title: Progress Toward Eliminating Mother to Child Transmission of HIV in Kenya: Review of Treatment Guideline Uptake and Pediatric Transmission at Four Government Hospitals Between 2010 and 2012.
abstract: We analyzed prevention of mother-to-child transmission (PMTCT) data from a retrospective cohort of n = 1365 HIV+ mothers who enrolled their HIV-exposed infants in early infant diagnosis services in four Kenyan government hospitals from 2010 to 2012. Less than 15 and 20 % of mother-infant pairs were provided with regimens that met WHO Option A and B/B+ guidelines, respectively. Annually, the gestational age at treatment initiation decreased, while uptake of Option B/B+ increased (all p's < 0.001). Pediatric HIV infection was halved (8.6-4.3 %), yet varied significantly by hospital. In multivariable analyses, HIV-exposed infants who received no PMTCT (AOR 4.6 [2.49, 8.62], p < 0.001), mixed foods (AOR 5.0 [2.77, 9.02], p < 0.001), and care at one of the four hospitals (AOR 3.0 [1.51, 5.92], p = 0.002) were more likely to be HIV-infected. While the administration and uptake of WHO PMTCT guidelines is improving, an expanded focus on retention and medication adherence will further reduce pediatric HIV transmission.
authors.affiliation: Department of Family Medicine, University of Kansas Medical Center, Kansas City, KS, USA. skessler2@kumc.edu.
authors.forename: Sarah
authors.initials: S
authors.lastname: Finocchario-Kessler
authors.affiliation: Department of Global Studies, University of Kansas, Lawrence, KS, USA.
authors.forename: Kristine F
authors.initials: KF
authors.lastname: Clark
authors.affiliation: Kenya Medical Research Institute, Centre for Virus Research, Nairobi, Kenya.
authors.forename: Samoel
authors.initials: S
authors.lastname: Khamadi
authors.affiliation: Global Health Innovations, Kansas City, USA.
authors.forename: Brad J
authors.initials: BJ
authors.lastname: Gautney
authors.affiliation: Kenya Medical Research Institute, Centre for Virus Research, Nairobi, Kenya.
authors.forename: Vincent
authors.initials: V
authors.lastname: Okoth
authors.affiliation: Health Services and Outcomes Research, Children's Mercy Hospital, Kansas City, USA.
authors.forename: Kathy
authors.initials: K
authors.lastname: Goggin
mesh_terms: D000328:Adult; D019380:Anti-HIV Agents / Q000627:therapeutic use*; D002648:Child; D015331:Cohort Studies; D003906:Developing Countries; D004305:Dose-Response Relationship, Drug; D004334:Drug Administration Schedule; D004359:Drug Therapy, Combination; D042241:Early Diagnosis; D005260:Female; D005865:Gestational Age; D006076:Government; D019983:Guideline Adherence; D015658:HIV Infections / Q000175:diagnosis / Q000453:epidemiology / Q000517:prevention & control*; D006779:Hospitals, Public; D006801:Humans; D007223:Infant; D007231:Infant, Newborn; D018445:Infectious Disease Transmission, Vertical / Q000517:prevention & control* / Q000706:statistics & numerical data; D007630:Kenya; D019259:Lamivudine / Q000008:administration & dosage; D055118:Medication Adherence; D011247:Pregnancy; D011251:Pregnancy Complications, Infectious / Q000453:epidemiology / Q000517:prevention & control*; D012189:Retrospective Studies; D015215:Zidovudine / Q000008:administration & dosage
chemical_list: D019380:Anti-HIV Agents; D019259:Lamivudine; D015215:Zidovudine
keywords: Adherence; Eliminating pediatric infection; Gestational week of initiation; HIV; Option B+; Preventing mother to child transmission (PMTCT); Retention in care; WHO guidelines