Mother-to-Child Transmission of HIV in Kenya

Abstract

Background Kenya has an estimated 13,000 new infant HIV infections that occur annually. We measured the burden of HIV infection among women of childbearing age and assessed access to and coverage of key prevention of mother-to-child transmission interventions. Methods The second Kenya AIDS Indicator Survey was a nationally representative 2-stage cluster sample of households. We analyzed data from women aged 15–54 years who had delivered a newborn within the preceding 5 years and from whom we obtained samples for HIV testing. Results Of 3310 women who had ≥1 live birth in the preceding 5 years, 2862 (86.5%) consented to HIV testing in the survey, and 171 (6.1%) were found to be infected. Ninety-five percent received pre-natal care, 93.1% were screened for HIV during prenatal care, and of those screened, 97.8% received their test results. Seventy-six women were known to be infected in their last pregnancy. Of these, 54 (72.3%) received antepartum antiretroviral prophylaxis, and 51 (69.1%) received intrapartum prophylaxis; 56 (75.3%) reported their newborns received postpartum prophylaxis. Of the 76 children born to these mothers, 63 (82.5%) were tested for HIV at the first immunization visit or thereafter, and 8 (15.1%) were HIV infected. Conclusions We found a substantial burden of HIV in Kenyan women of childbearing age and a cumulative 5-year mother-to-child transmission rate of 15%. Although screening has improved over the past 5 years, fewer than three-quarters of infected pregnant women are receiving antiretroviral prophylaxis. Universal antiretroviral therapy for HIV-infected pregnant women will be essential in achieving Kenyan’s target to eliminate mother-to-child transmission to <5% by 2015.

Factors associated with delivering premature and/or low birth weight infants among pregnant HIV-positive women on antiretroviral treatment at Dr George Mukhari Hospital, South Africa

“…From our study, 72% of the HIV-positive pregnant mothers were on ART, which was comparable to the rate of 72% found in Kenya 12 and 82% found in Ghana. 13 The report by UNAIDS showed that, in 2013, only 68% of HIV-positive pregnant women in sub-Saharan Africa received ART.…”

Implementation of repeat HIV testing during pregnancy in southwestern Kenya: progress and missed opportunities

“…We found that initial HIV testing rates (98.0%) in our study were higher than the national average (93.1%), potentially due to a higher HIV prevalence in the region 9. In a recent meta‐analysis, Drake et al .…”

“…The MTCT rate was estimated in 2012 to be 15%, accounting for 13,000 new childhood infections in Kenya annually 9, 10. In 2012, the Kenya Ministry of Health adopted international guidelines recommending that repeat HIV testing be offered three months after an initial negative HIV test result in early pregnancy 11.…”

Implementation and Operational Research

“…6 Specific features of the PEARL community methodology allowed us to build upon their approach. Rather than relying on self-reported clinical outcomes, we collected and tested biological specimens from HIV-exposed infants and children, to ascertain HIV status at the time of the survey.…”

“…2 For example, in their recent report of the 2012 Kenya AIDS Indicator Survey (KAIS), Sirengo and colleagues assessed key steps along the PMTCT cascade using such cross-sectional individual-level information, including those who visited antenatal care during pregnancy, tested for HIV during pregnancy, initiated any maternal or infant prophylaxis, and reported an HIV-negative infant test 6 weeks after birth. 6 We sought to further refine this household survey approach using data from the PMTCT Effectiveness in Africa: Research and Linkages to Care (PEARL) study conducted in Zambia, South Africa, Cote d’Ivoire, and Cameroon. Our overall aim was to describe a monitoring framework to illustrate gaps in PMTCT service provision and their relative contribution to negative health outcomes among HIV-exposed infants.…”