Factors associated with mother to child transmission of HIV despite overall low transmission rates in HIV-exposed infants in rural Kenya
Abstract
Despite the availability of efficacious prevention of mother-to-child transmission (PMTCT) interventions and improved access to preventive services in many developing countries, vertical HIV transmission persists. A matched case–control study of HIV-exposed infants between January and June 2012 was conducted at 20 clinics in Kenya. Cases were HIV-infected infants and controls were exposed, uninfected infants. Conditional logistic regression analysis was conducted to determine characteristics associated with HIV infection. Forty-five cases and 45 controls were compared. Characteristics associated with HIV-infection included poor PMTCT service uptake such as late infant enrollment (odds ratio [OR]: 7.1, 95% confidence interval [CI]: 2.6–16.7) and poor adherence to infant prophylaxis (OR: 8.3, 95%CI: 3.2–21.4). Maternal characteristics associated with MTCT included lack of awareness of HIV status (OR: 5.6, 95%CI: 2.2–14.5), failure to access antiretroviral prophylaxis (OR: 22.2, 95%CI: 5.8–84.6), and poor adherence (OR: 8.1, 95%CI: 3.7–17.8). Lack of clinic-based HIV education (OR: 7.7, 95%CI: 2.0–25.0) and counseling (OR: 8.3, 95%CI: 2.2–33.3) were reported by mothers of cases. Poor uptake of PMTCT services and a reported absence of HIV education and counseling at the clinic were associated with MTCT. More emphasis on high-quality, comprehensive PMTCT service provision are urgently needed to minimize HIV transmission to children.
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References
1. Joint United Nations Programme on HIV/Acquired Immune Deficiency Syndrome (UNAIDS). World AIDS Day Report Fact Sheet 2015. UNAIDS. Geneva, Switzerland, 2016.
2. Joint United Nations Programme on HIV/Acquired Immune Deficiency Syndrome (UNAIDS). Countdown to zero. Global plan towards the elimination of new HIV infections among children by 2015 and keeping their mothers alive. UNAIDS. Geneva, Switzerland, 2011.
3. Gourlay A, Birdthistle I, Mburu G, et al. Barriers and facilitating factors to the uptake of anti-retroviral drugs for prevention of mother-to-child transmission of HIV in sub-Saharan Africa: a systematic review. J Int AIDS Soc 2013; 16: 18588–18588.
4. Kinuthia J, Kiarie JN, Farquhar C, et al. Uptake of prevention of mother to child transmission interventions in Kenya: Health systems are more influential than stigma. J Int AIDS Soc 2011; 14: 61–61.
5. Wettstein C, Mugglin C, Egger M, et al. IeDEA Southern Africa Collaboration. Missed opportunities to prevent mother-to-child-transmission: systematic review and meta-analysis. AIDS 2012; 26: 2361–2373.
6. Woldesenbet S, Jackson D, Lombard C, et al. Missed opportunities along the prevention of mother-to-child transmission services cascade in South Africa: uptake, determinants, and attributable risk (the SAPMTCTE). PLoS One 2015; 10: e0132425–e0132425.
7. Ministry of Health Kenya. Kenya HIV Prevention Revolution Road Map. National AIDS/STI Control Programme (NASCOP). Nairobi, Kenya, 2014.
8. Government of Kenya. Kenya AIDS Indicator Survey Preliminary Results 2012. Nairobi, Kenya, 2013.
9. Sirengo M, Muthoni L, Kellogg TA, et al. Mother-to-child transmission of HIV in Kenya: results from a nationally representative study. J Acquir Immune Defic Syndr 2014; 66: S66–74.
10. Kulzer J, Penner J, Marima R, et al. Family model of HIV care and treatment: a retrospective study in Kenya. J Int AIDS Soc 2012; 15: 8–8.
11. Ministry of Health Kenya. Kenya HIV Treatment Guidelines. National AIDS/STI Control Programme (NASCOP). Nairobi, Kenya, 2012.
12. Family AIDS Care and Education Services. Report: FACES Migori County laboratory database. Unpublished, 2012.
13. Siegfried N, van der Merwe L, Brocklehurst P, et al. Antiretrovirals for reducing the risk of mother-to-child transmission of HIV infection. Cochrane Database Syst Rev 2011. CD003510.
14. Nachega JB, Uthman OA, Anderson J, et al. Adherence to antiretroviral therapy during and after pregnancy in low-income, middle-income, and high-income countries: a systematic review and meta-analysis. AIDS 2012; 26: 2039–2052.
15. Hodgson I, Plummer ML, Konopka SN, et al. A systematic review of individual and contextual factors affecting ART initiation, adherence, and retention for HIV-infected pregnant and postpartum women. PloS One 2014; 9. e111421.
16. Laher F, Cescon A, Lazarus E, et al. Conversations with mothers: exploring reasons for prevention of mother-to-child transmission (PMTCT) failures in the era of programmatic scale-up in Soweto, South Africa. AIDS Behav 2012; 16: 91–98.
17. Abdedimeji AAN, Merdekios B, Shiferaw M. A qualitative study of barriers to effectiveness of interventions to prevent mother-to-child transmission of HIV in Arba Minch, Ethiopia. Int J Popul Res 2012; 2012: 532154–532154.
18. Turan JM, Bukusi EA, Onono M, et al. HIV/AIDS stigma and refusal of HIV testing among pregnant women in rural Kenya: results from the MAMAS Study. AIDS Behav 2011; 15: 1111–1120.
19. Turan JM, Hatcher AH, Medema-Wijnveen J, et al. The role of HIV-related stigma in utilization of skilled childbirth services in rural Kenya: a prospective mixed-methods study. PLoS Med 2012; 9. e1001295.
20. Morrison CS, Demers K, Kwok C, et al. Plasma and cervical viral loads among Ugandan and Zimbabwean women during acute and early HIV-1 infection. AIDS 2010; 24: 573–582.
21. Wertz J, Cesario J, Sackrison J, et al. Acute HIV infection in pregnancy: The case for third trimester rescreening. Case Rep Infect Dis 2011; 2011: 340817–340817.
22. Drake A, Kinuthia J, Matemo D, et al. Virologic and immunologic response following antiretroviral therapy initiation among pregnant and postpartum women with acute HIV-1 infection. In: Presented at 20th international AIDS conference, Melbourne, Australia, 20–25 July 2014.
23. Gill M, Nelson Y, Appolinaire T, et al. Viral suppression among HIV-positive women starting antiretroviral therapy before or during pregnancy in Lesotho. In: Presented at the annual International AIDS conference, Durban, South Africa, 2016.
24. Tsondai P, Phillips T, Hsiao NY, et al. HIV viral load monitoring in HIV-infected pregnant women established on antiretroviral therapy in Cape Town, South Africa. In: Presented at Annual International AIDS Conference, Durban, South Africa, 2016.
25. Aluisio A, Richardson BA, Bosire R, et al. Male antenatal attendance and HIV testing are associated with decreased infant HIV infection and increased HIV-free survival. J Acquir Immune Defic Syndr 2011; 56: 76–82.
26. Kalembo FW, Zgambo M, Mulaga AN, et al. Association between male partner involvement and the uptake of prevention of mother-to-child transmission of HIV (PMTCT) interventions in Mwanza district, Malawi: a retrospective cohort study. PloS One 2013; 8: e66517–e66517.
27. Morfaw F, Mbuagbaw L, Thabane L, et al. Male involvement in prevention programs of mother to child transmission of HIV: a systematic review to identify barriers and facilitators. Syst Rev 2013; 2: 5–5.
28. Byamugisha R, Tumwine JK, Ndeezi G, et al. Attitudes to routine HIV counselling and testing, and knowledge about prevention of mother to child transmission of HIV in eastern Uganda: a cross-sectional survey among antenatal attendees. J Int AIDS Soc 2010; 13: 52–52.
29. Asefa A, Mitike G. Prevention of mother-to-child transmission (PMTCT) of HIV services in Adama town, Ethiopia: clients' satisfaction and challenges experienced by service providers. BMC Pregnancy Childbirth 2014; 14: 57–57.
30. Iroezi ND, Mindry D, Kawale P, et al. A qualitative analysis of the barriers and facilitators to receiving care in a prevention of mother-to-child program in Nkhoma, Malawi. Afr J Reprod Health 2013; 17: 118–129.
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Published In
Article first published online: February 9, 2017
Issue published: October 2017
Keywords
PubMed: 28181860
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Authors’ Contributions
NAO was responsible for project design, literature review, data collection, data interpretation, and manuscript preparation. KOO was responsible for data analysis and manuscript preparation. LKJ provided senior statistical oversight and manuscript/analysis review. GOO, RWW, and IAO oversaw local data collection and interpretation and manuscript review. EB and CC serve as co-principal investigators for FACES and supervise all program evaluations including writing and editing of the final manuscript. LA was responsible for project design, data interpretation, guidance and mentorship, and manuscript preparation and review.
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