Last modified: 2023-02-23
Abstract
Background: Despite the highest (88%) Prevention of Mother-To-Child Transmission (PMTCT) of HIV coverage in Eastern Africa, 50 % of new HIV infections in children aged 0–14 years occur in the region with the major transmission during breast feeding.
Objective: The aim of this study was to assess the feeding modalities, HIV transmission and its predictors among HIV-exposed infants (HIV-EIs) visited Gamo and Gofa Zones public health facilities, Southern Ethiopia from January 2013 to February 2019.
Method and Materials: Institution-based retrospective cohort study was employed among 404 HIV-EIs having DNA/PCR test results. All infant-mother pair records in selected health facilities were reviewed using a standard data extraction tool from March to July 2019. HIV transmission probabilities were assessed by Kaplan–Meier time-to-event analysis method and log-rank tests were used to compare the risk among different groups. The Cox-proportional hazards model, adjusted on infant feeding modalities and other co-variants was used to identify predictors of HIV transmission, and statistical significance was declared at a p-value of < 0.05.
Results: In total, 383 complete records were analyzed. In the study, 85.6% (95%CI: 81.6%-89.1%) of EIs were exclusively breastfed in the first six months. Only 1.9% (95%CI: 0.8%-4.0%) of infants had growth failure (weight for age or length for age <3 percentiles) at the end of their follow-up time. The 18 months probability of infant HIV transmission was 16.7% (95%CI:13.1%–20.8%). The risk of HIV-transmission was higher among infants who were delivered at the hospital than health centers/health posts (AHR=3.07;95%CI:1.19,7.95); discontinued cotrimoxazole prophylaxis in at least one visit (AHR=6.32; 95%CI:3.35,11.94); didn’t exclusively breastfeed (AHR=3.07; 95%CI:1.72,5.47) and came from urban areas (AHR=5.90; 95%CI: 1.40,24.85).
Conclusions: The study attested that EIs had a greater rate of 18 months HIV transmission. The risk of transmission is higher among infants who do not breastfeed exclusively for the first 6 months, and the risk increases with the number of months spent by breastfeeding. Therefore, strengthening counseling on safer feeding options and cotri-prophylaxis use; provision of quality PMTCT service with special focus in hospitals and urban residents were recommended.