title: Community-based evaluation of PMTCT uptake in Nyanza Province, Kenya.
abstract: BACKGROUND
  Facility-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.
  
  
  METHODS
  During 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.
  
  
  RESULTS
  Among 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.
  
  
  CONCLUSIONS
  Community-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.
authors.affiliation: Global Health and Psychosocial & Community Health, University of Washington, Seattle, Washington, United States of America.
authors.forename: Pamela K
authors.initials: PK
authors.lastname: Kohler
authors.affiliation: Center for Global Health Research, Kenya Medical Research Institute, Kisumu, Kenya.
authors.forename: John
authors.initials: J
authors.lastname: Okanda
authors.affiliation: Kenyatta National Hospital/University of Nairobi, Nairobi, Kenya.
authors.forename: John
authors.initials: J
authors.lastname: Kinuthia
authors.affiliation: Kenya Medical Research Institute/Centers for Disease Control and Prevention (KEMRI/CDC) Research and Public Health Collaboration, Kisumu, Kenya; and Division of HIV/AIDS Prevention, CDC, Atlanta, Georgia, United States of America.
authors.forename: Lisa A
authors.initials: LA
authors.lastname: Mills
authors.affiliation: Center for Global Health Research, Kenya Medical Research Institute, Kisumu, Kenya.
authors.forename: George
authors.initials: G
authors.lastname: Olilo
authors.affiliation: Center for Global Health Research, Kenya Medical Research Institute, Kisumu, Kenya.
authors.forename: Frank
authors.initials: F
authors.lastname: Odhiambo
authors.affiliation: Kenya Medical Research Institute/Centers for Disease Control and Prevention (KEMRI/CDC) Research and Public Health Collaboration, Kisumu, Kenya; and Division of HIV/AIDS Prevention, CDC, Atlanta, Georgia, United States of America.
authors.forename: Kayla F
authors.initials: KF
authors.lastname: Laserson
authors.affiliation: Biobehavioral Nursing & Health Systems, University of Washington, Seattle, Washington, United States of America.
authors.forename: Brenda
authors.initials: B
authors.lastname: Zierler
authors.affiliation: Biobehavioral Nursing & Health Systems, University of Washington, Seattle, Washington, United States of America.
authors.forename: Joachim
authors.initials: J
authors.lastname: Voss
authors.affiliation: Global Health, Medicine, Pediatrics, and Epidemiology, University of Washington, Seattle, Washington, United States of America.
authors.forename: Grace
authors.initials: G
authors.lastname: John-Stewart
mesh_terms: D000293:Adolescent; D000328:Adult; D019380:Anti-HIV Agents / Q000627:therapeutic use; D003625:Data Collection; D005260:Female; D015658:HIV Infections / Q000175:diagnosis / Q000188:drug therapy / Q000635:transmission*; D006801:Humans; D018445:Infectious Disease Transmission, Vertical / Q000517:prevention & control*; D007630:Kenya; D010342:Patient Acceptance of Health Care / Q000706:statistics & numerical data*; D011247:Pregnancy; D011251:Pregnancy Complications, Infectious / Q000175:diagnosis / Q000188:drug therapy; D011296:Prenatal Diagnosis; D012111:Residence Characteristics; D055815:Young Adult
chemical_list: D019380:Anti-HIV Agents