Success in prevention of mother-to-child transmission (PMTCT)
raises the prospect of eliminating pediatric HIV infection. To achieve global
elimination, however, strategies are needed to strengthen PMTCT interventions.
This study aimed to determine PMTCT outcomes and identify challenges facing its
successful implementation in a rural setting in Kenya.
A retrospective cohort design was used. Routine demographic
and clinical data for infants and mothers enrolling for PMTCT care at a rural
hospital in Kenya were analysed. Cox and logistic regression were used to
determine factors associated with retention and vertical transmission
respectively.
Between 2006 and 2012, 1338 infants were enrolled and
followed up for PMTCT care with earlier age of enrollment and improved
retention observed over time. Mother to child transmission of HIV declined from
19.4 % in 2006 to 8.9 % in 2012 (non-parametric test for trend p = 0.024). From 2009 to 2012, enrolling for care after 6 months of age, adjusted Odds
Ratio [aOR]: 23.3,
presence of malnutrition and lack of
maternal use of highly active antiretroviral therapy (HAART) was associated with increased risk of HIV infection.
Infant’s older age at enrollment, malnutrition and maternal HAART status, were
also associated with drop out from care. Infants who were not actively followed
up were more likely to drop out from care.
We report a temporal increase in the proportion of infants
enrolling for PMTCT care before 3 months of age, improved retention in PMTCT
and a significant reduction in the proportion of infants enrolled who became
HIV-infected, emphasizing the benefits of PMTCT.
A simple set of risk factors at enrollment can identify
mother-infant pairs most at risk of infection or drop out for targeted
intervention.
Below: Temporal changes in infant enrollment for PMTCT care at a rural HIV clinic in Kenya. Dashed line: infants enrolled each year. Light grey, mid-grey and dark-grey bars represent age at enrollment: enrolled before 3 months, between 3 to 6 months and after 6 months of age respectively. The total number of infants enrolled (n = 1338). PMTCT; Prevention of Mother to Child HIV-1 Transmission
Below: Prevalence of HIV vertical transmission among infants enrolled for PMTCT care at a rural HIV clinic in Kenya Dotted lines: prevalence during previous study, solid lines: prevalence during current study. Non-parametric test for trend, p = 0.024, confidence interval (CI) indicated. Total number of infants (n = 1338). PMTCT; Prevention of Mother to Child HIV-1 Transmission, MTCT; Mother to child Transmission of HIV
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