Factors associated with mother to child transmission of HIV despite overall low transmission rates in HIV-exposed infants in rural Kenya

• Published in: International journal of STD & AIDS 2017-10, Vol.28 (12), p.1215-1223
• Main Authors: Okoko, Nicollate A, Owuor, Kevin O, Kulzer, Jayne L, Owino, George O, Ogolla, Irene A, Wandera, Ronald W, Bukusi, Elizabeth A, Cohen, Craig R, Abuogi, Lisa L
• Format: Article
• Language: English
• Subjects: Adult; AIDS/HIV; Anti-HIV Agents - therapeutic use; Case-Control Studies; Child; Female; Health Knowledge, Attitudes, Practice; HIV Infections - drug therapy; HIV Infections - psychology; HIV Infections - transmission; Humans; Infant; Infectious Disease Transmission, Vertical - prevention & control; Kenya; Mothers - psychology; Pregnancy; Pregnancy Complications, Infectious - drug therapy; Prenatal Care; Risk Factors; Rural Population; Social Stigma; Treatment Outcome
• ISSN: 0956-4624; 1758-1052
• DOI: 10.1177/0956462417693735

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.