Background: Mother to child transmission (MTCT) of HIV is one of the commonest avenues through which infants are infected with the HIV virus. To achieve a HIV free generation, mother to child transmission of HIV should be eliminated. Nigeria began prevention of mother to child transmission (PMTCT) services 13 years ago, but still contributes to over a third of global MTCT burden. We set out to explore and define the effectiveness of PMTCT in selected sites in north-central Nigeria. Methods: We conducted a retrospective secondary data analysis at eight Service Delivery Points in two States. 1454 mother-infant pair data sets from 2012 – 2016 were extracted and analyzed. Maternal/infant ARV services, early infant diagnosis (EID) and final outcome were reviewed to examine the predictors of HIV transmission from mother-to-child in these centers. Results: We retrieved 1,454 mother-infant-pair. While 89.5% (1302) positive pregnant women (PPW) and 92.2% (1340) of HIV-exposed infants received antiretroviral prophylaxis/treatment, 88.4% (1285) infants were breastfed with 32.5% still receiving breast milk at the time of DBS collection. EID-PCR positivity rate was 3.5% (range: 0.0–11.1%). Facility of delivery (X=24.99, p<0.00), mother on ARV (X=48.8, p<0.00), mother having received ARV prophylaxis (X=89.59, p<0.00), infant having received ARV prophylaxis (X=58.56, p<0.00) and baby having received cotrimoxazole (X=55.24, p<0.00) were all significantly prevented positive EID results. However, mode of delivery and breastfeeding were not significantly associated with positive EID results. Conclusions: This study supports PMTCT services as it minimizes the transfer of HIV from infected mothers to HIV exposed infants (HEI). To eliminate HIV and achieve zero new infections, every HIV-positive pregnant woman should receive ARV prophylaxis and be supported post-delivery to prevent transfer of infection to the new born. Also, HEI should receive timely ARV and cotrimoxazole prophylaxis.