Pooled prevalence and temporal variations of infant HIV infection in Ethiopia: a systematic review and meta-analysis

Background Despite national efforts to prevent vertical HIV transmission in Ethiopia, mother-to-child transmission (MTCT) remains a significant public health concern. Thus, this systematic review and meta-analysis aimed to estimate the pooled prevalence and temporal variations of HIV infection among infants born to HIV-positive mothers in Ethiopia over the past 14 years. Methods A comprehensive search of Scopus, PubMed, Web of Science, ScienceDirect, Embase, and Google Scholar was conducted between June and September 2025 to identify studies published from October 2011 onward. Studies reporting infant HIV prevalence were included following PRISMA guidelines. Data were extracted using a standardized form, and study quality was assessed using the Joanna Briggs Institute (JBI) critical appraisal tool. The pooled prevalence was calculated using Stata version 17 with a random-effects model (DerSimonian and Laird estimator). Heterogeneity was assessed by using Higgins’ I² statistic. Subgroup and sensitivity analyses were performed to explore sources of heterogeneity. Small study effect was evaluated using funnel plots, Egger’s test, and trim-and-fill analysis. Results Thirty-one studies involving 15,251 infants were included. The pooled prevalence of HIV infection among infants born to HIV-positive mothers was 6.2% (95% CI: 4.7–7.9), with substantial heterogeneity (I² = 93.7%, p < 0.001). Subgroup analysis by study period showed as prevalence estimates were lower among studies published in more recent periods from 9.6% (2011–2015) to 6.4% (2016–2020) and 4.6% (2021–2024). Pooled regional estimates ranged from 2.3% in Tigray/Gambella to 7.6% in Oromia, although individual study estimates varied substantially within regions. No statistically significant evidence of small-study effects was detected using the applied tests (p > 0.05) following nonparametric trim and fill analysis. Conclusion Although infant HIV prevalence estimates have varied over time in Ethiopia, substantial between-study heterogeneity and regional differences suggest possible variations in the implementation and coverage of prevention of mother-to-child transmission interventions and access to maternal and infant HIV services. Continued efforts to strengthen antenatal HIV care, skilled institutional delivery, maternal ART adherence, timely infant prophylaxis, early infant diagnosis, and postnatal follow-up may contribute to further reducing mother-to-child HIV transmission.