Risk factors for HIV positivity in 2007–2010 (N = 96,505; 11.1% HIV-positive) vs. 2011–2013 (N = 168,346; 8.8% HIV-positive) vs. 2014–2015 (N = 100,990; 6.9% HIV-positive) among infants testing for HIV in Kenya.

<p>Risk factors for HIV positivity in 2007–2010 (N = 96,505; 11.1% HIV-positive) vs. 2011–2013 (N = 168,346; 8.8% HIV-positive) vs. 2014–2015 (N = 100,990; 6.9% HIV-positive) among infants testing for HIV in Kenya.</p

Characteristics [N (%)] of samples from patients receiving a routine viral load test after 6+ months on first-line^a treatment in 2015–2016 and associations with elevated VL (≥1000 copies/mL)^b.

<p>Characteristics [N (%)] of samples from patients receiving a routine viral load test after 6+ months on first-line<a href="http://www.plosone.org/article/info:doi/10.1371/journal.pone.0190659#t002fn001" target="_blank">^a</a> treatment in 2015–2016 and associations with elevated VL (≥1000 copies/mL)<a href="http://www.plosone.org/article/info:doi/10.1371/journal.pone.0190659#t002fn002" target="_blank">^b</a>.</p

Flow Chart of samples included in the analysis.

<p>Flow Chart of samples included in the analysis.</p

Mother-to-child transmission of HIV in Kenya: A cross-sectional analysis of the national database over nine years

<div><p>Objective</p><p>To describe factors associated with mother-to-child HIV transmission (MTCT) in Kenya and identify opportunities to increase testing/care coverage.</p><p>Design</p><p>Cross-sectional analysis of national early infant diagnosis (EID) database.</p><p>Methods</p><p>365,841 Kenyan infants were tested for HIV from January 2007-July 2015 and results, demographics, and treatment information were entered into a national database. HIV risk factors were assessed using multivariable logistic regression.</p><p>Results</p><p>11.1% of infants tested HIV positive in 2007–2010 and 6.9% in 2014–2015. Greater odds of infection were observed in females (OR: 1.08; 95% CI:1.05–1.11), older children (18–24 months vs. 6 weeks-2 months: 4.26; 95% CI:3.87–4.69), infants whose mothers received no PMTCT intervention (vs. HAART OR: 1.92; 95% CI:1.79–2.06), infants receiving no prophylaxis (vs. nevirapine for 6 weeks OR: 2.76; 95% CI:2.51–3.05), and infants mixed breastfed (vs. exclusive breastfeeding OR: 1.39; 95% CI:1.30–1.49). In 2014–2015, 9.1% of infants had mothers who were not on treatment during pregnancy, 9.8% were not on prophylaxis, and 7.0% were mixed breastfed. Infants exposed to all three risky practices had a seven-fold higher odds of HIV infection compared to those exposed to recommended practices. The highest yield of HIV-positive infants were found through targeted testing of symptomatic infants in pediatric/outpatient departments (>15%); still, most infected infants were identified through PMTCT programs.</p><p>Conclusion</p><p>Despite impressive gains in Kenya’s PMTCT program, some HIV-infected infants present late and are not benefitting from PMTCT best practices. Efforts to identify these early and enforce evidence-based practice for PMTCT should be scaled up. Infant testing should be expanded in pediatric/outpatient departments, given high yields in these portals.</p></div

Characteristics [N/%/median (IQR)] of samples in the viral load database over program scale-up.

<p>Characteristics [N/%/median (IQR)] of samples in the viral load database over program scale-up.</p

Predictive factors for HIV positivity in 365,841 infants testing for HIV in Kenya.

<p>Predictive factors for HIV positivity in 365,841 infants testing for HIV in Kenya.</p