n0(0)\n2(3.8)\n4(5.0)\n23(100)\n50(96.2)\n76(95.0)\n1\n2.857(0.91-4.43) 0.367\n1.649(0.518-8.24) 0.571\nInfant’s age at \nenrollment\n≤ 6 weeks\n>6 weeks\n2(2.0)\n4 (7.6)\n100(98.0)\n49 (92.4)\n1\n4.681(1.78-12.29) 0.002*\n1\n5.219(0.65-14.29) 0.327\nMaternal ARV \nintervention\nBefore delivery\nDuring/after delivery\nNo\n1(2.6)\n2(2.2)\n3 (11.1)\n38(97.4)\n87(97.8)\n24(88.9\n1\n1.857 (0.31-6.43) 0.367\n4.649(0.418-7.24) 0.771\nAttendant  of \ndelivery \n TBA \nSkilled delivery \n3(2.9)\n3 (5.7)\n99(97.1)\n50 (94.3)\n4.381(1.68-11.29) 0.001*\n1\n4.239(0.75-9.19)\n1\n0.512\nMaternal  ARV \nprophylaxis\nNot Received \nReceived \n4(11.1)\n2(1.7)\n32(88.9)\n117 (98.3)\n5.418(2.37-12.41) 0.001*\n1\n9.213(2.95-10.11)\n1\n0.001**\nInfant NVP \nprophylaxis \nYes\nNo \n2(2.2)\n4(6.4)\n90(97.8)\n59(93.6)\n1\n4.681(1.78-12.29) 0.002*\n1\n2.560(1.98-10.24) 0.007**\nMaternal CD4+ \n(cell/mm3)\n< 200\n≥ 200\n5(31.2)\n1(0.7)\n11(68.8)\n138 (99.3)\n1\n5.418(2.37-12.41) 0.001*\n1\n9.213(0.95-10.11) 0.354\nMaternal viral \nload \n<1000copies (Low)\n≥ 1000 copies)(High)\n2(1.4)\n4 (28.6)\n139(98.6)\n10(71.4)\n1\n4.681(1.78-12.29) 0.002* 5.120(2.75-11.18) 0.004**\n . CC-BY 4.0 International licenseIt is made available under a \n is the author/funder, who has granted medRxiv a license to display the preprint in perpetuity. (which was not certified by peer review)\nThe copyright holder for this preprintthis version posted September 2, 2024. ; https://doi.org/10.1101/2024.09.01.24312902doi: medRxiv preprint \n\n15\n253 Discussion \n254 The prevalence of HIV1 infection on infants born from HIV positive mothers in the current study \n255 was 3.87%. This finding was in line with studies conducted in varies part of Ethiopia like in \n256 Dessie Town Public Health Facilities 3.8% [25], Pastoralist Health Facilities, South Omo Zone \n257 5.3% [26], East and West Gojjam Zone5.9% [27] and University of Gondar Specialized Hospital \n258 5.5% [28], east Africa 7.68% (29)and Kenya 3.3% [30]. \n259 The current prevalence of HIV1 infection was lower than 11.4% pooled prevalence in Ethiopia \n260 [19], 9% in Sidama [31], 10.1% in Amhara Region [32] and 9.9% in Bahir Dar city public health \n261 facilities [33]. This difference might be due to the variation of ART and PMCT follow up, \n262 awareness to HIV, policies, and strategies on HIV control and prevention, methodology and \n263 sample size. In contrast, it was slightly higher than 1.5%, 1.6%, 2.7%, and2.1%, compared to the \n264 study conducted in France [34], Ukraine [35], Rwanda[36] and Tigray regional state, Northern \n265 Ethiopia [37], respectively. This difference might be due to high coverage of PMTCT \n266 interventions in developed countries and limited access, lack of awareness, poor quality of \n267 service in developing countries including Ethiopia.\n268 Regarding to multivariable logistic regression analysis in the current study, mothers had not \n269 ANC follow up(AOR=7.281, 95% CI: 2.53-20.96: P = 0.001)was significantly associated with \n270 MTCT ofHIV1. Meanwhile, mothers who did not attend ANC follow up were 7.281 times more \n271 likely to transmit the virus to their infants than mothers who had ANC visit. This finding was \n272 agreed with the study conducted in Rwanda [38], Ethiopia[ 39], Gondar city health institutions, \n273 Northwest Ethiopia[40]and public health facilities in Dessie town [41].Similarly, home delivery \n274 (AOR = 3.239, 95% CI: (1.75-9.19, P= 0.001)was also a factor significantly associated with \n . CC-BY 4.0 International licenseIt is made available under a \n is the author/funder, who has granted medRxiv a license to display the preprint in perpetuity. (which was not certified by peer review)\nThe copyright holder for this preprintthis version posted September 2, 2024. ; https://doi.org/10.1101/2024.09.01.24312902doi: medRxiv preprint \n\n16\n275 MTCT of HIV1 infection. Thus, infants born at home had a 3.239 times greater chance of \n276 contracting the virus than those born in health facilities. This finding was concordant with the \n277 study illustrated in East Africa [42], rural Uganda [43], South west Ethiopia [44], Dire Dawa \n278 [45], southern Ethiopia [46], Northwest Ethiopia [47], Gondar city health institutions [40],South \n279 Gondar zone [48]and  Bahir Dar administration(49).This might be due to HIV testing for \n280 mothers with unknown HIV status who delivered at health facility and immediate ARV \n281 intervention for mothers and their infants if the test was positive. In addition, safe delivery \n282 practice and appropriate post-natal care during health facility delivery might support this \n283 significant association.\n284 On the other hand, absence of maternal intake ARV prophylaxis(AOR = 9.213, 95% CI: 2.95-\n285 10.11, P = 0.001) was 9.213 times more likely to born HIV positive infants compared to those \n286 received ARV prophylaxis. A finding was in line with studies conducted in Vietnam[50],East \n287 Africa [ 42],Uganda[43], Northwest Ethiopia[47],Ethiopia such as Mekele city [51], health \n288 facilities of North Wollo Zone [52], Bahir Dar administration[49]. This might be as a result of \n289 maternal ARV drug intake causing the reduction of maternal viral load and reduced risk of viral \n290 transmission to their infants. Furthermore, infants not intake NVP prophylaxis (AOR = 2.560,  \n291 95% CI: 1.98-10.24, P = 0.007)were2.560times more likely to be HIV positive as compared  to \n292 infants received NVP prophylaxis at birth according to this study. Such findings were agreed \n293 with the previous studies reported in Brazil [53], Uganda (54), Dire Dawa [45], southern \n294 Ethiopia [55] and Ethiopian Public Health Institute [56, 57]. This might be due to the viral \n295 suppression effect of NVP, which is a non-nucleoside reverse transcriptase inhibitor, by binding \n296 to reverse transcriptase, thereby blocking RNA and DNA dependent DNA polymerase actions \n297 including HIV replication.\n . CC-BY 4.0 International licenseIt is made available under a \n is the author/funder, who has granted medRxiv a license to display the preprint in perpetuity. (which was not certified by peer review)\nThe copyright holder for this preprintthis version posted September 2, 2024. ; https://doi.org/10.1101/2024.09.01.24312902doi: medRxiv preprint \n\n17\n298 Finally, maternal high viral load (>1000 copies ) (AOR = 5.120, 95% CI: 2.75-11.18, P = 0.004) \n299 during pregnancy were the factors significantly associated with HIV infection among exposed \n300 infants by which infants from high maternal viral load were 5.120times more likely to be \n301 infected by HIV than infants born from low maternal viral load. The findings were concordant \n302 with a study carried out in India [ 58], Philadelphia [59], Uganda (54), Rwanda [38], Gaza \n303 Province—Mozambique (60), northeast South Africa [61]. This might be due to high viral load \n304 concentration could compromise the maternal immune system and leads to vertical \n305 transmission of HIV to infants.\n306 Conclusion \n307 The prevalence of HIV1 infection among exposed infants born to HIV positive mothers was still \n308 high (3.87%). Pregnant women had not ANC visits , home delivery, Absence of ARV \n309 prophylaxis, infants not intake NVP prophylaxis, and maternal high viral load increases HIV \n310 infection among exposed infants. Therefore, health facilities should strictly strengthen the \n311 PMTCT service by providing maternal ARV prophylaxis, infant NVP prophylaxis, promote \n312 ANC service, early screening maternal viral load and scale up skilled delivery to eliminate \n313 HIV infection among exposed infants. \n314 Abbreviations\n315 AOR–adjusted odd ratio, ART- Antiretroviral therapy, ARV-antiretroviral , ANC-Antenatal \n316 Care, COR- Crude odd ratio, DNA- Deoxy-ribose nucleicacid, EDTA- ethylenediamine tetra \n317 acetylene, EID- early infant diagnosis, HIV- Human immunodeficiency virus, NAAT- nucleic \n . CC-BY 4.0 International licenseIt is made available under a \n is the author/funder, who has granted medRxiv a license to display the preprint in perpetuity. (which was not certified by peer review)\nThe copyright holder for this preprintthis version posted September 2, 2024. ; https://doi.org/10.1101/2024.09.01.24312902doi: medRxiv preprint \n\n18\n318 acid amplification, NVP-nevirapine, PCR- polymerase chain reaction, PMTCT - prevention of \n319 mother- to child transmission, MTCT- mother to child transmission, RNA- ribose nucleic acid\n320 Acknowledgments\n321 The authors would like to thank administration of Shegaw Motta General Hospital for providing \n322 a permission to conduct this study. By the next, we would like to acknowledge Molecular \n323 biology laboratory of Debre Markos comprehensive specialized hospital (DMCSH) including its \n324 laboratory staffs that did the viral load of referred plasma sample. We would also like to thank all \n325 laboratory staffs in this hospital, study participants, and data collectors for their unreserved \n326 efforts and willingness to participate in this study.\n327 Authors Contribution\n328 Conceptualization: Destaw Kebede Nigusie, Fantahun Getaneh Damitew, \n329 Data curation: Fantahun Getaneh Damitew, Kirubel Endalamaw Melsew \n330 Formal analysis: Destaw Kebede Nigusie, Melsew , Girma Zerefaw, Abebe Fenta Nigusie :\n331 Investigation: Destaw Kebede Nigusie, Fantahun Getaneh Damitew, Kirubel Endalamaw \n332 Melsew , Girma Zerefaw, Abebe Fenta Nigusie\n333 Methodology: Kirubel Endalamaw Melsew, Girma Zerefaw, Abebe Fenta Nigusie\n334 Resources: Destaw Kebede Nigusie and Fantahun Getaneh Damitew\n335 Supervision:, Girma Zerefaw Abay, and  Abebe Fenta Nigusie\n336 Visualization: Fantahun Getaneh Damitew, Kirubel Endalamaw\n337 Writing – Original Draft Preparation: Destaw Kebede Nigusie, Fantahun Getaneh Damitew, \n338 Writing – Review & Editing: Girma Zerefaw Abay, and  Abebe Fenta Nigusie\n . CC-BY 4.0 International licenseIt is made available under a \n is the author/funder, who has granted medRxiv a license to display the preprint in perpetuity. (which was not certified by peer review)\nThe copyright holder for this preprintthis version posted September 2, 2024. ; https://doi.org/10.1101/2024.09.01.24312902doi: medRxiv preprint \n\n19\n339 References \n340 1. Vos T, Barber RM, Bell B, Bertozzi-Villa A, Biryukov S, Bolliger I, Charlson F, Davis \n341 A, Degenhardt L, Dicker D, Duan L. Global, regional, and national incidence, \n342 prevalence, and years lived with disability for 301 acute and chronic diseases and injuries \n343 in 188 countries, 1990–2013: a systematic analysis for the Global Burden of Disease \n344 Study 2013. The lancet. 2015 Aug 22;386(9995):743-800.\n345 2. UNAIDS World Health Organization. AIDS epidemic update: December 2009. WHO \n346 Regional Office Europe; 2010 Mar 24, 1-99. \n347 3. UNAIDS U. Countdown to ZERO: global plan towards the elimination of new HIV \n348 infections among children by 2015 and keeping their mother alive. UNAIDS; \n349 2011.http://library.tacaids.go.tz/bitstream/handle/123456789/68/Global-Plan-\n350 Elimination-HIV-Children%202011.pdf?sequence=1&isAllowed=y\n351 4. Newman Owiredu M, Newman L, Nzomo T, ConomboKafando G, Sanni S, Shaffer N, \n352 Bucagu M, Peeling R, Mark J, DiopToure I. Elimination of mother‐to‐child transmission \n353 of HIV and syphilis: A dual approach in the African Region to improve quality of \n354 antenatal care and integrated disease control. International Journal of Gynecology & \n355 Obstetrics. 2015 Jun;130:S27-31.\n356 5. Berhan Z, Abebe F, Gedefaw M, Tesfa M. Prevalence of HIV and associated factors \n357 among infants born to HIV positive women in Amhara Region, Ethiopia. International \n358 journal of clinical medicine. 2014 Apr 17;2014.\n359 6. Newell ML. Current issues in the prevention of mother-to-child transmission of HIV-1 \n360 infection. Transactions of the Royal Society of Tropical Medicine and Hygiene. 2006 Jan \n361 1;100(1):1-5.\n . CC-BY 4.0 International licenseIt is made available under a \n is the author/funder, who has granted medRxiv a license to display the preprint in perpetuity. (which was not certified by peer review)\nThe copyright holder for this preprintthis version posted September 2, 2024. ; https://doi.org/10.1101/2024.09.01.24312902doi: medRxiv preprint \n\n20\n362 7. Read DJ, Breastfeeding and HIV International Transmission Study Groupa. Late \n363 postnatal transmission of HIV-1 in breast-fed children: an individual patient data meta-\n364 analysis. The Journal of infectious diseases. 2004 Jun 15;189(12):2154-66.\n365 8. Zijenah LS, Bandason T, Bara W, Chipiti MM, Katzenstein DA. Mother-to-child \n366 transmission of HIV-1 and infant mortality in the first six months of life, in the era of \n367 Option B Plus combination antiretroviral therapy. International Journal of Infectious \n368 Diseases. 2021 Jun 21.\n369 9. Embree JE, Njenga S, Datta P, Nagelkerke NJ, Ndinya-Achola JO, Mohammed Z, \n370 Ramdahin S, Bwayo JJ, Plummer FA. Risk factors for postnatal mother–child \n371 transmission of HIV-1. Aids. 2000 Nov 10;14(16):2535-41.\n372 10. Van de Perre P, Simonon A, Karita E, Butera JB, Hitimana DG, Mukamabano B, Van \n373 Goethem C, Lepage P, Dabis F, Msellati P. Infective and anti-infective properties of \n374 breastmilk from HIV-1-infected women. The Lancet. 1993 Apr 10;341(8850):914-8.\n375 11. World Health Organization (WHO). New data on the prevention of mother-to-child \n376 transmission of HIV and their policy implications: conclusions and recommendations: \n377 WHO Technical consultation on behalf of the UNFPA/UNICEF/WHO/UNAIDS Inter-\n378 Agency Task Team on Mother-to-Child Transmission of HIV, Geneva, 11-13 October \n379 2000. World Health Organization; 2001.\n380 12. Read JS, Committee on Pediatric AIDS. Diagnosis of HIV-1 infection in children \n381 younger than 18 months in the United States. Pediatrics. 2007 Dec;120(6):e1547-62.\n382 13. World Health Organization. Manual on pediatric HIV care and treatment for district \n383 hospitals: addendum to the Pocket book of hospital care of \n384 children.https://apps.who.int/iris/bitstream/handle/10665/44511/9789241501026_eng.pdf\n . CC-BY 4.0 International licenseIt is made available under a \n is the author/funder, who has granted medRxiv a license to display the preprint in perpetuity. (which was not certified by peer review)\nThe copyright holder for this preprintthis version posted September 2, 2024. ; https://doi.org/10.1101/2024.09.01.24312902doi: medRxiv preprint \n\n21\n385 14. Creek T, Tanuri A, Smith M, Seipone K, Smit M, Legwaila K, Motswere C, Maruping \n386 M, Nkoane T, Ntumy R, Bile E. Early diagnosis of human immunodeficiency virus in \n387 infants using polymerase chain reaction on dried blood spots in Botswana's national \n388 program for prevention of mother-to-child transmission. The Pediatric infectious disease \n389 journal. 2008 Jan 1;27(1):22-6.\n390 15. Fonjungo PN, Mekonen T, Mengistu Y, Kebede Y, Kenyon TA, Girma M, Tegbaru B, \n391 Tibesso G, Ayana G, Abebe A, Messele T. Field expansion of DNA polymerase chain \n392 reaction for early infant diagnosis of HIV-1: the Ethiopian experience: lessons from the \n393 field. African journal of laboratory medicine. 2013 Jan 1;2(1):1-7.\n394 16. Yitayew YA, Bekele DM, Demissie BW, Menji ZA. Mother to child transmission of HIV \n395 and associated factors among HIV exposed infants at public health facilities, Dessie \n396 Town, Ethiopia. Hiv/aids (Auckland, NZ). 2019;11:343.\n397 17. Tadele T, Tamiso A, Tadele T. Incidences and predictors of HIV positivity among infants \n398 who born from HIV positive mother who have follow up at two hospitals of southern \n399 Ethiopia, 2014. Sci J Public Health. 2014 Sep 1;2(5):431-9.\n400 18. Kassie DG, Bogale WA, Addisu A. The prevalence of HIV-positive infants born to HIV-\n401 positive mothers attended at the University of Gondar Specialized Hospital Anti-\n402 Retroviral Therapy Services, Northwest Ethiopia, 2018. HIV/AIDS (Auckland, NZ). \n403 2020;12:135.\n404 19. Endalamaw A, Demsie A, Eshetie S, Habtewold TD. A systematic review and meta-\n405 analysis of vertical transmission route of HIV in Ethiopia. BMC infectious diseases. 2018 \n406 Dec;18(1):1-1.\n . CC-BY 4.0 International licenseIt is made available under a \n is the author/funder, who has granted medRxiv a license to display the preprint in perpetuity. (which was not certified by peer review)\nThe copyright holder for this preprintthis version posted September 2, 2024. ; https://doi.org/10.1101/2024.09.01.24312902doi: medRxiv preprint \n\n22\n407 20. Mazanderani AH, Moyo F, Kufa T, Maritz J, Sherman GG. Differentiating clearly \n408 positive from indeterminate results: A review of irreproducible HIV-1 PCR positive \n409 samples from South Africa's Early Infant Diagnosis Program, 2010–2015. Diagnostic \n410 microbiology and infectious disease. 2018 Jul 1;91(3):248-55.\n411 21. Michaeli M, Wax M, Gozlan Y, Rakovsky A, Mendelson E, Mor O. Evaluation of Xpert \n412 HIV-1 Qual assay for resolution of HIV-1 infection in samples with negative or \n413 indeterminate Geenius HIV-1/2 results. Journal of Clinical Virology. 2016 Mar 1; 76:1-3.\n414 22. Opollo VS, Nikuze A, Ben-Farhat J, Anyango E, Humwa F, Oyaro B, Wanjala S, \n415 Omwoyo W, Majiwa M, Akelo V, Zeh C. Field evaluation of near point of care Cepheid \n416 GeneXpert HIV-1 Qual for early infant diagnosis. PloS one. 2018 Dec 27;13(12): \n417 e0209778.\n418 23. Garrett NJ, Drain P, Werner L, Samsunder N, Karim SS. Diagnostic accuracy of the \n419 point-of-care Xpert® HIV-1 viral load assay in a South African HIV clinic. Journal of \n420 acquired immune deficiency syndromes (1999). 2016 Jun 1;72(2):e45.\n421 24. Murtagh MM. Molecular Diagnostics for Use in HIV/AIDS Care and Treatment in \n422 Resource‐Limited Settings. Molecular Microbiology: Diagnostic Principles and Practice. \n423 2016 Apr 28:580-8.\n424 25. Yitayew YA, Bekele DM, Demissie BW, Menji ZA. Mother to child transmission of HIV \n425 and associated factors among HIV exposed infants at public health facilities, Dessie \n426 Town, Ethiopia. Hiv/aids (Auckland, NZ). 2019; 11:343.\n427 26. Tadewos K, Adimasu M, Tachbele E. Mother-to-Child Transmission of HIV and \n428 Associated Factors Among Exposed Infants in Pastoralist Health Facilities, South Omo \n . CC-BY 4.0 International licenseIt is made available under a \n is the author/funder, who has granted medRxiv a license to display the preprint in perpetuity. (which was not certified by peer review)\nThe copyright holder for this preprintthis version posted September 2, 2024. ; https://doi.org/10.1101/2024.09.01.24312902doi: medRxiv preprint \n\n23\n429 Zone, Ethiopia, 2020–A Retrospective Cross-Sectional Study. HIV/AIDS (Auckland, \n430 NZ). 2021; 13:1015.\n431 27. Moges NA, Kassa GM, Boneya DJ. Rate of HIV transmission and associated factors \n432 among HIV-exposed infants in selected health facilities of East and West Gojjam Zones, \n433 Northwest Ethiopia; retrospective cohort study. BMC infectious diseases. 2017 \n434 Dec;17(1):1-0.\n435 28. Kassie DG, Bogale WA, Addisu A. The prevalence of HIV-positive infants born to HIV-\n436 positive mothers attended at the University of Gondar Specialized Hospital Anti-\n437 Retroviral Therapy Services, Northwest Ethiopia, 2018. HIV/AIDS (Auckland, NZ). \n438 2020;12:135.\n439 29. Amare Belachew , Tilahun Tewabe and GizatAbinetMalede. Prevalence of vertical HIV \n440 infection and its riskfactors among HIV-exposed infants in East Africa.Tropical Medicine \n441 and Health.2020; 48:85\n442 30. Opollo VS, Nikuze A, Ben-Farhat J, Anyango E, Humwa F, Oyaro B, Wanjala S, \n443 Omwoyo W, Majiwa M, Akelo V, Zeh C. Field evaluation of near point of care Cepheid \n444 GeneXpert HIV-1 Qual for early infant diagnosis. PloS one. 2018 Dec \n445 27;13(12):e0209778.\n446 31. Yosef Y, Tebeje B, Joseph J, Abeje S. HIV Sero Status and Associated Factors Among \n447 HIV-Exposed Infants’ in Selected Health Facilities in Sidama Zone, Southern Ethiopia. \n448 Journal of Family Medicine and Health Care. 2020 Jun 10;6(3):70-7.\n449 32. Berhan Z, Abebe F, Gedefaw M, Tesfa M. Prevalence of HIV and associated factors \n450 among infants born to HIV positive women in Amhara Region, Ethiopia. International \n451 journal of clinical medicine. 2014 Apr 17;2014.\n . CC-BY 4.0 International licenseIt is made available under a \n is the author/funder, who has granted medRxiv a license to display the preprint in perpetuity. (which was not certified by peer review)\nThe copyright holder for this preprintthis version posted September 2, 2024. ; https://doi.org/10.1101/2024.09.01.24312902doi: medRxiv preprint \n\n24\n452 33. Birhanu M, Ergetie T, Tenna T, Ayana T, Dessie W, Belay W. Maternal Educational \n453 Level Determine Mother-to-child Transmission of HIV Among HIV-exposed Infants in \n454 Governmental Health Facility of Bahir Dar City, Northwest Ethiopia.\n455 34. Tubiana R, Le Chenadec J, Rouzioux C, Mandelbrot L, Hamrene K, Dollfus C, Faye A, \n456 Delaugerre C, Blanche S, Warszawski J. Factors associated with mother-to-child \n457 transmission of HIV-1 despite a maternal viral load< 500 copies/ml at delivery: a case-\n458 control study nested in the French perinatal cohort (EPF-ANRS CO1). Clin Infect Dis. \n459 2010;50(4):585–96.\n460 35. Bailey H, Semenenko I, Pilipenko T, Malyuta R, Thorne C. Ukraine European \n461 collaborative study group: factors associated with abandonment of infants born to HIV-\n462 positive women: results from a Ukrainian birth cohort. AIDS Care. 2010;22(12):1439–\n463 48.\n464 36. Nsengimana B, Nkurunziza F, Ntaganira WM, Uzayisenga R, Rutayisire G. HIV \n465 Prevalence and risk factors for infants born to mothers on ARV treatment at \n466 CHUB/Rwanda.https://doi.org/10.20944/preprints202109.0015.v1\n467 37. Desta ML, Saravanan M, Hilekiros H, Kahsay AG, Mohamed NF, Gezahegn AA, Lopes \n468 BS. HIV prevalence and risk factors in infants born to HIV positive mothers, measured \n469 by dried blood spot real-time PCR assay in Tigray, Northern Ethiopia. BMC pediatrics. \n470 2019 Dec;19(1):1-8.\n471 38. Bernard Nsengimana, Francois Nkurunziza, Wivine M Ntaganira, Ruth Uzayisenga and \n472 Gad Rutayisire. HIV Prevalence and risk factors for infants born to mothers on ARV \n473 treatment at CHUB/Rwanda. Preprints, 2021;01(09);1-13. \n474 https://doi.org/10.20944/preprints202109.0015.v1\n . CC-BY 4.0 International licenseIt is made available under a \n is the author/funder, who has granted medRxiv a license to display the preprint in perpetuity. (which was not certified by peer review)\nThe copyright holder for this preprintthis version posted September 2, 2024. ; https://doi.org/10.1101/2024.09.01.24312902doi: medRxiv preprint \n\n25\n475 39. Kassie SY, Chereka AA, Damtie Y. Systematic review and meta-analysis of knowledge \n476 on PMTCT of HIV/AIDS and Association factors among reproductive age women in \n477 Ethiopia, 2022. BMC Infectious Diseases. 2023 Jul 25;23(1):491.\n478 40. Tiruneh GA, Dagnew EZ. Prevalence of HIV infection and associated factors among \n479 infants born to HIV-positive mothers in health institutions, northwest Ethiopia, 2021. \n480 Women's Health. 2022 Aug;18:17455057221117407.\n481 41. Yibeltal Asmamaw Yitayew, Daniel Mengistu Bekele ,BirhanuWondimeneh\n482 Demissie andZeleke Argaw Menji. Mother to Child Transmission of HIV and Associated \n483 Factors Among HIV Exposed Infants at Public Health Facilities, Dessie Town, \n484 Ethiopia.2019;11 :343–350\n485 42. Belachew A, Tewabe T, Malede GA. Prevalence of vertical HIV infection and its risk \n486 factors among HIV exposed infants in East Africa: a systematic review and meta-\n487 analysis. Tropical Medicine and Health. 2020 Dec;48:1-1.\n488 43. Kahungu MM, Kiwanuka J, Kaharuza F, Wanyenze RK. Factors associated with HIV \n489 positive sero-status among exposed infants attending care at health facilities: a cross \n490 sectional study in rural Uganda. BMC public health. 2018 Dec; 18:1-1.\n491 44. TAD BB, Sisay K, Gurmessa A, Seyoum D, Tadesse M. Mother tochild HIV \n492 transmission and its predictors among HIV-exposedinfants: a retrospective follow-up \n493 study in Southwest Ethiopia.J AIDS Clin Res. 2016;7(9):1–7.\n494 45. Fisseha W, Damtew B. Mother-to-child transmission of HIV infectionand its \n495 determinants among exposed infants on care and follow-up inDire Dawa City, Eastern \n496 Ethiopia.AIDS Res Treat. 2016; 2016:6.\n . CC-BY 4.0 International licenseIt is made available under a \n is the author/funder, who has granted medRxiv a license to display the preprint in perpetuity. (which was not certified by peer review)\nThe copyright holder for this preprintthis version posted September 2, 2024. ; https://doi.org/10.1101/2024.09.01.24312902doi: medRxiv preprint \n\n26\n497 46. Hussen R, Zenebe WA, Mamo TT, Shaka MF. Determinants of HIV infection among \n498 children born from mothers on prevention of mother to child transmission programme of \n499 HIV in southern Ethiopia: a case–control study. BMJ open. 2022 Feb 1;12(2):e048491\n500 47. Tsehay AK. Risk of HIV and associated factors among infants born to HIV-positive \n501 women in northwest Ethiopia. Ethiopian Journal of Health Development. 2019;33(1).\n502 48. Digsu M. Mother - to - child transmission of HIV - and its predictorsamong HIV - \n503 exposed infants at aPMTCT clinic in Northwest Ethiopia.BioMed Center. 2013; 13:398.\n504 49. Tsehay AK. Factors associated with HIV-positive sero-status among exposed infants \n505 attending care at health facilities in Bahir Dar administration, Ethiopia: evidence from \n506 medical records. Cogent Medicine. 2019 Jan 1;6(1):1623754\n507 50. Nguyen RN, Ton QC, Tran QH, Nguyen TK. Mother-to-child transmission of HIV and \n508 its predictors among HIV-exposed infants at an outpatient clinic for HIV/AIDS in \n509 Vietnam. HIV/AIDS-Research and Palliative Care. 2020 Jul 15:253-61.\n510 51. Ebuy H, Bekele A, Redae G. HIV testing, test results and factors influencing among \n511 infants born to HIV positive mothers in public hospitals of Mekelle City, North Ethiopia: \n512 a cross-sectional study. BMC Infectious Diseases. 2020 Dec; 20:1-0.\n513 52. Alachew Y, Ejigu T, Mulugeta Y, AshagreaMDeterminants of Mother to Child \n514 Transmission of HIV Among Infants Born from HIV Positive Women in North \n515 WolloZone, North East Ethiopia: 2018, Case Control Study. J Aids HIV Inf.2019; 5(1): \n516 102\n517 53. Ligia MD, de Lemos JL, Rutherford GW, et al. Maternal risk factorsfor HIV infection in \n518 infants in northeastern Brazil. Int J Inf Dis.2013; 17:913–918. \n . CC-BY 4.0 International licenseIt is made available under a \n is the author/funder, who has granted medRxiv a license to display the preprint in perpetuity. (which was not certified by peer review)\nThe copyright holder for this preprintthis version posted September 2, 2024. ; https://doi.org/10.1101/2024.09.01.24312902doi: medRxiv preprint \n\n27\n519 54. Kasozi GK, Robert A. Risk factors associated with HIV infection among infants below \n520 24 months born to HIV positive mothers. IntJr of HIV/AIDS PrEdu and Beha Sc. \n521 2017;3(10.11648).\n522 55. Tariku Tadele AT, Tadele T. Incidences and predictors of HIV positivity among infants \n523 who born from HIV positive mother who havefollow up at two hospitals of southern \n524 Ethiopia.Sci J Public Health.2014;2(5):431–439\n525 56. Gutema G, Tola HH, Fikadu D, Leta D, Bejiga B, Tura JB, Abdella S, Mamo H. \n526 Positivity rate, trend and associated risk factors of mother-to-child transmission of HIV \n527 among HIV-exposed infants. BMC pediatrics. 2023 Jun 6;23(1):283.\n528 57. Gutema G, Tola HH, Fikadu D, Leta D, Bejiga B, Tura JB, Abdella S, Mamo H. \n529 Positivity rate, trend and associated risk factors of mother-to-child transmission of HIV \n530 among HIV-exposed infants. BMC pediatrics. 2023 Jun 6;23(1):283.\n531 58. Bardeskar NS, Ahir-Bist SP, Mehta PR, Samant-Mavani P, Nanavati R, Mania-Pramanik \n532 J. Anti-retroviral therapy failure in HIV-1 infected pregnant women and its associated \n533 risk of HIV transmission. Archives of Gynecology and Obstetrics. 2020 Nov;302:1229-\n534 35.\n535 59. Momplaisir FM, Nassau T, Moore K, Grayhack C, Njoroge WF, Roux AV, Brady KA. \n536 Association of adverse neighborhood exposures with HIV viral load in pregnant women \n537 at delivery. JAMA Network Open. 2020 Nov 2;3(11):e2024577-.\n538 60. Osório D, Munyangaju I, Nacarapa E, Muhiwa A, Nhangave AV, Ramos JM. Mother-to-\n539 child transmission of HIV infection and its associated factors in the district of Bilene, \n540 Gaza Province—Mozambique. PLoS One. 2021 Dec 10;16(12):e0260941.\n . CC-BY 4.0 International licenseIt is made available under a \n is the author/funder, who has granted medRxiv a license to display the preprint in perpetuity. (which was not certified by peer review)\nThe copyright holder for this preprintthis version posted September 2, 2024. ; https://doi.org/10.1101/2024.09.01.24312902doi: medRxiv preprint \n\n28\n541 61. Ngandu NK, Lombard CJ, Mbira TE, Puren A, Waitt C, Prendergast AJ, Tylleskär T, \n542 Van de Perre P, Goga AE. HIV viral load non-suppression and associated factors among \n543 pregnant and postpartum women in rural northeastern South Africa: a cross-sectional \n544 survey. BMJ open. 2022 Mar 1;12(3):e058347\n545\n546\n547\n . CC-BY 4.0 International licenseIt is made available under a \n is the author/funder, who has granted medRxiv a license to display the preprint in perpetuity. (which was not certified by peer review)\nThe copyright holder for this preprintthis version posted September 2, 2024. ; https://doi.org/10.1101/2024.09.01.24312902doi: medRxiv preprint \n\n . CC-BY 4.0 International licenseIt is made available under a \n is the author/funder, who has granted medRxiv a license to display the preprint in perpetuity. (which was not certified by peer review)\nThe copyright holder for this preprintthis version posted September 2, 2024. ; https://doi.org/10.1101/2024.09.01.24312902doi: medRxiv preprint","source_license":"CC-BY-4.0","license_restricted":false}