Department of Epidemiology and Biostatistics, School of Public Health, College of Health Sciences and Medicine, Wolaita Sodo University, Wolaita Sodo, P.O.BOX 136, Wolaita Sodo, Ethiopia.
School of Public Health, College of Medicine and Health Sciences, Hawassa University, P.O.BOX: 1560, Hawassa, Ethiopia.
AIDS Res Ther. 2024 Jun 7;21(1):39. doi: 10.1186/s12981-024-00623-6.
Mother-to-child transmission (MTCT) of the human immunodeficiency virus (HIV) remains a major public health challenge in Ethiopia. The objective of this review was to assess the pooled magnitude of MTCT of HIV and its risk factors among mother-infant pairs who initiated antiretroviral therapy (ART) after Option B+ in Ethiopia.
A systematic search of literature from PubMed, Hinari, African Journals Online (AJOL), Science Direct, and Google Scholar databases was conducted from June 11, 2013 to August 1, 2023. The authors used the Preferred Reporting Items for Systematic Reviews and Meta-Analysis (PRISMA) guidelines to guide the article selection process and reporting. Observational studies that reported the magnitude and/or risk factors on MTCT of HIV among mother-infant pairs who initiated ART after the implementation of Option B+ in Ethiopia were included. We applied a random-effect model meta-analysis to estimate the overall pooled magnitude and risk factors of MTCT of HIV. A funnel plot and Egger's regression test were employed to check publication bias, and heterogeneity was assessed using I statistics. The protocol was registered in the PROSPERO database with registration ID number CRD42022325938.
Eighteen published articles on the magnitude of MTCT and 16 published articles on its risk factors were included in this review. The pooled magnitude of MTCT of HIV after the Option B+ program in Ethiopia was 4.05% (95% CI 3.09, 5.01). Mothers who delivered their infants at home [OR: 9.74; (95% CI: 6.89-13.77)], had not been on ART intervention [OR: 19.39; (95% CI: 3.91-96.18)], had poor adherence to ART [OR: 7.47; (95% CI: 3.40-16.45)], initiated ART during pregnancy [OR: 5.09; (95% CI: 1.73-14.97)], had WHO clinical stage 2 and above [OR: 4.95; (95% CI: 1.65-14.88]], had a CD4 count below 350 at enrolment [OR: 5.78; (95% CI: 1.97-16.98], had no or low male partner involvement [OR: 5.92; (95% CI: 3.61-9.71]] and whose partner was not on ART [OR: 8.08; (95% CI: 3.27-19.93]] had higher odds of transmitting HIV to their infants than their counterparts.
This review showed that the pooled magnitude of MTCT of HIV among mother-infant pairs who initiated ART after the Option B + program in Ethiopia is at the desired target of the WHO, which is less than 5% in breastfeeding women. Home delivery, lack of male partner involvement, advanced HIV-related disease, lack of PMTCT intervention, and poor ARV adherence were significant risk factors for MTCT of HIV in Ethiopia.
母婴传播（MTCT）艾滋病毒（HIV）仍然是埃塞俄比亚的一个主要公共卫生挑战。本研究的目的是评估在埃塞俄比亚实施 B 方案+后开始接受抗逆转录病毒治疗（ART）的母婴对 HIV 母婴传播的综合发生率及其危险因素。
从 2013 年 6 月 11 日至 2023 年 8 月 1 日，对 PubMed、Hinari、非洲期刊在线（AJOL）、科学直接和谷歌学术数据库进行了系统的文献搜索。作者使用系统评价和荟萃分析的首选报告项目（PRISMA）指南指导文章选择过程和报告。纳入了报告了在埃塞俄比亚实施 B 方案+后开始接受 ART 的母婴对 HIV 母婴传播发生率和/或危险因素的观察性研究。我们应用随机效应模型荟萃分析来估计 HIV 母婴传播的综合发生率和危险因素。使用漏斗图和 Egger 回归检验来检查发表偏倚，并用 I 统计量评估异质性。该方案已在 PROSPERO 数据库中注册，注册号为 CRD42022325938。
本研究共纳入了 18 篇关于 HIV 母婴传播发生率的已发表文章和 16 篇关于其危险因素的已发表文章。埃塞俄比亚实施 B 方案+后，HIV 母婴传播的综合发生率为 4.05%（95%CI 3.09,5.01）。在家分娩的母亲[比值比（OR）：9.74；95%置信区间（CI）：6.89-13.77]、未接受 ART 干预的母亲[OR：19.39；95%CI：3.91-96.18]、ART 依从性差的母亲[OR：7.47；95%CI：3.40-16.45]、在孕期开始接受 ART 的母亲[OR：5.09；95%CI：1.73-14.97]、有 WHO 临床分期 2 期及以上的母亲[OR：4.95；95%CI：1.65-14.88]、入组时 CD4 计数低于 350 的母亲[OR：5.78；95%CI：1.97-16.98]、男性伴侣参与度低或不参与的母亲[OR：5.92；95%CI：3.61-9.71]、伴侣未接受 ART 的母亲[OR：8.08；95%CI：3.27-19.93]，其将 HIV 传播给婴儿的几率高于其他母亲。
本研究表明，在埃塞俄比亚实施 B 方案+后开始接受 ART 的母婴对 HIV 母婴传播的发生率符合世卫组织的目标，即低于母乳喂养妇女的 5%。在家分娩、缺乏男性伴侣参与、艾滋病毒相关疾病进展、缺乏 PMTCT 干预和抗逆转录病毒药物依从性差是埃塞俄比亚 HIV 母婴传播的重要危险因素。
