Human immunodeficiency virus (HIV) is a virus that attacks the body’s immune system. If HIV is not treated, it can lead to acquired immunodeficiency syndrome (AIDS) (1). HIV can be transmitted from mother to child vertically, sexually, through contaminated blood products, and intravenous drug abuse (2). Vertical transmission of HIV infection occurs during pregnancy, labor and delivery, and breastfeeding (3). In 2009, AIDS was a major global health problem, that has been estimated that globally 33.4 million people were living with HIV (4, 5). At the end of 2011, 3.2 million under the age of 15 years children were living with HIV globally, among these children 91% found in Africa (6). Without intervention, 25–40% of HIV infection in children is acquired through vertical transmission (7). In the United States, perinatal transmission of HIV by the mother accounts for 80% of pediatric HIV infections. Sexual abuse of children and high-risk behaviors in adolescents also contribute to youth HIV infection (7).
The number of HIV infected children has increased radically in developing countries over the last 30 years since the first HIV cases were identified in 1981. This is due to that the number of HIV-infected women of childbearing age has climbed (8). However, great improvements have been made in the United States and other industrialized countries to control mother to child transmission of HIV. The World Health Organization (WHO) estimates that almost 2.5 million children were living with HIV infection as of 2009 (8). Newly HIV-infected children in 2009 alone were 370,000 (9), this is a fall of 24% from 5 years before (10). Globally, one million HIV-exposed infants are born with HIV-infected women every year (11). There are about 1.4 million HIV-positive pregnant women who contribute to more than 300,000 neonatal and fetal deaths each year globally (12).
The HIV infection rate in pregnant women is as high as 0.3%. In untreated women with viral loads of less than 100 copies/ml, the perinatal HIV transmission rates are 25% (13). Even though prophylactic interventions have decreased the vertical transmission of HIV, perinatal transmission continues to occur (14). This is generally due to missed opportunities for HIV prevention, especially among women who miss prenatal care or who are not being offered voluntary HIV counseling and testing during pregnancy. For the majority 40% of mothers of infants with perinatally acquired HIV infection, the infection was not detected before delivery (13).
The Center for Disease Control (CDC) estimates that in 2009, in the 40 states with confidential name-based HIV infection reporting, an estimated 131 infants acquired HIV infection through vertical transmission (15). In 2012, antiretroviral prophylaxis or treatment was over 900,000 HIV positive women, to get HIV/AIDS-free children (16). To achieve HIV/AIDS-free children WHO started to implement different strategies for the optimization of prevention of mother to child transmission (PMTCT) care and support. These strategies are options A, B, and B+ (17).
Globally, the burden of HIV infection in children are high in 22 countries(18). Ethiopia is one of these highly burdened countries where one of every three children born from HIV-positive women. The government has taken measures to expand the prevention of mother-to-child transmission of HIV service by endorsing antenatal care free of charge (19). To eliminate HIV infection in children and keep mothers alive, a comprehensive package of interventions implemented. This package includes preventing women from HIV infection, protect unwanted pregnancy, PMTCT throughout pregnancy, provide skilled delivery, exclusive breastfeeding, and providing appropriate HIV treatment, care, and support for mother and infants (20).
Moreover, in 2013, all pregnant women have been considered eligible to start long-term antiretroviral therapy (ART). Through a package is called option B + which has a great role to ensure prevention of at least 98 percent of mother to child transmission of HIV (21). According to the WHO 2010 report, the prevalence of HIV in infants who are born from HIV-positive mothers who attend both treatment and prophylaxis was 10.9% (4). Worldwide 3.2 million Children living with HIV are 91% live in sub-Saharan Africa; 6% living in Asia and Pacific; the remaining 3% are situated in the rest of the world (16).
Infants are infected with HIV at least 1600 every day and more than 600,000 infants are infected by the virus annually mostly in developing countries mainly in sub-Saharan Africa (21). In Ethiopia an estimated 1.2% of pregnant women are living with HIV consequently one of every three children born to these women is being infected with HIV (21).
Interventions like the use of ART drugs infected pregnant women, safe delivery practices, and safe infant feeding, avoid unwanted pregnancy has helped to reduce mother to child transmission (MTCT) from 40–5% respectively (22).
The UNAIDS on the fast-track to an AIDS-free generation 2016 report showed that the rate of HIV positive infants was 2.9% in Uganda, 4.1% in Namibia, and 3.3% in Swaziland (23). In 2013, the database of UNAIDS showed that the prevalence of HIV among infants born to HIV-infected mothers was 2% in Botswana, 34% in Congo, and 25% in Ethiopia (24). A study conducted in Ethiopia in 2014 with exposed infants the result showed that MTCT prevalence was 4.16% (25). A different study has showen that socio-demographic factors, prenatal factors, intrapartum factors, postnatal factors, and PMTCT services affect MTCT (25–33).
Thusly, assessing the HIV status of infants and its contributing factors among infants who were delivered from HIV positive pregnant and lactating mothers and who were enrolled in PMTCT service, important for program planners, policymakers, governmental organization, and non-governmental organizations to design strategies and interventions to decrease MTCT of HIV. Therefore, this study aimed to determine the proportion of mother-to-child transmission of HIV among HIV-exposed infants on PMTCT services and its associated factors in public health facility of Bahir Dar city, Ethiopia, 2018.