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Introduction While antiretroviral therapy (ART) coverage for pregnant women has undergone steady scale-up, Nigeria’s final mother- to-child transmission of HIV (MTCT) rate remains unacceptably high at 10%. This study aimed to determine final outcomes (MTCT rates) and their correlates among HIV-exposed infants (HEI) in nine states and the Federal Capital Territory, Nigeria. Methods This retrospective, cross-sectional study was conducted at 96 primary, secondary and tertiary health facilities supported by the Institute of Human Virology Nigeria. Data was abstracted for a birth cohort of HEI born between October 30, 2014 and April 30, 2015 whose 18–24 month final outcome was assessed by October 30, 2016. Only infants with a six-week first DNA PCR result, and a rapid HIV antibody test result at age 18 to 24 months were included. Multivariate logistic regression (adjusted odds ratios [aORs]) evaluated for predictors of HIV positivity at ≥18 months. Results After testing at ≥18 months, 68 (2.8%) of the 2,405 exposed infants in the birth cohort were HIV-positive. After a minimum of 18 months of follow-up, 51 (75%) HIV-positive infants were alive on ART; 7 (10%) had died, 5 (7.3%) were lost to follow-up and 5 (7.3%) were transferred out. Rural maternal residence, lack of maternal ART/ARV prophylaxis, mixed infant feeding and infant birth weight less than 2.5 kg correlated with an HIV-positive status for infant final outcomes. Conclusion The final HIV positivity rate of 2.8% is encouraging, but is not population-based. Nevertheless, supported by our findings, we recommend continued programmatic focus on early access to quality prenatal care and maternal ART for pregnant women, especially for women living with HIV in rural areas. Furthermore, implementation of nationwide sensitization and education on six-months’ exclusive infant breastfeeding with concurrent maternal ART should be strengthened and sustained to reduce MTCT rates.

Introduction: There were an estimated 37,000 new child HIV infections in Nigeria in 2016, the highest globally. For Nigeria, 6 week and final mother-to-child transmission of HIV (MTCT) rates are estimated at 13.1% and 23.0%, respectively. The UNAIDS has targeted final MTCT rates of <2% and <5% among non-breastfeeding and breastfeeding infants, respectively. Data on 18-month final outcomes among HIV-Exposed Infants (HEI) in Nigeria is scarce. We evaluated for predictors of HIV status among HEI at 18 months of life in 10 Nigerian states. Methods: This retrospective, cross-sectional study collected data from 96 PEPFAR-supported health facilities supported by the Institute of Human Virology Nigeria in 10 Nigerian states between October 2014 and September 2015. Only HEI with a first DNA PCR result at ≥4–6 weeks, and a rapid HIV antibody test result at ≥18 months of age were included. Data including residence, birth weight, breastfeeding status, and maternal ART access were collected for analysis. Multivariate logistic regression (adjusted odds ratios [aORs] evaluated for predictors of HIV test positivity at 18 months. Results: A total of 2405 HEI from the 96 facilities were included in the study. Median birthweight was 3 kg (IQR 1.2–6.1), and at final testing was 10 kg (IQR 5.5–15). Of the 2405 HEI negative at first DNA PCR test and tested at ≥18 months, 68 (2.8%) were positive. After a minimum of 18 months of age, 51 (75%) of the 68 HIV-positive infants were alive on ART; 7 (10%) had died, 4 (6%) were lost to follow-up and 6 (9%) had transferred out to other facilities for care. Infant birth weight of ≥2.5 kg (AOR 0.40, P = 0.009), urban residence (OR 0.45, P = 0.008) and exclusive breastfeeding (OR 0.04, P < 0.001) protected against MTCT; maternal non-initiation/utilization of antenatal/in-labor ART (OR 9.59, P < 0.001) correlated with MTCT. Conclusions: The final HIV positivity rate of 2.8% in our cohort is lower than the national estimates, which is encouraging. However, this should be interpreted with caution: the HIV status of HEI seen at the study facilities who did not present for early and/or final testing was not available and thus not evaluated. Nevertheless, supported by our findings, we recommend strengthening universal maternal access to ART, ideally in the pre-conception and prenatal stages. This should be prioritized especially for rural women living with HIV. Furthermore, our findings correlate with the nationally-recommended 6-months of exclusive infant breastfeeding. We acknowledge that data from non-presenting HEI are also needed to devise interventions for universal uptake of early and final HIV testing. We expect that as Option B plus is scaled up in Nigeria, more women would access and be maintained on ART through their first and subsequent pregnancies, thereby reducing the gaps in maternal-infant HIV service uptake.