Each year more than 90 percent of childhood HIV infections (>390,000 infections) occur in Sub-Saharan Africa. In Ethiopia, mother-to-child transmission accounts for over 95 percent of childhood infections. Despite PMTCT programs in Ethiopia, attrition and loss to follow-up (LTF) are high, threatening the effectiveness of PMTCT intervention. This research identifies points where women, or mother-infant pairs, become disengaged and are lost to the system. Semi-structured interviews and qualitative coding revealed four major points of LTF along the PMTCT cascade: (1) ANC uptake, (2) ARV adherence, (3) post-delivery, and (4) post-infant vaccinations. Promising interventions for increasing retention, and reducing LTF are presented for each dropout point. Policy and programming options addressing the first point of LTF – low ANC uptake by pregnant women – are explored and evaluated within the Ethiopian context. Two simultaneous strategies are recommended for increasing ANC uptake: (1) community education sessions and (2) expansion of Ethiopia’s Mother Support Group.