P45.08
Background: Despite the availability of Prevention of Mother-to-Child HIV Transmission (PMTCT) interventions and donor and government investments in developing country implementation, vertical HIV transmission persists. In Kenya, an estimated 37,000 to 42,000 infants are infected with HIV annually due to mother-to-child transmission (MTCT). This study explored the reasons for MTCT persistence in areas with overall low transmission rates and PMTCT service provision.
Methods: A case-control study of HIV-exposed infants (HEI) enrolled in follow-up care between January and June 2012 was conducted at 20 rural health facilities supported by Family AIDS Care and Education Services (FACES) in Nyanza Province, Kenya. Cases were HEI who turned HIV positive, controls were HEI who remained negative at last test; an equal number of controls were randomly selected after matching based on birth month and gender. Data were abstracted from routine PMTCT registers, HEI cards, and infant forms. Logistic regression analysis was conducted to determine factors associated with HIV infection.
Results: Forty-five cases and 45 controls were compared. Maternal, clinical and infant factors associated with HIV-infected infants included poor PMTCT service uptake including late enrolment of infant to follow-up, (OR=0.14, 95%CI: 0.06 - 0.38), poor infant prophylaxis adherence (OR=8.32, 95%CI 3.24−21.38), and fewer antenatal (ANC) visits (OR=0.62, 95% CI: 0.41 - 0.96). Mothers of cases were significantly less likely to report having received clinic level HIV education and counseling compared to controls (OR 0.13, 95%CI 0.04 - 0.54 and OR 0.12, 95% CI 0.03−0.46). Maternal disclosure, gestation at first ANC visit, and infant feeding type were not significantly associated.
Conclusions: Poor PMTCT service uptake and a reported absence of clinic level HIV education and counseling were associated with MTCT. More emphasis on PMTCT service provision including counseling and education are needed to minimize HIV transmission to infants.
