Hospitalized Children Reveal Health Systems Gaps in the Mother-Child HIV Care Cascade in Kenya.
To identify missed opportunities in HIV prevention, diagnosis, and linkage to care, we enrolled 183 hospitalized, HIV-infected, ART-naïve Kenyan children 0-12 years from four hospitals in Nairobi and Kisumu, and reviewed prevention of mother-to-child transmission of HIV (PMTCT), hospitalization, and HIV testing history. Median age was 1.8 years (IQR = 0.8, 4.5). Most mothers received HIV testing during pregnancy (77%). Among mothers tested, 60% and 40% reported HIV-negative and positive results, respectively; 33% of HIV-diagnosed mothers did not receive PMTCT antiretrovirals. First missed opportunities for pediatric diagnosis and linkage were due to failure to test mothers (23.1%), maternal HIV acquisition following initial negative test (45.7%), no early infant diagnosis (EID) or provider-initiated testing (PITC) (12.7%), late breastfeeding transmission (8.7%), failure to collect child HIV test results (1.2%), and no linkage to care following HIV diagnosis (8.7%). Among previously hospitalized children, 38% never received an HIV test. Strengthening initial and repeat maternal HIV testing and PITC are key interventions to prevent, detect, and treat pediatric HIV infections.
1 Department of Pediatrics and Child Health, University of Nairobi , Nairobi, Kenya .
Irene N
IN
Njuguna
2 Department of Global Health, University of Washington , Seattle, Washington.
Anjuli D
AD
Wagner
3 Department of Pediatrics, Division of Pediatric Infectious Diseases, Emory University School of Medicine , Atlanta, Georgia .
Lisa M
LM
Cranmer
1 Department of Pediatrics and Child Health, University of Nairobi , Nairobi, Kenya .
Vincent O
VO
Otieno
1 Department of Pediatrics and Child Health, University of Nairobi , Nairobi, Kenya .
Judith A
JA
Onyango
1 Department of Pediatrics and Child Health, University of Nairobi , Nairobi, Kenya .
Daisy J
DJ
Chebet
1 Department of Pediatrics and Child Health, University of Nairobi , Nairobi, Kenya .
Helen M
HM
Okinyi
4 Department of Medicine, University of Washington , Seattle, Washington.
Sarah
S
Benki-Nugent
1 Department of Pediatrics and Child Health, University of Nairobi , Nairobi, Kenya .
Elizabeth
E
Maleche-Obimbo
2 Department of Global Health, University of Washington , Seattle, Washington.
Jennifer A
JA
Slyker
2 Department of Global Health, University of Washington , Seattle, Washington.|4 Department of Medicine, University of Washington , Seattle, Washington.|5 Department of Epidemiology and Pediatrics, University of Washington , Seattle, Washington.
Grace C
GC
John-Stewart
1 Department of Pediatrics and Child Health, University of Nairobi , Nairobi, Kenya .
Dalton C
DC
Wamalwa
D019380:Anti-HIV Agents / Q000627:therapeutic use; D002648:Child; D002675:Child, Preschool; D003266:Continuity of Patient Care / Q000458:organization & administration*; D003376:Counseling / Q000706:statistics & numerical data*; D003695:Delivery of Health Care / Q000458:organization & administration*; D042241:Early Diagnosis; D005260:Female; D015658:HIV Infections / Q000188:drug therapy*; D006760:Hospitalization / Q000706:statistics & numerical data; D006801:Humans; D007223:Infant; D007231:Infant, Newborn; D018445:Infectious Disease Transmission, Vertical / Q000517:prevention & control*; D007630:Kenya; D008403:Mass Screening / Q000706:statistics & numerical data*; D009035:Mothers; D011247:Pregnancy
D019380:Anti-HIV Agents