Outcomes of HIV-Exposed Children in Western Kenya: Efficacy of Prevention of Mother to Child Transmission in a Resource-Constrained Setting

Abstract

Though ascertainment bias is likely, results strongly suggest a benefit of antiretroviral prophylaxis in reducing infant death and HIV infection, but do not show a benefit at 18-months from the use of formula. There was a high rate of loss to follow up, and adherence to the HIV infant testing protocol was less than 50% indicating the need to address barriers related to infant HIV testing, and to improve outreach and follow-up services.

High Baseline CD4 Count and Exclusive Breastfeeding Are Associated with Lower Rates of Mother to Child HIV Transmission in Northwestern Uganda: A Two-Year Retrospective Cohort Study

“…Also, the overall rate of MTCT at the end of 18 months was higher than that reported previously in Ethiopia at 5.9% [13] although lower than 10.5% in Western Kenya [11]. Overall, the rate of MTCT was unacceptably high, suggesting the need for urgent amelioration interventions.…”

“…6 Advances in Public Health 4.9% at 6 weeks, 1.1% at 1-year, and 0.98% at 18 months, similar to previous study conducted across four geographic regions in Uganda [10], Western Kenya [11], and Ethiopia [12]. Also, the overall rate of MTCT at the end of 18 months was higher than that reported previously in Ethiopia at 5.9% [13] although lower than 10.5% in Western Kenya [11].…”

Active tracking of rejected dried blood samples in a large program in Nigeria

“…Our study agrees with other investigations where pre-analytical [33][34][35]45] . Other adverse patient outcomes due to sample rejection include demand for patient revisits for specimen recollection, discomfort to the patient, test abandonment or LTFU and time lost in waiting for results with the accompanying cost implications associated with multiple clinic visits [22,46,47] . The extended delay in results may also have contributed to the high attrition and low repeat rates among rejected samples.…”

“…Lack of standardized protocols for laboratory processes including sample collection, specimen acquisition, management and storage contributes up to 93% of errors in diagnostics [50] . Implementing standardized protocols for reporting and managing non-conformance events can also improve service performance [46,47] . The majority of the samples in our study were rejected due to improper collection, a factor attributable to personnel error and is seen to be highest in secondary health clinics where the number of patients presenting for EID testing is highest.…”

“…A recent study reported that staff sensitization on patient preparation, test request forms, and sample management significantly reduced pre-analytical error rate from 19.07% to 6.76% [47] . Thus, programs should intensify monitoring of pre-analytical staff, processes and performance towards improving sample quality [25,30,46,51] . Significant correlations between the annual number of DBS sample collection clinics and the annual sample rejection rate also suggests that an increasing number of EID clinics can put a strain on the program.…”