Enhancing Public Health Strategies to Prevent Mother-To-Child Transmission of Hiv: Insights From a Cohort Study in Iran Publisher

Summary: What helps prevent HIV transmission to infants? An Iranian cohort of 1,210 mother–infant pairs linked viral-load control and timely care to lower transmission risk. #HIVPrevention #MaternalHealth

Faghir Ganji M ; Motevalian S A ; Tayeri K ; Ansari Moghaddam A ; Eshrati B
Source: Medical Journal of the Islamic Republic of Iran Published:2025

Abstract

Background: Expanded access to antiretroviral therapy (ART) has dramatically reduced mother-to-child transmission of HIV. However, delayed diagnosis, poor linkage to care, and persistent socioeconomic barriers remain key challenges. This cohort study in Iran aimed to assess service delivery performance and address these existing gaps to optimize prevention strategies and further minimize the risks of perinatal transmission. Methods: This retrospective cohort study analyzed 1,210 HIV-positive mother-infant pairs using data from the Ministry of Health's electronic registry (spanning 2011 to 2024). Infants were followed up for up to 18 months, and their final HIV status was confirmed by PCR testing; infants with at least one positive PCR were considered HIV positive, while those with two negative PCRs were classified as HIV negative. Inclusion criteria included maternal HIV diagnosis, attendance at counseling centers, and documentation of two neonatal PCR test results; cases with incomplete data were excluded. The final neonatal HIV status was considered the outcome variable. Data were analyzed using descriptive statistics and multivariate logistic regression (SPSS 26), with p < 0.05 as the criterion for statistical significance. Results: The study cohort included 1,210 infants, identifying 60 HIV-positive cases and 1,150 HIV-negative cases. Initial descriptive analyses showed that the mean maternal age did not differ significantly between the HIV-positive mothers (37.88 ± 5.34 years) and HIV-negative mothers (37.49 ± 6.11 years), with p > 0.05. Multivariate logistic regression analysis independently associated four major factors with the risk of transmission. Normal Vaginal Delivery (NVD) was associated with a significantly increased risk, showing 5.41 times higher odds of the outcome compared to C-section delivery (OR = 5.41; 95% CI: 2.60–11.30), higher maternal viral load (OR = 2.92; 95% CI: 1.30–6.59), and an earlier date of the first prenatal visit (OR = 0.99; 95% CI: 0.99–1.00), which conferred a minor protective effect. While the effect of ART initiation timing was statistically significant, its OR was very close to unity (1.00; 95% CI: 1.00–1.001), rendering it clinically negligible. Only the Type of Delivery remained the strongest independent risk factor for transmission (OR = 7.39, 95% CI: 3.83–14.2), and the effect of timing factors (such as Date of First Visit and Start Date of ART) was attenuated by this stronger factor in the final model. Conclusion: Overall, this study highlights that preventing HIV transmission from mother to child relies on factors such as the delivery method based on viral load, early initiation of ART, timely prenatal visits, and monitoring of viral load. Maintaining a low viral load is crucial, and prevention programs should prioritize these elements to minimize the risk of transmission. Copyright © Iran University of Medical Sciences. This work has been published under CC BY-NC-SA 4.0 license.