Magnitude of HIV and associated factors among antenatal care pregnant women at public hospitals of eastern zone Tigray Ethiopia, 2025 G.C

doi:10.21203/rs.3.rs-8455195/v1

Background: HIV infection is mainly transmitted via sexual contact and mother to child during pregnancy, delivery and breast feeding and among avertable infection; it is significantly contributor to adverse birth outcomes of pregnancy worldwide particularly in low and middle income countries. Sub-Saharan African countries including Ethiopia are among affected areas with HIV infection. Ethiopia is currently providing and demonstrating strategies aimed to ending AIDS death, to eliminate new infection of HIV and elimination of MTCT of HIV particularly in pregnant women by 2030, as part of Sustainable Development goals. Hence, this study aimed to assess the magnitudes of HIV infection and associated factors among pregnant women attending antenatal care at public hospitals of eastern zone, Tigray, Ethiopia during the period 2024/25. Methods- Institutional-based cross-sectional study was conducted at public hospitals of eastern zone, Tigray, Ethiopia. Initially hospitals were selected via simple random sampling then pregnant women were selected using a systematic random sampling technique. Interviewer questionnaire and chart reviews were used to collect data. Data was collected using kobo collect tool, cleaned using Excel and analyzed in SPSSV23.0. Descriptive statistics was used to assess the magnitude of HIV and binary logistic regression was used to determine associated factors. Variables with p-value less than 0.25 were transferred to multivariable analysis. Variables with P-value<0.05 were used to declare statistical significance.

Result:-The magnitude of HIV infection among pregnant women was 11.4 % with (95% CI,8.4-14.4). This study showed 64% of the pregnant women who reported history of sexually forced or raped were found to be living with HIV infection. Significant associated factors for HIV prevalence were history of sexually Forced /raped within five years, women with STI history within one year, number of sexual partners in her life and women had Sign and symptoms of STI.

Conclusion: The present study found significant high rate of HIV infection among pregnant women and history of sexually Forced /raped within last five years were also among significant influential associated factors to this high prevalence.

Infectious Diseases

HIV

magnitude

pregnant women

eastern zone Tigray

Sexual transmitted infections(STI) can be bacteria, viruses, fungi or parasites that mainly transmitted via sexual contact including vaginal, anal and oral sex as well as from mother to child during pregnancy, childbirth and breast feeding[1]. Human immunodeficiency virus (HIV) infection is among prevalent Sexual transmitted infections and is the most serious public health problem that leads to adverse birth outcomes of pregnancy worldwide particularly Africa region including Ethiopia[2]. Human immunodeficiency virus (HIV) is a viral infection that causes acquired immunodeficiency syndrome (AIDS) and predominantly transmitted through sexual contact. Human immunodeficiency virus (HIV) can also be spread via blood contact, breast milk and during pregnancy and delivery to the child, but cannot transmitted through ordinary day-to-day contact such as kissing, hugging, shaking hands, or sharing personal objects, food or water[3].

HIV is a viral infection that can affect all age groups of the population; however the most vulnerable groups are Women and girls, young people, people who inject drugs, sex workers, people who live in low socioeconomic conditions and prisoners. This virus is transmitted through certain body fluids and weakens the immune system by destroying cells that fight disease and it can also spread from a mother to her baby[4]. There were an estimated 39.9 million [36.1–44.6 million) people living with HIV in 2023, among whom 53% were women and girls. Despite ongoing transmission in all countries globally and there were also 1.3 million new HIV infections globally which decline 40% from 2010[5]. In Africa an estimated 25.6 million people living with HIV, 760,000 newly infected with HIV and about 380,000 people died from AIDS related illness in 2022 [6] .

HIV infection is still among the most serious health problems of the world, particularly in low-income countries. HIV infection during pregnancy has been associated with numerous adverse pregnancy outcomes. The maternal infection can lead to spontaneous abortion, preterm labor, fetal death, fetal-growth restriction, or fetal infection. [7].In 2023, around 1.2 million pregnant women were living with HIV and the rate of mother-to-child HIV transmission including perinatal and postnatal infections were 10%. Over all, Sub-Saharan Africa countries are covers to above 80% of children living with HIV aged 0–19 years[8]. In 2023, there were 120,000 new HIV infections among children under five which was dramatic declining from 300,000 in 2010.There is progress in reducing mother-to-child transmission of HIV due to increased access to PMTCT-related services and increased number of pregnant women living with HIV being initiated on lifelong antiretroviral medicines. But progress is slow and not enough to meet the 2025 targets[9]. HIV incidence and HIV-related deaths are slowly declining and numerous countries reported increases in adult cases. However, the risk of HIV infection is increasing with key populations as compared to the general population and it requires further fast intervention in HIV prevention. In Africa the prevalence of HIV among pregnant women is higher than other continents and it is as high as 44.3%[10] .

Currently in Ethiopia around 610,000 people are living with HIV and an estimated 100,000 people living with HIV (PLHIV) are not aware of their status. In 2021 G.C the annual report of new HIV infection was 12,000 people which decreased by 54% since 2010. Around 12,000 people died in Ethiopia due to AIDS, a 56% reduction from 27,000 in 2010.The prevalence of HIV infection trend demonstrated a downward from 1.4% in 2010 to 0.8% in 2021 and 0.77% in 2022 [11]. Based on the data EPHI 2019 estimate, Ethiopia had 18,677 mothers who need ART for PMTCT across the nation, of whom 17,164 received ART which is a 91.9% performance. In Ethiopia the prevalence of HIV is higher in urban areas than in rural areas and it also varies from region to region. In 2016, the rural prevalence was 0.4%, which was seven times less than the urban prevalence 2.9% and based on this national report of Ethiopia in diverse geographic areas, HIV prevalence varies by location, ranging from less than 0.15% in Ethiopia Somali to 3.99% in Gambella regions in 2019/20 [2]. However, many studies in Ethiopia showed that the prevalence of HIV infection among pregnant women is higher than the national reports, the prevalence of HIV among pregnant women rose to 11.2% and the prevalence of adverse birth out-come among HIV-positive mothers was also high, which showed 21%[12, 13].

Currently new HIV infection in key populations continues to face increases from time to time particularly low-income countries like Ethiopia, though the core objective of Ethiopia and different international organizations are focused on ending AIDS death, eliminating new HIV infections and eliminating mother to child transmission of HIV. Although the international organizations including Ethiopia did not achieve the targets of 2025, Still these organizations are continuing promote synergies across the disease areas under a universal health coverage framework and promote implementation focused on achieving the goals of ending AIDS death related, eliminating new HIV infections, and eliminating MTCT of HIV by 2030, as part of efforts towards achieving the 2030 Agenda for Sustainable Development. Despite Ethiopia having launched and demonstrated strategies to achieving the 2030 Agenda for Sustainable development goals and to ensure no child is born infected with HIV, ending AIDS death and eliminating new HIV infections, Still HIV infection is continues to be a major global public health concern. Although there are some studies done in other regions of Ethiopia regarding HIV infection in pregnancy, but there is no clear study in Tigray region concerning magnitudes of HIV infection in pregnancy as far as our knowledge, likely due to Covid19 & war zone. Thus, this study was designed to assess magnitude of HIV infection and associated factors among antenatal care pregnant women at public hospitals of eastern zone, Tigray, Ethiopia.

Study Area and Period

The study was conducted at public hospitals of Eastern zone, Tigray, Ethiopia. It is one of the seven zones in Tigray regional state. Adigrat town is the zonal town which is located 116.7 Kms north of Mekelle city and 1035.3Kms north of Addis Abeba. Based on a 2007 census, this zone has a total population of 755,343. According to the 2019 Tigray regional health bureau data, there are 2 general hospitals,5 primary hospitals, 40 health centers and 132 health posts in Eastern zone Tigray, all of which are governmental. List of the hospitals are Adigrat Hospital, Wukro Hospital, Dr.Tsegay Hospital, Freweyni Hospital, Dewuhan Hospital, Fresemetat Hospital and Mulu Assefa Hospital and Five of these hospitals were included in the study. The Study was conducted from March to May 2025.

Study Design

The purpose of this study was to assess magnitude of HIV infection among pregnant women attending antenatal care and associated factors at public hospitals of eastern zone Tigray Ethiopia, during the 2025 G.C. The appropriate method for this study was an institutional- based analytical cross-sectional study, as this design was suitable or important for collecting or gathering data at single point of time and was appropriate for showing magnitude and associated factors of HIV infection among antenatal care pregnant women.

Population

Source of population

All pregnant women who came to antenatal care at public hospitals of Eastern zone.

Study population

All pregnant women who came to antenatal care at selected public hospitals Eastern zone during the study period.

Inclusion and Exclusion criteria

Inclusion criteria

All pregnant women who came to antenatal care in selected public hospitals Eastern zone during the study period.

Exclusion criteria

Pregnant women who were seriously ill and those who were mentally ill during data collection time were excluded.

Sample Size Determination

The sample size was calculated using a single proportion formula considering the following assumptions.

n= the required sample size

Z= is the standard normal deviation usually set at 1.96

d= the degree of accuracy desired usually set as 0.03

P= it was taken from study done in Referral Hospitals of the Amhara Regional State, Ethiopia which is 10.4% [14].

n= Z²p(1-p)/d2

n=(1.96)² 0.104(1-.104)/(.03)² =398 with 10% non-response rate 438

Sampling Procedures

Simple random sampling was used to select hospitals. Initially, hospitals were selected, followed by a selection of study participants using systematic sampling methods. Five hospitals were included via simple random sampling methods out of seven hospitals of eastern zone Tigray,Ethiopia. The selected hospitals were Adigrat Hospitals, Wukro Hospital, Dr.Tsegay Hospital, Freweyni Hospital and Dewuhan Hospital. The sample was allocated to hospitals via proportionally, based on their average monthly antenatal care client flow from previous months. Over the last three months, the average number of pregnant women who visited at specific hospitals were 480 Adigrat Hospital, 420 Wukro Hospital, 360 Freweyni Hospital,320 Dr.Tsegay Hospital and 170 Dewuhan Hospital. The sampling interval (K) value was calculated as 1750/438=4. All pregnant women who came to antenatal care in selected public hospitals of the Eastern zone during the study period and those who fulfilled the criteria were included.

Study variables

Independent variables

Socio-demographic variables (age, education level(status), marital status, occupational status, and educational status )
Obstetrics, reproductive and medical history (ANC follow-up, blood transfusion, gravidity, previous history of abortion, stillbirth, the presence or History of STIs ,Husband’s history of STI, and syphilis status)
Sexual and Behavior-related variables (number of life time sexual partners, new sexual partner, sexual violence ,alcohol and condom use)

Dependent variable

Magnitude of HIV infection among pregnant women

Operational Definitions

Sexual Violence-Pregnant women who have any history of the act of forcing or attempting to force through physical body harm or any means to engage in sexual behavior against their will.

Alcohol use: It was assessed with the question “Have you been drinking alcohol during your current pregnancy?” If the answer will “yes” and took any unit of alcohol during the current pregnancy, then the mother was considered to have alcohol exposure while pregnant.

Data collection instrument and procedure

In this Study, the data were gathered using primary sources and chart review. The primary data were obtained using structured questionnaire administered through face to face interviews with pregnant women and via chart review. The questionnaire was developed following a review of different literatures [10, 13-25] and it included socio-demographic characteristics, obstetrics history, reproductive health and medical history, Sexual and behavioral factors. The questionnaire was prepared in English, translated into the local language Tigrigna, then back-translated to English to check its consistency. A Pre-test was carried out outside study area at Fresemaetat hospital and necessary modifications were made. Ten degree holder midwives participated to collect the data; and two master midwives and four general practitioners (GP) participated as supervisors.

Data quality and management

We gave Training for data collectors and supervisors for two days on how to collect the data, how to handle the participants and how to follow the data collectors. A Pretest was conducted on 5% of the total sample and based on the pre-test modification was made on the questionnaire. The data compilation system and data completeness were checked and strictly controlled by the principal investigator and supervisors. Data were collected using kobo-collect, cleaned in Microsoft excel and exported to SPSS version 23 software package. Double data entry and random checks were made to ensure the validity of the study. Confidentiality and privacy were given special emphasis during the training session and data collection time.

Data processing and analysis

Data was checked and screened each questionnaire and codes were carefully written at each margin of the questionnaire after the data collection period was complete. After data was collected using kobo-collect and cleaned using Microsoft Excel then exported to SPSS (Statistical Package for the Social science) version 23 for analysis. Data cleaning was performed for each variable to check its accuracy, identify inconsistencies and address missing values of the data. Descriptive statistics like mean, frequency and percentage was explored using tables and figures to display the values of the variables in the study. Bivariate and multivariable analysis was also conducted to see the association and to measure the strength of the relationship between dependent and independent variables. Variables with p-value of less than 0.25 were transferred to multivariable analysis and Variable with P-value<0.05 was used to declare statistical significance. The association between dependent and independent variables was determined using Adjusted Odds Ratio (AOR) with a 95% confidence Interval (CI).

Socio-demographic characters

Total of 438 participants were interviewed and their charts were reviewed, making 100 % response rate. The socio- demographic data mainly focused on the distribution of age, residence, marital status, maternal education, maternal occupation, and gravidity. The largest age group was from 25-34 years, accounting for nearly half of the sample (48.6%, n=213). A significant number of the participants lived in urban areas accounting for 72.1% (n=316). Of the participants,84.5%(n=370) of the pregnant women were married and most mothers had completed some level of schooling, with Elementary and high school accounting for 325(74.2%).The majority of participants,296(67.6%) of the pregnant women were housewives and around 384(87.7%) were also Orthodox religion. Among respondents more than half 55.7% had an income less than 5000 ETB and most of the pregnant women were multigravida 330 (75.3%)(Table-1).

Table-1:- Socio-demographic characters

Variables	Frequency	Percent
Age in years
18-24	124	28.3
25-34	213	48.6
35-55	101	23.1
Residence	Frequency	Percent
Urban	316	72.1
Rural	122	27.9
Marital status	Frequency	Percent
Married	370	84.5
Not Married	68	15.5
Educational level of the mother	Frequency	Percent
Illiterate	52	11.9
Elementary and high school	325	74.2
Deploma and above	61	13.9
Occupation of the mother	Frequency	Percent
Housewife	296	67.6
Merchant	20	4.6
Government employed	41	9.4
Private employed	59	13.5
Others	22	5
Gravidity	Frequency	Percent
Primgravida	108	24.7
Multigravida	330	75.3
Income	Frequency	Percent
50-5000	244	55.7
5001-10000	109	24.9
10001-20000	82	18.7
20001-50000	3	.7
Religion	Frequency	Percent
Orthodox	384	87.7
Catholic	33	7.5
Muslim	20	4.6
Protestant	1	.2

Maternal, reproductive and sexual health related factors

The table or data focused on the descriptive analysis of reproductive history, gestational age at time data collection, sexual health, relationship dynamics, sexual history/risk behaviors, and current infection status for Syphilis and HIV of the pregnant women. Of the total respondents, 108 (24.7%) of the pregnant women had a history of abortion. Majority 268(61.2%) of the respondents were in third trimester whereas 128(29.2%) were second trimester and only 42(9.6%) were in the first trimester. Regarding current and history of sexually transmitted infections, around 72(16.4%) of the pregnant women reported having had STI within the past one year and 45(10.3%) of the respondents were also reported having signs and symptoms of sexual transmitted infections (STI).

Among the total respondents, the majority 296(67.6%) were currently living with their husband and 89(20.3%) of the total participants suspected their regular partner was having a sexual relationship with someone else. 337(76.9%) of the pregnant women reported having only one lifetime sexual partner, while 101(23.1%) reported more than one sexual partner. Of all respondents, around 25(5.7%) of the pregnant women reported a history of sexually forced/rape or had sex against their will within the last five years and 64% of those women were found to be living with HIV. Nearly 63(14.4%) of all participants had multiple sexual partners in the last one year, while a small group 21(4.8%) were receiving money or goods for sex.

Prevalence of current HIV infection of pregnant women

Of the total 438 respondents, 50(11.4%)(95%CI:8.4%-14.4%) of the pregnant women were HIV seropositive. In addition to this, 20(4.6%)95%CI:2.5%-6.6%) of the participants were also syphilis seropositive and 8(1.8%) of the women had HIV-Syphilis co-infection (Table-2).

Table-2- Maternal, reproductive and sexual health related factors

Variables	Category	Frequency (%)
History of abortion	Yes	108(24.7%)
History of abortion	No	330(74.3%)
Gestational age at time of data collection	First trimester	42(9.6%)
	Second trimester	128(29.2%)
	Third trimester	268((61.2%)
History of STI in last one year	Yes	72(16.4%)
History of STI in last one year	No	366(83.6%)
Do you currently live with your husband/ partner	Yes	296(67.6%)
Do you currently live with your husband/ partner	No	142(32.4%)
Do you suspecting your regular partner is having a sexual relationship with some	Yes	89(20.3%)
	No	349(79.7%)
Received money or goods for sex	Yes	21(4.8%)
Received money or goods for sex	No	417(95.2%)
In your lifetime, have you ever had sex with a casual partner who was 10 or more than10 years	Yes	12(2.7%)
	No	426(97.3%)
Did you have Multiple sexual partner in the past 1 year	Yes	63(14.4%)
Did you have Multiple sexual partner in the past 1 year	NO	375(85.6%)
In your lifetime, have you ever received money or goods for sex	Yes	21(4.8%)
	No	417(95.2%)
How many sexual partner did you have in your lifetime	One partner	337(76.9%)
How many sexual partner did you have in your lifetime	Two or More partner	101(23.1%)
Have ever had sex with some body forced/raped or Against your will with in the last five year?	Yes	25(5.7%)
	No	413(94.3%)
Sign and symptoms of STI	Yes	45(10.3%)
Sign and symptoms of STI	No	393(89.7%)
Family history of HIV	Yes	27(6.2%)
Family history of HIV	No	411(93.8%)
Current Syphilis condition	Yes	20(4.6%)95%,2.5-6.6)
Current Syphilis condition	No	418(95.4%)
Current HIV status	Yes	50(11.4%)(95%,8.4-14.4)
Current HIV status	No	388(88.6%)
HIV-Syphilis Co-infection	Yes	8(1.8%)
HIV-Syphilis Co-infection	No	430(98.2%)

Factors associated with HIV among pregnant women

In the bivariate logistic regression analysis, the factors associated with HIV infection of Sero-prevalence included nine variables such as Age , Women with STI history with in one year, Husband suspecting another sexual partners, multiple sexual partners within 1 year, Number of sexual partner in her life , history of Sexually Forced /rape within five years, Sign and symptoms of STI, history of Sex for money or good and Syphilis condition/status were considered as candidate to further analysis to multivariable logistic regression with p-value was less than 0.25.

Of the total 438 respondents, 50(11.4%)(95%,) of the pregnant women were HIV seropositive. In multivariate logistic regression analysis, after controlling possible confounders, variables or factors were considered significantly associated with Sero-prevalence of HIV infection at p-value less than 0.05 were: history of Sexually Forced /rape within five years, Women with STI history within one year, Number of sexual partners in her life and women had Sign and symptoms of STI.

This study indicated that pregnant women who reported STI history in the past year had 3.7 times more likely to have HIV positive compared to those who did not with (AOR=3.7,95%CI(1.5-8.9). In this study pregnant women who experienced sexually Forced /rape against her will within five years had 5.4 times being HIV positive compared to those who did not with (AOR=5.4,95%,CI(1.76-16.67). The study finding showed that mothers who had more than one sexual partners in their life time had 4.8 times more likely to have HIV positive than who had one sexual partners in their life time (AOR=4.8,95% CI(1.8-12.77). Participants who reported signs and symptoms of an STI had nearly 6.6 times having HIV positive compared to those who did not reported with (AOR= 6.6,95%,CI(2.3-18.7) (Table-3).

Table-3- Factors associated with HIV among pregnant women at public hospitals of Tigray,Ethiopia.

Variables	Category	HIV		COR (95%CI)	AOR (95%CI)	P-Value
Variables	Category	Positive	Negative	COR (95%CI)	AOR (95%CI)	P-Value
Age	15-24	8(16%)	116(29.9%)	.25(.105-.584)	.396(.12-1.26)	.118
	25-34	20(40%)	193(49.7%)	.37(.19-.7)	.73(.28-1.9)	.518
	35-55	22(44%)	79(20.4%)	1	1
Women with STI history with in one year	Yes	31(62%)	41(10.6%)	13.8(7.2-26.6)	3.7(1.5-8.9)	.004
Women with STI history with in one year	No	19(38%)	347(89.4%)	1	1
Husband had another sexual partner	Yes	36(72%)	53(13.7%)	16.3(8.2-32.2)	2.44(.95-6.3)	.063
Husband had another sexual partner	No	14(28%)	335(86.3%)	1	1
Women had multiple sexual partner with in 1 year	Yes	29(58%)	34(8.8%)	14.38(7.4-27.9)	1.5(.53-4)	.46
Women had multiple sexual partner with in 1 year	No	21(42%)	354(91.2%)	1	1
Number of sexual partner in her life	1	12(24%)	325(83.8%)	1	1
Number of sexual partner in her life	2 and above	38(76%)	63(16.2%)	16.3(8.09-32.99)	4.8(1.8-12.77)	.002
Sexually Forced /rape within five years	Yes	16(32%)	9(2.3%)	19.8(8.15-48.2)	5.4(1.76-16.67)	0.003
Sexually Forced /rape within five years	No	34(68%)	379(97.7%)	1	1
Sign and symptoms of STI	Yes	26(52%)	19(4.9%)	21(10.3-43.3)	6.6(2.3-18.7)	.000
Sign and symptoms of STI	No	24(48%)	369(95.1%)	1	1
Sex for money or good	Yes	13(26%)	8(2.1%)	16.7(6.5-42.9)	.98(.25-3.8)	.98
Sex for money or good	No	37(74%)	38(97.9%)	1
Syphilis condition	Yes	8(16%)	12(3.1%)	5.97(2.3-15.4)	3.65(.9-14.6)	.067
Syphilis condition	No	42(84%)	376(96.9%)	1	1

COR=crude odds ratio, AOR=adjusted odds ratio

This study focused on the investigation of HIV prevalence and associated factors among pregnant women in Eastern zone, Tigray, Ethiopia and the results provided us update finding about current HIV prevalence among pregnant women in Tigray. In addition to HIV prevalence this study also investigated the prevalence of syphilis in pregnancy and HIV/Syphilis co-infection. According to current study done in Tigray, Ethiopia, the prevalence of HIV among pregnant women was 50(11.4%)(95%,8.4-14.4) and this high prevalence is alarming for the region and nation. This study is comparable with the study done in Felege Hiwot Comprehensive Specialized Hospital, Amhara region, Ethiopia which was 10.4% [8] and study conducted in yirgalem hospital ,southern Ethiopia(10.1%) [23].Our result was also familiar with study Carried out in Democratic Republic of Congo(11%) [26] and study done in Mozambique(11.48%)[27],Cameroon (9.3%)[28].

Based on the present study conducted in Tigray, Ethiopia, the prevalence of HIV during pregnancy is 11.4%,which is higher than study conducted in Amhara regional state, northern Ethiopia(7.6%) [24], Atat Hospital, Southern Ethiopia(2.7%)[29], in Mizan Tepi University Teaching Hospital, Southwest Ethiopia(5%)[19], in Debre Berhan ,Ethiopia(7.2%)[25].This difference might be due to,Tigray was at war zone for the last three years and it was impacted population, particularly due to sexual violence and destruction of the health system.

The current study done in Tigray, Ethiopia HIV prevalence among pregnant women were also higher than as compare to study conducted in Tanzania(2.4%)[18], in Kabarole District, Uganda(2.9%)[16], in Nigeria(7.22%)[21], in rural Gabon (3.9%)[30],in Cameroon(6.8%)[31], in a Tertiary Care Hospital in Islamabad,Pakistan(1.5%)[32], a systematic review and meta-analysis in china(2.9%)[22]. This discrepancy might be due to study time, study area and socio-demographic characteristics of the population. Studies carried out in South Africa, in Luanda (Angola) and a Tertiary Hospital in Ibadan, Nigeria, in Lusaka Province, Zambia and in Cameroon revealed HIV prevalence among pregnant was 44.3%,13.4%, 26.4% , 26% and 13.1% respectively[17, 20, 33-35], which were slightly higher as compared to the current study. The possible reason for this difference might be due to inadequacy and poorly targeted intervention activities and antenatal follow up.

This study also identified factors associated with HIV prevalence among pregnant women like history of Sexually Forced /rape within five years, Women with STI history within one year, Number of sexual partners in her life and women had Sign and symptoms of STI. The current study carried out in Tigray showed that pregnant women who experienced history of sexually violence / Forced or rape against her will within five years had 5.4 times being HIV positive compared to those who did not with(AOR=5.4,95%,CI(1.76-16.67).This finding was consistent with cross-sectional study done in Kobo Town, Ehtiopia [15]. The reason might be due to both area were affected by war/conflict.

In this study the Pregnant women who had history of STI 3.7 times more likely have HIV infection when we compared to their counterparts with (AOR=3.7,95%CI(1.5-8.9). This finding has agreement with study conducted in Amhara region, northern Ethiopia[24] and in Kobo Town, Ehtiopia[15].This might be due to there is high risk HIV infection transmission increases with who have Sexually transmitted infection.

The probability of acquiring HIV infection was 4.8 times higher among Mothers who had more than one sexual partners in their life time had than who had one sexual partners in their life time (AOR=4.8,95% CI(1.8-12.77). The finding in line with study carried-out in Kabarole District,Uganda[16] in Lusaka, Zambia[36].The reason is logically the risk of acquiring any sexually transmitted infection specifically HIV infection increases with increasing number of sexual partner. Pregnant women who reported signs and symptoms of an STI had nearly 6.6(AOR= 6.6,95%,CI(2.3-18.7) times significantly increases HIV infection compared to those who did not reported. This is similar with study done in South Africa[37]. The possible reason might be due to the presence of genital ulcer and inflammation may increase susceptible to HIV infection.

Limitation of the study

The current study was done at specific zone of Tigray region, which has been affected region with war and post war crisis ,so it might not generalized to the other areas of the country.

Based on this study the magnitude of HIV infection among pregnant women was significantly high which gave alarming for the region and as whole nation. This result indicated that it needs tremendous intervention on the institutions and community as whole to resolve the problem. According to this study the factors significantly associated to the increment of HIV infection among pregnant women were sexually forced /rape within five years, women with STI history within one year, number of sexual partners in her life and women had Sign and symptoms of STI. Therefore the finding indicated that the region still on the post war impact or post war health crisis, so the regional and national government more expected to do on prevention and intervention to eliminate new infection among pregnant women and eliminate maternal to child transmission.

AIDS-Acquired Immunodeficiency Syndrome , ANC -Antenatal Care, AOR -Adjusted Odds Ratio, ART-Antiretroviral treatment, CI-Confidence Interval ,COR -Crude Odds Ratio,Covid19 –Coronavirus diseases 2019,Dr. -Doctor ,ETB- Ethiopian birr ,G.C - Gregorian calendar, HIV-Human immunodeficiency virus, MTCT -Mother to child Transmission ,PMTCT -Prevention of mother-to-child transmission, SD -Standard deviation ,SPSS-Statistical package for the social science , STI -Sexual transmitted infections.

Ethical Consideration

The ethical approval and permission was obtained from Adigrat University College of Medicine and health sciences, Institutional Review Board. Permission was also obtained from study areas before the data collection was started. Additionally, data collectors were informed to the staff and Permission were requested to the responsible body at the beginning of data collection. Data collectors were accompanied by an official letter from Adigrat University College of Medicine and health sciences and Tigray regional health bureau. In accordance with the Declaration of Helsinki, behaviors of the study were clearly explained to the participants and data were collected after getting informed verbal consent from the respondents and maximum effort was invested to keep their privacy. Respondents were informed in advance about the purpose of the study as well as privacy and confidentiality of the participants was also protected.

Consent for publication

Not applicable

Data availability

The datasets used and/or analyzed during this study are available from the corresponding author on reasonable request.

Competing interests

The authors declare no competing interests

Funding

Adigrat University was source of funding to carry out for this research. The funding organization has no role in the design of the study and collection, analysis, and interpretation of data and in writing of the manuscript.

Author Contributions

AG, GM,TH, MG and GT contributed to the conception and design of the study, collected, entered, analyzed, interpreted the data and prepared the manuscript .HH,DG,HT,MK,NL and LT contributed to data analysis, interpretation and drafted the manuscript. All authors read and approved the final manuscript.

Acknowledgments

Our special gratitude goes to ANC staff, respondents for the priceless support during collection of the data for this project. We are also grateful to thank to public hospitals of eastern zone, Tigray for their assistance and cooperation in the data collection process.

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The authors declare no competing interests.

Magnitude of HIV and associated factors among antenatal care pregnant women at public hospitals of eastern zone Tigray Ethiopia, 2025 G.C

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