Community-Based Evaluation of PMTCT Uptake in Nyanza Province, Kenya

Abstract

IntroductionFacility-based assessments of prevention of mother-to-child HIV transmission (PMTCT) programs may overestimate population coverage. There are few community-based studies that evaluate PMTCT coverage and uptake.MethodsDuring 2011, a cross-sectional community survey among women who gave birth in the prior year was performed using the KEMRI-CDC Health and Demographic Surveillance System in Western Kenya. A random sample (n = 405) and a sample of women known to be HIV-positive through previous home-based testing (n = 247) were enrolled. Rates and correlates of uptake of antenatal care (ANC), HIV-testing, and antiretrovirals (ARVs) were determined.ResultsAmong 405 women in the random sample, 379 (94%) reported accessing ANC, most of whom (87%) were HIV tested. Uptake of HIV testing was associated with employment, higher socioeconomic status, and partner HIV testing. Among 247 known HIV-positive women, 173 (70%) self-disclosed their HIV status. Among 216 self-reported HIV-positive women (including 43 from the random sample), 82% took PMTCT ARVs, with 54% completing the full antenatal, peripartum, and postpartum course. Maternal ARV use was associated with more ANC visits and having an HIV tested partner. ARV use during delivery was lowest (62%) and associated with facility delivery. Eighty percent of HIV infected women reported having their infant HIV tested, 11% of whom reported their child was HIV infected, 76% uninfected, 6% declined to say, 7% did not recall; 79% of infected children were reportedly receiving HIV care and treatment.ConclusionsCommunity-based assessments provide data that complements clinic-based PMTCT evaluations. In this survey, antenatal HIV test uptake was high; most HIV infected women received ARVs, though many women did not self-disclose HIV status to field team. Community-driven strategies that encourage early ANC, partner involvement, and skilled delivery, and provide PMTCT education, may facilitate further reductions in vertical transmission.

HIV testing uptake and retention in care of HIV‐infected pregnant and breastfeeding women initiated on ‘Option B+’ in rural Zimbabwe

“…The low rates of HIV testing in women attending late for ANC in our study have also been found in Vietnam [16], and again in Zimbabwe where women with fewer ANC visits declined HIV testing due to fear of disclosure and the need to have partners' consent [17]. The high uptake of Option B+ in our study was similar to what was found in a recent study in Kenya [14]. While most of the reasons for declining Option B+ were unspecified and are therefore speculative, in Malawi, the fear of HIV disclosure was the reason most commonly given for refusal to take up ART [18].…”

“…We also encountered missing data due to incomplete documentation in registers and our findings from just two districts further limit our ability to infer study findings to the general population. Despite these limitations, the general high level of HIV testing uptake in this study is encouraging and comparable to findings from a community-based study in Kenya [14]. HIV testing uptake was also slightly better when compared to previous demographic and health survey (DHS) data from sub-Saharan Africa which found an HIV testing uptake of 73% in ANC clinics in Zimbabwe [15].…”

A community-based assessment of correlates of facility delivery among HIV-infected women in western Kenya

“…The methodology of the parent study has previously been described [ 20 ]. A list of women in the KEMRI-CDC HDSS area who had delivered in 2010 was generated.…”

Safety and immunogenicity of RTS,S/AS01 malaria vaccine in infants and children with WHO stage 1 or 2 HIV disease: a randomised, double-blind, controlled trial

“…Two-hundred children aged 6 weeks to 17 months (inclusive) at first vaccination were enrolled at two study sites in Western Kenya, KEMRI/WRAIR, Kisumu and KEMRI/CDC, Siaya. The sites are located in an area with high malaria prevalence (38 % in children 0-14 years) 14 and vertical transmission rates of HIV (between 7 -15% in the context of increased uptake of PMCT) 15,16 . Infants and children known to be HIV infected (documented positive DNA PCR) were included, whether or not they were on antiretroviral medication.…”