Antenatal Care Uptake and Observance of Prophylactic Antiretroviral Therapy among HIV-Positive Pregnant Mothers in Nyahururu County Referal Hospital, Kenya

Background: Prevention of Mother-To-Child Transmission (PMTCT) of Human Immunodeficiency Virus (HIV) infection has been a fundamental advancement in the Acquired Immunodeficiency Syndrome (AIDS) response for the past decade. Although Kenya introduced the antiretroviral therapy programme as early as 2011, babies are still born with HIV. This study aimed at assessing the uptake of Antenatal Care Services (ACS) and the level of observance of prophylactic antiretroviral therapy among HIV-positive pregnant mothers attending antenatal clinics in Nyahururu Referral County hospital, Laikipia County, Kenya.Materials and Methods: We conducted an institutional-based prospective cohort study in a hospital. Our participants were 180 pregnant HIV-positive women enrolled through systematic random sampling from the PMTCT department. We followed and monitored them prospectively for nine months. In addition, were commenced on prophylactic antiretroviral therapy. We used descriptive statistical methods, correlations, bivariate analysis and multivariable logistic regression analyses to make sense of the collected data. A p-value of less than 0.05 was considered significant.Results: There was a significant response rate of 91%. Social support from partners accounted for 69.3%. In addition, 69.3% of the mothers had visited antenatal care more than four times. The majority of participants had undetectable viral load 97.5% and 89.0% had a cluster of differentiation above 250/ml).Conclusions: Adequate follow-up, counselling, monitoring, social support and adherence to antiretroviral therapy can increase the chances of the HIV infected mothers delivering HIV-negative babies. It is also a prediction that majority of the infants will turn out HIV negative

Maternal Outcomes among HIV Positive Pregnant Mothers and Birth Outcomes of HIV Exposed Newborns in Nyahururu County Referral Hospital, Kenya

Background: Approximately 37 million people were living with HIV by the end of 2015. This led to high morbidity and mortality among women of childbearing age, especially in Sub-Saharan Africa which was the epicentre of this global pandemic. Strengthening and implementing prevention of mother-to-child (PMTCT) services could reduce the incidence of vertical transmission and improve quality of life. We aimed to determine maternal and birth outcomes among HIV-positive pregnant mothers and HIV-exposed newborns in Nyahururu county referral hospital, Laikipia, Kenya. Main Outcomes Measures: Reduce maternal morbidity and mortality and other birth-related complications. In addition, this will also reduce infant mortality and morbidity among HIV-exposed infants. Materials and Methods: This was a hospital-based descriptive prospective study conducted at the PMTCT department at the Nyahururu County referral hospital. A sample of 180 HIV-positive pregnant women enrolled at the PMTCT consented to participate in the study. We monitored them until delivery and labour complications were addressed. Babies were scored against the APGAR scale, weighed and spot dried blood samples taken before breastfeeding; and started on prophylactic antiretroviral therapy. Results: Out of 180 participants, only 17 did not complete the study. Our findings indicate that 97.5 % of the mothers delivered in the hospital, had labour lasting less than 12 hours, 92.6% had a normal delivery and 94.9% had no complications during the labour period. About 2.5 % of the women had misoprostol administration. The majority of exposed babies had an average weight of between 2.51 - 3.00kg. No neonatal asphyxia was evident among exposed babies. Conclusions: The majority of the respondents delivered in the hospital; no neonatal asphyxia was evidenced and there was a significant correlation between APGAR scores and infant weight. There is a need for active follow-up and monitoring of HIV pregnant women and their unborn babies until delivery

Genotypes of HBV and HCV among HIV-1 co-infected individuals in Ngong Sub-County, Kenya

Background: Hepatitis B and Hepatitis C viruses are the major causes of liver disease worldwide. Co-infections with HBV and HCV have turned out to be increasingly very common among people living with HIV, leading to a major public health concernObjective: To determine HBV and HCV diversity among HIV infected patients attending the Ngong sub-county hospital comprehensive care clinic.Design: A cross-sectional studySetting: HIV research laboratory in Centre for virus research at Kenya medical research institute, Nairobi.Subjects: HIV infected patients attending the comprehensive care clinic at Ngong subcounty hospital between May and August 2015.Results: One hundred and ninety (190) HIV-1 positive patients participated in this study, consisting of 78.9% females and 21.1% males. Out of the 190 participants, 11(5.8%) were positive for Hepatitis B surface antigen and eight (4.2%) were positive for anti- HCV antibodies. 5/11 samples were positive for HBV DNA PCR and five belonged to HBV genotype A and E . However, none of the eight samples for HCV were positive for HCV RNA PCR.Conclusion: None of the patients was infected with HCV. HBV genotype A1 was the most dominant circulating genotype in Ngong sub-County followed by genotype E. Nevertheless, there could be other HBV genotypes circulating in Kenya especially among higher risk populations

Infant feeding knowledge and practices among lactating mothers in Kwale County, Kenya

Background: Lactating mother’s knowledge on infant feeding and its practices are key determinants of children’s nutritional status and future food habits. In Kenya, stunting rates among children below five years is 26 %. Objective: To assess infant feeding knowledge and practices among lactating mothers in Kwale County where stunting stands at 29%.Design: A cohort study. Setting: Maternal and Child Health clinics or respective households.Subjects: Lactating mothers who were part of the baseline survey.Results: One hundred and ninety-seven lactating mothers were interviewed. Most mothers (65.3%) had knowledge of breastfeeding within the first hour and majority (91.8%), gave colostrum to the newly born. Majority (84%) had no knowledge on expressing a mother’s milk for later use. Complementary feeds had been introduced by 48.2% of which more than a quarter gave before six months. Maize meal porridge was the common weaning food in addition to mother’s milk. There was a significant relationship between: breast feeding advice given during antenatal care and use of colostrum (r = 0.165, N = 197, p = 0.021); breastfeeding initiation and pre-lacteal feeding (r = - 0.264, N = 197, p = 0.0001); parity and place of birth (r = 0.184, N = 197, p = 0.001) as well as pre- lacteal feeding and use of colostrum (r = - 0.289, N = 197, p = 0.0001).Conclusion: There was poor knowledge of preservation of mother’s milk and dietary diversity during complementary feeding. There is need for an intervention to empower mothers on best practices for optimal growth and development of infants

MATERNAL IMMUNE RESPONSES AND RISK OF INFANT INFECTION WITH HIV-1 AFTER A SHORT COURSE ZIDOVUDINE IN A COHORT OF HIV-1 INFECTED PREGNANT WOMEN IN RURAL KENYA

Objective: To investigate the effects of short-course nucleoside reverse transcriptaseinhibitor (Zidovudine, ZDW/AZT) on maternal immune responses and risk of infantinfection with HIV-1 among rural-based mothers in western Kenya.Design: A prospective cohort study involving HIV-1 seropositive pregnant mothers andtheir infants.Subjects: One hundred and seven HIV-1 seropositive asymptomatic pregnant womenand their infants.Methods: After informed consent, the women were enrolled at gestation age between16-24 weeks. For cultural and economic reasons, all mothers were allowed to breastfeed their infants. Short-course antepartum regime of AZT was administered to allmothers starting at 36 weeks gestation until start of labour. Maternal absolute CD4+T cell subset assays were performed before 3rd trimester (about 36 weeks gestation)and after a 4-week therapy of AZT (at least one month post-nuptially). Infant HIV-1 status was determined by HIV-1 DNA polymerase chain reaction (PCR) on samplessequentially taken at 1, 2, 3, 4, 6 and 9 months and confirmed by serology at 18 monthsof age.Interventions: Antepartum short-course orally administered AZT: 300mg twice-dailystarting at 36 weeks gestation until start of labour, 300mg at labour onset and 300mgevery three hours during labour until delivery.Main Outcome Measures: Maternal CD4+ T cell counts before and after AZT treatment.Determination of infant HIV-1 infection status.Results: Among 107 women sampled, only 59 received full dose of AZT and thus qualifiedfor present analysis. Of these, 12 infected their children with HIV, while 47 did not.Comparison of CD4+ T cells before and after AZT treatment scored a significant risein all mothers (P = 0.01). This increase in CD4+ T cells was not significant amongmothers who infected their infants with HIV-1 (P = 0.474). However, a significant risein CD4+ T cells following AZT therapy was observed only in mothers who did nottransmit HIV-1 to their infants (P=0.014).Conclusion: These data suggest that a rise in the CD4+ T cell counts following shortAZT regimen, now widely in use in resource-weak countries, may be evidence of theactive suppression of the replication of HIV. However, further studies to examine themulti-factorial effect of CD4+ lymphocytes and pregnancy on MTCT of HIV need tobe carried out to help fully explain the effect of AZT on immune response and whetherthe CD4+T cell count can be used as a true test of immunological normalisation duringantiretroviral therapy

Sero-prevalence of human cytomegalovirus infection and predisposing factors among HIV infected patients attending comprehensive care clinic at Kenyatta National Hospital, Kenya

Background: Human Cytomegalovirus (hCMV) is one of the opportunistic infections in HIV patients. During an active infection it's a common cause of Pneumonia, retinitis, gastro-intestinal disease, and hepatitis. It is significantly associated as a HIV disease co-factor. It does quicken HIV acquisition, disease progression and high mortality and morbidity in HIV patients. Currently there is scanty data on this disease in Kenya leading to lack of recognition on the magnitude especially in HIV patients.Objective:To determine the sero-prevalence and predisposing factors associated with hCMV infection among HIV infected individuals attending comprehensive care clinic (CCC) at Kenyatta National Hospital, Nairobi County, Kenya.Design: A cross sectional study.Setting: Kenyatta National Hospital.Subjects: A total of 400 consenting patients were systematically sampled from HIV comprehensive clinic of Kenyatta National Hospital between July and August 2015Results: A total of 400 HIV-infected individuals who were 18 years and above with an average age of 42.73 (SD, 9.5) years were screened for CMV infections. Of these, 246(61.5%) were female and 154(38.5%) were male. Of 400,398 (99.0%) were hCMV IgG sero-positive, 32 (8.0%) were hCMV IgM sero-positive. Age group between 19 and 28 years [OR= 4.8 95% CI: (1.4-16.4); P=0.012], never been married [OR= 4.3 95% CI: (1.3-14.5); p=0.020], never had children [OR=3.2 95% CI: (1.2-8.5); p=0.022] and use of highly active anti-retroviral therapy (HAARn [OR=3.5 95% CI: (1.2-10.3); p=0.031]were found to be significantly associated with CMV sero-positivity in bivariate analysis. In multivariate analysis, bothCD4 (p <0.001) and viral loads (p <0.001) were found to be significantly associated with CMV sero-positivity.Conclusion: The 99.0% sero-prevalence of hCMV in the HIV patient's calls for routine screening for hCMV infections in order to prevent neurological clinical manifestations associated with CMV in HIV patients. Human cytomegalovirus preventive measures may be necessary to decrease mortality and morbidity associated with hCMV infections

Viral Hepatitis B and Hepatitis C co-infections of HIV-1 infected patients in Kenya

Background: Co-infections with hepatitis B and hepatitis C (HBV/HCV) viruses continue to be of significant concern among HIV-1 patients. In resource limited settings like Kenya where HIV-1 still remains endemic, infections with diverse viral genotypes complicates prognosis and treatment outcomes. Objective: To determine the prevalence and co-prevalence of HCV and HBV among HIV-1 infected antiretroviral-naïve and experienced subjects from selected facilities in Kenya. Design: A cross-sectional study. Setting: Center for Research in Therapeutic Sciences laboratory at Strathmore University, Nairobi, Kenya Subjects: HIV infected patients attending the comprehensive care clinic from six County hospitals in Kenya. Results: Overall, 32 of the 140 HIV infected patients were also infected with either HBV (n=24, 17.1 %) or HCV (n=8, 5.7 %). Five of the 24 HBV positive and six of the 8 HCV positive patients were ART experienced, with the rest in these positive categories being ART naïve. All the HBV DNA PCR positive patients were ART experienced. Only 4/24 HIV/HBV+ patients were also co-infected with HCV. Confirmatory genetic testing of the 24 HBV co-infected patients showed that seven were positive by PCR. Genotyping of the seven PCR positive samples revealed 4 of these isolates to be HBV genotype A Conclusions: HBV and HCV coinfection among HIV infected patients is higher than previously reported, with majority of ART experienced still at an increased risk for co-infection with both viruses

MATERNAL IMMUNE RESPONSES AND RISK OF INFANT INFECTION WITH HIV-1 AFTER A SHORT COURSE ZIDOVUDINE IN A COHORT OF HIV-1 INFECTED PREGNANT WOMEN IN RURAL KENYA

ABSTRACTObjective: To investigate the effects of short-course nucleoside reverse transcriptaseinhibitor (Zidovudine, ZDW/AZT) on maternal immune responses and risk of infantinfection with HIV-1 among rural-based mothers in western Kenya.Design: A prospective cohort study involving HIV-1 seropositive pregnant mothers andtheir infants.Subjects: One hundred and seven HIV-1 seropositive asymptomatic pregnant womenand their infants.Methods: After informed consent, the women were enrolled at gestation age between16-24 weeks. For cultural and economic reasons, all mothers were allowed to breastfeed their infants. Short-course antepartum regime of AZT was administered to allmothers starting at 36 weeks gestation until start of labour. Maternal absolute CD4+T cell subset assays were performed before 3rd trimester (about 36 weeks gestation)and after a 4-week therapy of AZT (at least one month post-nuptially). Infant HIV-1 status was determined by HIV-1 DNA polymerase chain reaction (PCR) on samplessequentially taken at 1, 2, 3, 4, 6 and 9 months and confirmed by serology at 18 monthsof age.Interventions: Antepartum short-course orally administered AZT: 300mg twice-dailystarting at 36 weeks gestation until start of labour, 300mg at labour onset and 300mgevery three hours during labour until delivery.Main Outcome Measures: Maternal CD4+ T cell counts before and after AZT treatment.Determination of infant HIV-1 infection status.Results: Among 107 women sampled, only 59 received full dose of AZT and thus qualifiedfor present analysis. Of these, 12 infected their children with HIV, while 47 did not.Comparison of CD4+ T cells before and after AZT treatment scored a significant risein all mothers (P = 0.01). This increase in CD4+ T cells was not significant amongmothers who infected their infants with HIV-1 (P = 0.474). However, a significant risein CD4+ T cells following AZT therapy was observed only in mothers who did nottransmit HIV-1 to their infants (P=0.014).Conclusion: These data suggest that a rise in the CD4+ T cell counts following shortAZT regimen, now widely in use in resource-weak countries, may be evidence of theactive suppression of the replication of HIV. However, further studies to examine themulti-factorial effect of CD4+ lymphocytes and pregnancy on MTCT of HIV need tobe carried out to help fully explain the effect of AZT on immune response and whetherthe CD4+T cell count can be used as a true test of immunological normalisation duringantiretroviral therapy