Outcomes of prevention of mother to child transmission of the human immunodeficiency virus-1 in rural Kenya—a cohort study

Abstract

BackgroundSuccess 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.MethodsA 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.ResultsBetween 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 [95 % confidence interval (CI): 8.3–65.4], presence of malnutrition ([aOR]: 2.3 [95 % CI: 1.1–5.2]) and lack of maternal use of highly active antiretroviral therapy (HAART) (aOR: 6.5 [95 % CI: 1.4–29.4]) 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 (adjusted Hazard Ratio: 6.6 [95 % CI: 2.9–14.6]).DiscussionWe 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.ConclusionA simple set of risk factors at enrollment can identify mother-infant pairs most at risk of infection or drop out for targeted intervention.

Diagnostic criteria for severe acute malnutrition among infants aged under 6 mo

“…However, the majority of the HIV-exposed infants are unlikely to be HIV infected (31). However, exposure status may indicate infection risks in the household, maternal physical and mental health, poverty, and the ability of the mother to provide care.…”

Early Emergence and Long-Term Persistence of HIV-Infected T Cell Clones in Children

“…Despite effective therapies, which have reduced the rate of mother-to-child HIV-1 transmission (53)(54)(55), approximately 180,000 infants were infected worldwide in 2018 (53). These children must be included in the larger quest for effective HIV-1 curative interventions and such interventions may need to be tailored to their developing immune systems.…”

Cytomegalovirus viraemia is associated with poor growth and T-cell activation with an increased burden in HIV-exposed uninfected infants

“…Enrolment specimens were obtained from two groups recruited contemporaneously (from 2011 to 2013) to study immune health in HEU infants [ 25 ]. Specimens from the first group were from an observational cohort of HIV-exposed infants attending the Kilifi County Hospital for PMTCT care, a tertiary-level health facility in rural coastal Kenya [ 26 ]. PMTCT provision was according to Kenyan national guidelines [ 27 ] as previously described [ 26 ].…”