Сlinical and organizational determinants of vertical HIV transmission in Kazakhstani national cohort: analysis of the prevention cascade
DOI:
https://doi.org/10.37800/RM.1.2026.694Keywords:
HIV infection, vertical transmission, prevention of mother-to-child transmission, HIV-exposed uninfected children, antiretroviral therapyAbstract
Relevance: Despite the high coverage of programs for the prevention of mother-to-child transmission of HIV (PMTCT), cases of vertical transmission continue to be reported, indicating vulnerabilities in the prevention cascade, particularly at the stages of childbirth and postnatal follow-up. National registry data allow assessment not only of population-level transmission rates but also of clinical and organizational risk determinants in real-world practice, including loss to follow-up and disruptions in continuity of care.
The study aimed to assess the rate of vertical HIV transmission and identify independent clinical and organizational determinants of infection among children born to women living with HIV, based on national registry data, in order to reveal systemic vulnerabilities and substantiate directions for improving PMTCT programs.
Materials and methods: A retrospective cohort analysis was conducted using data from the national registry of children with perinatal HIV exposure for the period 2015–2024. The overall cohort included 5,890 observations. An analytical sample of children with confirmed outcomes (HIV-positive or HIV-negative status) was formed for risk factor analysis and comprised 4,703 cases.
Associations were assessed using univariate and multivariate logistic regression models, with odds ratios (ORs) and 95% confidence intervals (95% CIs) calculated. Statistical significance was defined as p < 0.05.
Results: Confirmed vertical HIV transmission was identified in 121 children (2.05%; 121/5,890). The proportion of incomplete follow-up was 18.5% (1,090/5,890).
In univariate analysis, the strongest associations with infection risk were observed for breastfeeding (OR = 20.75; 95% CI 6.98–61.73; p < 0.0001) and absence of neonatal antiretroviral prophylaxis (OR = 7.79; 95% CI 2.62–23.16; p = 0.0002).
In the multivariate model, independent predictors remained breastfeeding (OR = 15.51; 95% CI 4.83–49.82; p < 0.0001) and absence of prophylaxis in the child (OR = 6.06; 95% CI 1.75–20.91; p = 0.0044).
Conclusion: Vertical HIV transmission in the national cohort remains at a relatively low level but is primarily determined by postnatal modifiable factors, including non-adherence to infant feeding recommendations and gaps in neonatal antiretroviral prophylaxis.
Key priorities for strengthening PMTCT include enhanced postnatal monitoring, standardized patient referral pathways, and reduction of loss to follow-up among children with perinatal HIV exposure.
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