The Human Immunodeficiency Virus (HIV) can be transmitted from HIV-positive mothers to their child during pregnancy, at birth and breastfeeding which accounts for the majority of infection in children [1–3]. The proportion of Mother-To-Child-Transmission (MTCT) of HIV in treatment–naive pregnant women ranges from 15% to 45%. However, antiretroviral therapy (ART), post-exposure prophylaxes and Prevention of Mother-To-Child Transmission (PMTCT) service can reduce the proportion of MTCT to less than 5% [2, 4]. Virological screening for exposed infants at six weeks of age or at the earliest possible stage after six week plays a great role to PMTCT [2, 5-6]. However, only half of HIV–exposed infants (HEI) are tested within a World Health Organization (WHO) recommended age .
According to the United Nations Programme on Human Immunodeficiency Virus/Acquired Immunodeficiency Syndrome (UNAIDS) annual review, although different efforts were being made, about 500 children under 15 years of age were infected with HIV per a day in 2018 globally. In the same year, it was estimated that 1.7 million children live with HIV and 100,000 children died due to Acquired Immune Deficiency Syndrome (AIDS), and 160,000 acquired new HIV infection . Furthermore, each year over half a million new born are infected with HIV in sub–Saharan Africa through MTCT .
An estimate indicates that, in 2010; 6,200 children were newly infected with HIV in Ethiopia, while in 2015; 3,300 and in 2018; 2,700. In addition, in 2010; 5,400 children died due to AIDS, whereas in 2015; 2,400 and in 2018;1,800 children were died .
Despite, ART service for children was launched in 2005 in Ethiopia and national PMTCT program was started in 2001, only 23,400 of children were on ART in 2017 . Thus, ART coverage for children remains low (23.5%) in Ethiopia . While, more than 92% of pregnant women living with HIV access preventive prophylaxes in 2018 in Ethiopia. Laboratory test coverage of Early Infant Diagnosis (EID) was 68% in 2018. Furthermore, the rate of MTCT decreased from 18% in 2010 to 9% in 2018 .
Local studies reported from Ethiopia indicated that considerable infants born from HIV positive mother are infected [10–12]. For instance, study reported from Amhara regional state has shown 2.3% infants born from HIV positive mother are infected with HIV . An another study reported from Amhara regional state has shown that 10.1% of infants born from HIV positive mother are infected with HIV . Furthermore, a study reported from Dire Dawa revealed that 15.7% of infant born from HIV positive mothers were HIV positive . Moreover, a study reported from Addis Ababa indicated that 2% of infants were HIV positive at 6 week of age, while 4% were HIV positive at 18 month of age . Another study reported from Bahir-Dar indicated that 5.8% of infants born from HIV positive mothers are infected . Furthermore, reviews from Ethiopia have shown 11.4 % and 9.9% pooled prevalence of MTCT in Ethiopia [15-16].
Several factors are associated with HIV infection among infants born from HIV positive mothers. For example delayed diagnosis, failure to receive either ART or prophylaxis during pregnancy, breastfeeding, and short duration since prophylaxes started during pregnancy are significantly associated with HIV infection of HEI . Moreover, infants not receiving ART prophylaxis at birth, mixed feeding practices, and mother–child pairs not receiving prophylaxes are also significantly associated with MTCT .
In general, MTCT is decreasing globally. A study reported from Burkina Faso indicated HIV transmission rate decreased from 10.4% in 2006 to 0% in 2015 . In Kenya, the positive rate declined from 17.0% in 2007 to 7.2% in 2013 . Moreover, the burden of MTCT is decreased in Vietnam from 27.9% in 2007 to 0% in 2018 .
Global plan provides the foundation for country–led movement towards the elimination of new HIV infections among children. However, Ethiopia is among the ten countries in the world with the highest burden of HIV infections among children . Although, there are small scales local studies conducted on MTCT in Ethiopia, there is limited information from large scale samples on the burden and factors associated with HIV infection among infants born from HIV positive mothers. Thus, this study was aimed to estimate the prevalence, past five-year trend (2016-2020) and factors associated with HIV in HEIs from large sample.