{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2025,11,4]],"date-time":"2025-11-04T19:09:46Z","timestamp":1762283386944,"version":"build-2065373602"},"reference-count":40,"publisher":"Springer Science and Business Media LLC","issue":"6","license":[{"start":{"date-parts":[[2025,7,1]],"date-time":"2025-07-01T00:00:00Z","timestamp":1751328000000},"content-version":"tdm","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0"},{"start":{"date-parts":[[2025,7,1]],"date-time":"2025-07-01T00:00:00Z","timestamp":1751328000000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0"}],"funder":[{"DOI":"10.13039\/501100004047","name":"Karolinska Institute","doi-asserted-by":"crossref","id":[{"id":"10.13039\/501100004047","id-type":"DOI","asserted-by":"crossref"}]}],"content-domain":{"domain":["link.springer.com"],"crossmark-restriction":false},"short-container-title":["J Community Health"],"published-print":{"date-parts":[[2025,12]]},"abstract":"<jats:title>Abstract<\/jats:title>\n                  <jats:p>Despite global advancements, pregnant women living with HIV in Nepal remain at risk for vertical transmission. This study examined demographic and clinical characteristics, antiretroviral therapy (ART) retention, and transmission outcomes among this population. A retrospective cohort analysis was conducted using data from Nepal\u2019s national electronic HIV register, including 322 women who became pregnant between 2020 and 2023. We analyzed sociodemographic profiles, clinical status at diagnosis, ART initiation timing, retention rates at 6, 12, and 24 months, and infant HIV status. The mean age was 26.9 years; over half (56.2%) were aged 25\u201339 years. Nearly 40% were illiterate, 87.6% unemployed, and 66.8% reported unsafe sexual behavior as the mode of HIV transmission. Over half (58.1%) were diagnosed prior to pregnancy, and 75.5% were in WHO Stage 1. ART began on the same day in 34.8% and within a week in 40.1%, with 56.8% already on ART during pregnancy. Retention was high: 96.9% at 6 months, 94.8% at 12 months, and 96.0% at 24 months. Vertical transmission occurred in 4.3% of pregnancies. Higher transmission rates were observed among younger mothers (6.9%), Dalit women (11.5%), those in advanced HIV stages (11.1%), with delayed ART initiation (8.6%), high viral loads (13.3%), and home deliveries (17.6%). In Nepal, approximately 1 in 23 infants born to women living with HIV still acquire the infection. Strengthening early diagnosis, improving ART uptake, and addressing disparities in care especially among high-risk groups are essential to eliminating vertical transmission and improving maternal and child health outcomes.<\/jats:p>","DOI":"10.1007\/s10900-025-01474-6","type":"journal-article","created":{"date-parts":[[2025,7,1]],"date-time":"2025-07-01T17:06:56Z","timestamp":1751389616000},"page":"1105-1114","update-policy":"https:\/\/doi.org\/10.1007\/springer_crossmark_policy","source":"Crossref","is-referenced-by-count":0,"title":["Progress Toward the Elimination of Vertical HIV Transmission in Nepal: A Retrospective Cohort Study"],"prefix":"10.1007","volume":"50","author":[{"given":"Upendra","family":"Shrestha","sequence":"first","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Lok Raj","family":"Pandey","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Man Bahadur","family":"KC","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-0478-3220","authenticated-orcid":false,"given":"Ali","family":"Mirzazadeh","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-9933-2210","authenticated-orcid":false,"given":"Keshab","family":"Deuba","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"297","published-online":{"date-parts":[[2025,7,1]]},"reference":[{"key":"1474_CR1","unstructured":"UNAIDS (2023). UNAIDS fact sheet. https:\/\/www.unaids.org\/sites\/default\/files\/media_asset\/data-book-2023_en.pdf"},{"key":"1474_CR2","unstructured":"WHO (2021). Elimination of mother to child transmission of HIV, Syphilis and Hepatitis B virus. https:\/\/www.who.int\/publications\/i\/item\/9789240039360"},{"key":"1474_CR3","unstructured":"UNICEF (2024). HIVAIDS elimination of mother to child transmission. https:\/\/data.unicef.org\/topic\/hivaids\/emtct\/"},{"key":"1474_CR4","unstructured":"UNAIDS (2023). Regional factsheets, Asia and Pacific. https:\/\/www.aidsdatahub.org\/resource\/asia-and-pacific-regional-hiv-factsheet-2023"},{"key":"1474_CR5","unstructured":"UNAIDS (2021). Joint United Nations programme on HIV. Global AIDS response progress reporting. https:\/\/www.aidsdatahub.org\/sites\/default\/files\/resource\/unaids-global-aids-monitoring-2021.pdf"},{"key":"1474_CR6","unstructured":"WHO, UNAIDS and UNICEF (2020). Key considerations for programming and prioritization. Going the \u2018Last Mile\u2019 to EMTCT: a road map for ending the HIV epidemic in children. https:\/\/www.childrenandaids.org\/sites\/default\/files\/2020-02\/Last-Mile-To-EMTCT_WhitePaper_UNICEF2020.pdf"},{"key":"1474_CR7","unstructured":"WHO (2021). Global guidance on criteria and processes for validation: elimination of mother-to-child transmission of HIV, syphilis and hepatitis B virus. https:\/\/iris.who.int\/bitstream\/handle\/10665\/349550\/9789240039360-eng.pdf?sequence=1"},{"key":"1474_CR8","doi-asserted-by":"crossref","unstructured":"The Lancet HIV. (2022). The Path to elimination of vertical transmission of HIV.","DOI":"10.1016\/S2352-3018(22)00012-1"},{"key":"1474_CR9","unstructured":"National Statistic Office (2021). National Population and Housing Census. https:\/\/censusnepal.cbs.gov.np\/results\/files\/result-folder\/National%20Report_English.pdf"},{"key":"1474_CR10","unstructured":"Ministry of Health and Population (MoHP) (2022). Nepal Demographic Health Survey. https:\/\/www.dhsprogram.com\/pubs\/pdf\/FR379\/FR379.pdf"},{"key":"1474_CR11","unstructured":"Family Welfare Division (FWD) (2024). N. public dashboard. http:\/\/182.93.95.152\/rmncah\/app\/#\/public\/dashboard"},{"key":"1474_CR12","unstructured":"National Center for AIDS and STD Control (NCASC) (2024). National HIV fact sheet. https:\/\/ncasc.gov.np\/information\/101"},{"key":"1474_CR13","unstructured":"National Center for AIDS and STD Control (NCASC) (2011). National Guidelines-prevention of mother to child transmission of HIV in Nepal 2011 (4th edition). https:\/\/ncasc.gov.np\/demo\/public\/publications\/140"},{"key":"1474_CR14","unstructured":"National Center for AIDS and STD Control (NCASC) (2022). National HIV fact sheet. https:\/\/ncasc.gov.np\/information\/85"},{"key":"1474_CR15","unstructured":"National Center for AIDS and STD Control (NCASC) (2022\u20132026). National HIV Strategic Plan. https:\/\/ncasc.gov.np\/publications\/252"},{"key":"1474_CR16","unstructured":"Family Welfare Division (FWD) (2019). Nepal Safe Motherhood and Newborn Health Road map 2030. https:\/\/fwd.gov.np\/wp-content\/uploads\/2021\/08\/SMNH-Roadmap-2030-SGOP.pdf"},{"key":"1474_CR17","unstructured":"National Center for AIDS and STD Control (NCASC) (2022). National HIV testing and treatment guidelines. https:\/\/ncasc.gov.np\/publications\/254"},{"key":"1474_CR18","unstructured":"DHIS2 (2023). Nepal employs DHIS2 tracker for improved data and results in its national HIV program. Retrieved Dec 3 2024 from https:\/\/dhis2.org\/nepal-hiv-tracker\/"},{"key":"1474_CR19","unstructured":"AIDS Data Hub (2023). Nepal data book. https:\/\/www.aidsdatahub.org\/sites\/default\/files\/resource\/nepal-data-book-2023.pdf"},{"key":"1474_CR20","doi-asserted-by":"publisher","unstructured":"Niragire, F., Ndikumana, C., Nyirahabimana, M. G., & Uwizeye, D. (2021). Prevalence and factors associated with fertility desire among HIV-positive women in Rwanda in the context of improved life expectancy. Archives of Public Health, 79(1). https:\/\/doi.org\/10.1186\/s13690-021-00742-w","DOI":"10.1186\/s13690-021-00742-w"},{"issue":"8","key":"1474_CR21","doi-asserted-by":"publisher","first-page":"e036391","DOI":"10.1136\/bmjopen-2019-036391","volume":"10","author":"TR Feyissa","year":"2020","unstructured":"Feyissa, T. R., Harris, M. L., Forder, P. M., & Loxton, D. (2020). Fertility among women living with HIV in Western Ethiopia and its implications for prevention of vertical transmission: A cross-sectional study. British Medical Journal Open, 10(8), e036391. https:\/\/doi.org\/10.1136\/bmjopen-2019-036391","journal-title":"British Medical Journal Open"},{"key":"1474_CR22","doi-asserted-by":"crossref","unstructured":"Semahegn, T., Wassie, S. M. Y., & Birhanu, T. (2022). Fentaw Fertility desire of HIV-positive men and women in public health hospitals. Sage open medicine, 10.","DOI":"10.1177\/20503121221124755"},{"key":"1474_CR23","doi-asserted-by":"publisher","first-page":"103490","DOI":"10.1016\/j.midw.2022.103490","volume":"115","author":"J Kownaklai","year":"2022","unstructured":"Kownaklai, J., Graham, M., & Hayter, M. (2022). Pregnancy decision making among Thai women living with HIV: A grounded theory study. Midwifery, 115, 103490. https:\/\/doi.org\/10.1016\/j.midw.2022.103490","journal-title":"Midwifery"},{"issue":"5","key":"1474_CR24","doi-asserted-by":"publisher","first-page":"427","DOI":"10.1097\/qai.0000000000001616","volume":"77","author":"BA Knettel","year":"2018","unstructured":"Knettel, B. A., Cichowitz, C., Ngocho, J. S., Knippler, E. T., Chumba, L. N., Mmbaga, B. T., & Watt, M. H. (2018). Retention in HIV care during pregnancy and the postpartum period in the option B\u2009+\u2009Era: Systematic review and Meta-Analysis of studies in Africa. JAIDS Journal of Acquired Immune Deficiency Syndromes, 77(5), 427\u2013438. https:\/\/doi.org\/10.1097\/qai.0000000000001616","journal-title":"JAIDS Journal of Acquired Immune Deficiency Syndromes"},{"key":"1474_CR25","doi-asserted-by":"publisher","DOI":"10.1007\/s10461-022-03666-w","author":"JM Humphrey","year":"2022","unstructured":"Humphrey, J. M., Songok, J., Ofner, S., Musick, B., Alera, M., Kipchumba, B., McHenry, M. S., Carlucci, J. G., Park, J., Mwangi, W., Yiannoutsos, C., Bakoyannis, G., & Wools-Kaloustian, K. (2022). Retention in care and viral suppression in the PMTCT continuum at a large referral facility in Western Kenya. AIDS and Behavior. https:\/\/doi.org\/10.1007\/s10461-022-03666-w","journal-title":"AIDS and Behavior"},{"issue":"6","key":"1474_CR26","doi-asserted-by":"publisher","first-page":"e0218781","DOI":"10.1371\/journal.pone.0218781","volume":"14","author":"A Rahmalia","year":"2019","unstructured":"Rahmalia, A., Price, M. H., Hartantri, Y., Alisjahbana, B., Wisaksana, R., van Crevel, R., & van der Ven, A. (2019). Are there differences in HIV retention in care between female and male patients in Indonesia? A multi-state analysis of a retrospective cohort study. PLOS ONE, 14(6), e0218781. https:\/\/doi.org\/10.1371\/journal.pone.0218781","journal-title":"PLOS ONE"},{"key":"1474_CR27","doi-asserted-by":"publisher","unstructured":"Bhatta, M., Dutta, N., Nandi, S., Dutta, S., & Saha, M. K. (2020). Mother-to-child HIV transmission and its correlates in India: Systematic review and meta-analysis. BMC Pregnancy and Childbirth, 20(1). https:\/\/doi.org\/10.1186\/s12884-020-03193-3","DOI":"10.1186\/s12884-020-03193-3"},{"key":"1474_CR28","unstructured":"CDC (2024). Success stories. https:\/\/www.cdc.gov\/global-hiv-tb\/php\/success-stories\/uganda-pmtct.html"},{"key":"1474_CR29","doi-asserted-by":"publisher","unstructured":"Potty, R. S., Sinha, A., Sethumadhavan, R., Isac, S., & Washington, R. (2019). Incidence, prevalence and associated factors of mother-to-child transmission of HIV, among children exposed to maternal HIV, in Belgaum district, Karnataka, India. Bmc Public Health, 19(1). https:\/\/doi.org\/10.1186\/s12889-019-6707-3","DOI":"10.1186\/s12889-019-6707-3"},{"issue":"11","key":"1474_CR30","doi-asserted-by":"publisher","first-page":"12629","DOI":"10.1007\/s10668-022-02582-2","volume":"25","author":"K Atreya","year":"2023","unstructured":"Atreya, K., Rimal, N. S., Makai, P., Baidya, M., Karki, J., Pohl, G., & Bhattarai, S. (2023). Dalit\u2019s livelihoods in Nepal: Income sources and determinants. Environment Development and Sustainability, 25(11), 12629\u201312657. https:\/\/doi.org\/10.1007\/s10668-022-02582-2","journal-title":"Environment Development and Sustainability"},{"key":"1474_CR31","doi-asserted-by":"crossref","unstructured":"French, A. N. (2020). Dalits and mental health: Investigating perceptions, stigma and barriers to support in Kathmandu, Nepal. Journal of Global Health Reports, 4.","DOI":"10.29392\/001c.12136"},{"issue":"7\u20139","key":"1474_CR32","doi-asserted-by":"publisher","first-page":"914","DOI":"10.1080\/07399332.2019.1597366","volume":"40","author":"D Sharma Gautam","year":"2019","unstructured":"Sharma Gautam, D., & Hearn, G. (2019). No time, no money, no luck: Barriers to prenatal care among Dalit women in rural Nepal. Health Care for Women International, 40(7\u20139), 914\u2013930. https:\/\/doi.org\/10.1080\/07399332.2019.1597366","journal-title":"Health Care for Women International"},{"key":"1474_CR33","unstructured":"DFID and World Bank (2006). Unequal Citizens-Gender, Caste and Ethinic Exclusion in Nepal. https:\/\/documents1.worldbank.org\/curated\/zh\/745031468324021366\/pdf\/379660v20WP0Un00Box0361508B0PUBLIC0.pdf"},{"key":"1474_CR34","unstructured":"United Nation Nepal (2020). Literature Review on Harmful Practices in Nepal. https:\/\/nepal.unfpa.org\/sites\/default\/files\/pub-pdf\/Literature%20Review%20on%20Harmful%20Practices%20in%20Nepal.pdf"},{"key":"1474_CR35","doi-asserted-by":"publisher","unstructured":"Tuthill, E. L., Odhiambo, B. C., & Maltby, A. E. (2024). Understanding mother-to-child transmission of HIV among mothers engaged in HIV care in Kenya: A case report. International Breastfeeding Journal, 19(1). https:\/\/doi.org\/10.1186\/s13006-024-00622-3","DOI":"10.1186\/s13006-024-00622-3"},{"key":"1474_CR36","doi-asserted-by":"publisher","unstructured":"Tilaye, B. A., Hailemeskel, H. S., Baye, F. D., Hailu, M. K., Mekonnen, G. B., Arage, G., Birhane, B. M., Tibebu, N. S., & Moges, N. (2024). Incidence of mother-to-child transmission of HIV and predictors of positivity among HIV exposed infants in South Gondar public hospitals, Northwest Ethiopia: Competing risk regression model. BMC Pediatrics, 24(1). https:\/\/doi.org\/10.1186\/s12887-024-05061-x","DOI":"10.1186\/s12887-024-05061-x"},{"key":"1474_CR37","unstructured":"WHO and UNICEF, (2023). Key considerations for fast-tracking the elimination of mother-to-child transmission of HIV in lower-prevalence settings: lessons from validated countries 2023. https:\/\/iris.who.int\/bitstream\/handle\/10665\/375803\/9789240076488-eng.pdf?sequence=1"},{"issue":"10037","key":"1474_CR38","doi-asserted-by":"publisher","first-page":"2488","DOI":"10.1016\/S0140-6736(16)30787-5","volume":"387","author":"M Sidib\u00e9","year":"2016","unstructured":"Sidib\u00e9, M., & Singh, P. K. (2016). Thailand eliminates mother-to-child transmission of HIV and syphilis. The Lancet, 387(10037), 2488\u20132489. https:\/\/doi.org\/10.1016\/S0140-6736(16)30787-5","journal-title":"The Lancet"},{"key":"1474_CR39","doi-asserted-by":"publisher","unstructured":"Lolekha, R., Thisyakorn, U., & Sharma, M. (2021). Thailand: Elimination of Mother-to-Child Transmission of HIV and Syphilis. In P. K. Singh (Ed.), Elimination of Infectious Diseases from the South-East Asia Region: Keeping the Promise (pp. 13\u201323). Springer Singapore. https:\/\/doi.org\/10.1007\/978-981-16-5566-1_2","DOI":"10.1007\/978-981-16-5566-1_2"},{"key":"1474_CR40","doi-asserted-by":"publisher","unstructured":"Mohamed, I., Hameed, A., Adam, A., & Pant, S. (2021). Leveraging Health System Gains Towards Eliminating Mother-to-Child Transmission (EMTCT) of HIV and Syphilis: How Maldives Became the Second Country in WHO South-East Asia Region to Achieve This Feat. In (pp. 105\u2013114). https:\/\/doi.org\/10.1007\/978-981-16-5566-1_12","DOI":"10.1007\/978-981-16-5566-1_12"}],"container-title":["Journal of Community Health"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/link.springer.com\/content\/pdf\/10.1007\/s10900-025-01474-6.pdf","content-type":"application\/pdf","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/link.springer.com\/article\/10.1007\/s10900-025-01474-6\/fulltext.html","content-type":"text\/html","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/link.springer.com\/content\/pdf\/10.1007\/s10900-025-01474-6.pdf","content-type":"application\/pdf","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2025,11,4]],"date-time":"2025-11-04T19:02:32Z","timestamp":1762282952000},"score":1,"resource":{"primary":{"URL":"https:\/\/link.springer.com\/10.1007\/s10900-025-01474-6"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2025,7,1]]},"references-count":40,"journal-issue":{"issue":"6","published-print":{"date-parts":[[2025,12]]}},"alternative-id":["1474"],"URL":"https:\/\/doi.org\/10.1007\/s10900-025-01474-6","relation":{},"ISSN":["0094-5145","1573-3610"],"issn-type":[{"type":"print","value":"0094-5145"},{"type":"electronic","value":"1573-3610"}],"subject":[],"published":{"date-parts":[[2025,7,1]]},"assertion":[{"value":"18 April 2025","order":1,"name":"accepted","label":"Accepted","group":{"name":"ArticleHistory","label":"Article History"}},{"value":"1 July 2025","order":2,"name":"first_online","label":"First Online","group":{"name":"ArticleHistory","label":"Article History"}},{"order":1,"name":"Ethics","group":{"name":"EthicsHeading","label":"Declarations"}},{"value":"We received ethical approval from the ethical review board (ERB) at the Nepal Health Research Council (NHRC). The study was retrospective and hence the client\u2019s consent could not be obtained, this was acknowledged in our ERB application.","order":2,"name":"Ethics","group":{"name":"EthicsHeading","label":"Ethics Approval"}},{"value":"Not applicable.","order":3,"name":"Ethics","group":{"name":"EthicsHeading","label":"<!--Emphasis Type='Bold' removed-->Patient Consent for Publication"}},{"value":"All authors confirm that they do not have any conflicts of interest to disclose.","order":4,"name":"Ethics","group":{"name":"EthicsHeading","label":"Competing Interests"}}]}}