Factors associated with mother to child transmission of HIV despite overall low transmission rates in HIV-exposed infants in rural Kenya.
Despite the availability of efficacious prevention of mother-to-child transmission (PMTCT) interventions and improved access to preventive services in many developing countries, vertical HIV transmission persists. A matched case-control study of HIV-exposed infants between January and June 2012 was conducted at 20 clinics in Kenya. Cases were HIV-infected infants and controls were exposed, uninfected infants. Conditional logistic regression analysis was conducted to determine characteristics associated with HIV infection. Forty-five cases and 45 controls were compared. Characteristics associated with HIV-infection included poor PMTCT service uptake such as late infant enrollment (odds ratio [OR]: 7.1, 95% confidence interval [CI]: 2.6-16.7) and poor adherence to infant prophylaxis (OR: 8.3, 95%CI: 3.2-21.4). Maternal characteristics associated with MTCT included lack of awareness of HIV status (OR: 5.6, 95%CI: 2.2-14.5), failure to access antiretroviral prophylaxis (OR: 22.2, 95%CI: 5.8-84.6), and poor adherence (OR: 8.1, 95%CI: 3.7-17.8). Lack of clinic-based HIV education (OR: 7.7, 95%CI: 2.0-25.0) and counseling (OR: 8.3, 95%CI: 2.2-33.3) were reported by mothers of cases. Poor uptake of PMTCT services and a reported absence of HIV education and counseling at the clinic were associated with MTCT. More emphasis on high-quality, comprehensive PMTCT service provision are urgently needed to minimize HIV transmission to children.
1 Family AIDS Care and Education Services (FACES), Research Care and Training Program (RCTP), Center for Microbiology Research (CMR), Kenya Medical Research Institute (KEMRI), Kisumu, Kenya.
Nicollate A
NA
Okoko
1 Family AIDS Care and Education Services (FACES), Research Care and Training Program (RCTP), Center for Microbiology Research (CMR), Kenya Medical Research Institute (KEMRI), Kisumu, Kenya.
Kevin O
KO
Owuor
2 Department of Obstetrics, Gynecology & Reproductive Sciences, University of California San Francisco (UCSF), San Francisco, CA, USA.
Jayne L
JL
Kulzer
1 Family AIDS Care and Education Services (FACES), Research Care and Training Program (RCTP), Center for Microbiology Research (CMR), Kenya Medical Research Institute (KEMRI), Kisumu, Kenya.
George O
GO
Owino
1 Family AIDS Care and Education Services (FACES), Research Care and Training Program (RCTP), Center for Microbiology Research (CMR), Kenya Medical Research Institute (KEMRI), Kisumu, Kenya.
Irene A
IA
Ogolla
3 Ministry of Health (MOH), Rongo District Hospital, Rongo, Kenya.
Ronald W
RW
Wandera
1 Family AIDS Care and Education Services (FACES), Research Care and Training Program (RCTP), Center for Microbiology Research (CMR), Kenya Medical Research Institute (KEMRI), Kisumu, Kenya.
Elizabeth A
EA
Bukusi
2 Department of Obstetrics, Gynecology & Reproductive Sciences, University of California San Francisco (UCSF), San Francisco, CA, USA.
Craig R
CR
Cohen
4 Department of Pediatrics, University of Colorado, Denver, CO, USA.
Lisa L
LL
Abuogi
D000328:Adult; D019380:Anti-HIV Agents / Q000627:therapeutic use*; D016022:Case-Control Studies; D002648:Child; D005260:Female; D015658:HIV Infections / Q000188:drug therapy* / Q000523:psychology / Q000635:transmission*; D007722:Health Knowledge, Attitudes, Practice; D006801:Humans; D007223:Infant; D018445:Infectious Disease Transmission, Vertical / Q000517:prevention & control*; D007630:Kenya; D009035:Mothers / Q000523:psychology*; D011247:Pregnancy; D011251:Pregnancy Complications, Infectious / Q000188:drug therapy*; D011295:Prenatal Care; D012307:Risk Factors; D012424:Rural Population; D057545:Social Stigma; D016896:Treatment Outcome
D019380:Anti-HIV Agents
Africa; HIV; PMTCT; prevention; prevention of mother-to-child transmission; women