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Background Without intervention, transmission rate of HIV from mother to child ranges from 15% to 45%, that can be reduced to below 5% with effective intervention. In West Shewa zone transmission rate is 10% currently. Aim of the study is to identify determinants of transmission of HIV from mother to child in West Shewa Zone which has 2.1 million populations. Methods Mixed methods: unmatched case-control study, N = 96(24 cases, 72 controls) and one-on-one questioner was conducted. Variables of interest were collected using structured and semi-structured questioner and data abstraction forms from mothers of exposed infants, medical records of mothers and children. Result Majority among cases(70.8%) were not included in to option B+ program. Home delivery increases 6 times chance of HIV, AOR=6.047, CI(1.549–29.230), none inclusion in to option B+ increase 18 chance of HIV transmission, AOR=18.0;CI(5.0–68.1). Partner noninvolvement to HIV care increases chance of transmission by 7.3 times, AOR=7.3;CI(1.14–37.459). Mother- mother support program decrease chance of transmission by 86.5% with AOR=0.135CI (0.11–0.396). Poor ANC practices among rural residents contributed to unaware MTCT of HIV. Conclusion Mother-to-mother support program has protective effect, while None inclusion to option B+, partner noninvolvement to HIV care, Home delivery and poor ANC practice were determinant factors of HIV transmission from mother to child. Key messages Health education and awareness creation should be implemented by HEW to improve ANC practice, and increase VCT among rural residents.

492Determinants of mother to child transmission of HIV in West Shewa, Oromiya: Mixed-method study