Persistent gaps in the prevention of mother-to-child HIV transmission in central Uganda: a case-control study.

OBJECTIVES: Achieving elimination of mother-to-child transmission (eMTCT) remains a challenge in sub-Saharan Africa. Identifying persistent risk factors is critical for addressing remaining gaps in the prevention-of-mother-to-child HIV transmission (PMTCT) cascade. METHODS: We conducted a case-control study among mother-child pairs where cases were mothers of HIV-positive children aged <6 years, while controls were mothers of HIV-exposed but HIV-negative children aged <6 years. Data were collected on sociodemographic characteristics, antiretroviral therapy (ART), antenatal care (ANC), infant-feeding practices, and partner involvement. Logistic regression identified factors independently associated with being a case. RESULTS: A total of 183 mothers (91 cases and 92 controls) were included, with a median age of 30.9 (IQR 27.0-36.0) years. Attending <4 ANC visits (aOR 2.58; 95% CI 1.07-6.22) and mixed feeding before 6 months (aOR 5.56; 95% CI 2.22-13.94) were significantly associated with increased odds of MTCT. Child age ≥4 years (aOR 5.65; 95% CI 2.36-13.51) was associated with HIV-positive status. ART duration >5 years (aOR 0.07; 95% CI 0.03-0.18) and partner support (aOR 0.20; 95% CI 0.07-0.59) were strongly protective. CONCLUSION: Residual MTCT remains associated with modifiable factors across the PMTCT cascade. Strengthening early and sustained ANC attendance, partner involvement, exclusive breastfeeding, and ART retention may accelerate progress towards eMTCT.