Prevalence and Predictors of Mother-to-Child Transmission of Human Immunodeficiency Virus (HIV) among HIV-exposed Infants.

Background and objective: There is a global effort to eliminate new human immunodeficiency virus (HIV) infections among children. However, mother-to-child transmission (MTCT) of HIV, which accounts for nearly all pediatric infections, remains disproportionately high in Africa, including Ghana. This study aims to determine the prevalence and identify the key predictors of MTCT of HIV among HIV-exposed infants in the Ashanti Region of Ghana.

Methods: A retrospective cohort analysis of routine follow-up records of HIV-infected mothers and their exposed infants was conducted between August 2023 and June 2024 in four hospitals. A convenient consecutive sampling technique was employed to include exposed infants who were at least 18 months old, had ceased breastfeeding, and had definite HIV test results. A structured form was used to collect sociodemographic, clinical, and treatment data of mother-infant pairs. The data were entered into an Excel sheet and exported to STATA version 17.0 for analysis. Bivariate and multivariate logistic regression models were used to determine key predictors of MTCT.

Results: Out of the 220 records reviewed, 24 infants tested positive for HIV, giving an overall prevalence of 10.9%. The prevalence was 17.5% (21/120) among participants living in rural communities, compared to 0.03% (3/100) in urbanized areas. Maternal viral load ≥1000 copies/mL (adjusted odds ratio [aOR]: 13.13; 95% confidence interval [CI]: 2.75-62.69), no antiretroviral (ARV) prophylaxis in infant (aOR: 11.05; 95% CI: 2.18-55.91), and mixed feeding during the first 6 months of life of the infant (aOR: 5.65; 95% CI: 1.34-23.87) were the main predictors of MTCT of HIV.

Conclusion and global health implications: The prevalence of MTCT of HIV is high, especially in rural settings. Eliminating MTCT will require effective maternal viral suppression through optimal ART adherence, ensuring prompt ARV prophylaxis for infants at birth and promoting safer feeding practices during the infant's first 6 months of life.