ArticleBMJ global health2026
HIV care continuity for women in postconflict Tigray: assessing mother-to-child transmission rates, infant health and cervical cancer screening.
Article in BMJ global health, 2026. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Not yet cited in PubMed.
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Abstract
introductionThe Tigray War (November 2020-November 2022) caused catastrophic health system collapse in northern Ethiopia, with substantial excess mortality and near-total destruction of health infrastructure. The impact on HIV care services remains poorly documented. We comprehensively assessed HIV care continuum recovery across prevention of mother-to-child transmission (PMTCT), HIV-exposed infant care and cervical cancer screening among women living with HIV during the postconflict period.
methodsWe conducted a retrospective multidomain cohort study across seven health facilities in Mekelle City, Tigray, from November 2022 to May 2025. We assessed: (1) mother-to-child transmission (MTCT) rates among 405 HIV-exposed infants using Firth's penalised logistic regression; (2) feeding practices, growth outcomes, cotrimoxazole prophylaxis coverage and retention among 2482 follow-up visits using generalised estimating equations and (3) cervical cancer screening cascade completion among 2515 women living with HIV using mixed-effects logistic regression.
resultsAmong 405 HIV-exposed infants, 11 were diagnosed HIV-positive, an MTCT rate of 2.72% (95% CI 1.36% to 4.81%). MTCT declined significantly from 5.56% in 2022 to 0% by early 2025 (p=0.0015). All transmissions occurred in primary-level facilities (8.27%), with none in secondary-level facilities (0%). Exclusive breastfeeding occurred in 90.9% of visits (95% CI 89.3 to 92.4%). Growth failure was rare among exclusively breastfed infants (0.48%) but markedly higher among replacement-fed infants (26.2%). Programme retention was 99.8%, mortality 0.2%, and no infants were lost to follow-up. Cervical cancer screening coverage was high (98.6% offered, 98.3% accepted), though only 76.9% completed screening.
conclusionDespite catastrophic health system disruption, facility-based HIV services in post-war Tigray achieved near-elimination of MTCT by 2025, with exceptional retention, prophylaxis coverage and breastfeeding outcomes. Concentration of PMTCT services at secondary-level facilities was strongly associated with reduced transmission. However, these findings represent a selected population successfully accessing services; true population-level outcomes are likely substantially worse. Sustained investment in facility-based services and community outreach is essential for comprehensive HIV care recovery.
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