Mother-To-Child HIV Transmission using Single, Dual and Triple ARV Prophylaxis Regimens and their Correlates in Western Kenya: Chart Review

Background: It is estimated that 2.1 million individuals worldwide became newly infected with HIV in 2013, and this included 240,000 children (<15 years).  Most of these children live in sub-Saharan Africa and were infected by their HIV-positive mothers during pregnancy, childbirth or breastfeeding. Objective: This study sought to ascertain the different PMTCT approaches or regimens that mothers and infants receive, their Mother-To-Child Transmission of HIV (MTCT) rates and associated correlates in Western Kenya. Methods: A retrospective cohort study using prospectively collected data in Ministry of Health HIV-Exposed Infant (HEI) register from 24 health facilities.  The study population was HIV-positive mothers enrolled from January 2012 to June 2013. The main outcomes were infant HIV status at 6 weeks, 9 to <18 months and 18-24 months. The correlates were maternal haemoglobin levels, WHO staging, CD4 counts, duration between enrolment and delivery, duration between enrolment and ART initiation, TB status, place of delivery, mode of delivery, and infant feeding options at 6 weeks, 9 to <18 months and 18-24 months. Proportions were analyzed using Chi-square tests while associations between MTCT correlates and outcomes were established using logistic regression. Results: 1,751 HIV mother-baby pairs were enrolled in the 24 health facilities: 78.1% received Highly Active Antiretroviral Therapy (HAART), 14.2% received Zidovudine (AZT), 1.7% received Single-dose Nevirapine (SdNVP), and 4.3% received no prophylaxis. MTCT rates were 5.5%, 7.4% and 5.6% at 6 weeks, 9 to <18 months and 18-24 months, respectively. MTCT rate at 18-24 months showed a significant difference (p<0.001) across PMTCT regimens. Women with CD4 cells between 350 to 500 cells/mm3 were about twice as likely to have HIV-negative babies compared to those with CD4 cells count <350cells/mm3. Women on TB treatment are less likely to have HIV-negative babies compared to those without TB. Exclusive breastfeeding at 6 weeks was associated with lower MTCT rates.  Feeding option at 6 weeks is a strong predictor of HIV status (p<0.001) as compared to babies on exclusive breastfeeding (EBF). Conclusion: Most of the mother-baby pairs received HAART. AZT depicted the lowest MTCT rate at 18-24 months.  Higher CD4 counts, no TB signs, and EBF at 6 weeks were associated with lower MTCT rates at 18-24 months Key words:  Antiretroviral prophylaxis, Mother-To-Child Transmission of HIV rates

Mother-To-Child HIV Transmission using Single, Dual and Triple ARV Prophylaxis Regimens and their Correlates in Western Kenya: Chart Review - SUPPORTING INFORMATION

Background: It is estimated that 2.1 million individuals worldwide became newly infected with HIV in 2013, and this included 240,000 children (<15 years).  Most of these children live in sub-Saharan Africa and were infected by their HIV-positive mothers during pregnancy, childbirth or breastfeeding. Objective: This study sought to ascertain the different PMTCT approaches or regimens that mothers and infants receive, their Mother-To-Child Transmission of HIV (MTCT) rates and associated correlates in Western Kenya. Methods: A retrospective cohort study using prospectively collected data in Ministry of Health HIV-Exposed Infant (HEI) register from 24 health facilities.  The study population was HIV-positive mothers enrolled from January 2012 to June 2013. The main outcomes were infant HIV status at 6 weeks, 9 to <18 months and 18-24 months. The correlates were maternal haemoglobin levels, WHO staging, CD4 counts, duration between enrolment and delivery, duration between enrolment and ART initiation, TB status, place of delivery, mode of delivery, and infant feeding options at 6 weeks, 9 to <18 months and 18-24 months. Proportions were analyzed using Chi-square tests while associations between MTCT correlates and outcomes were established using logistic regression. Results: 1,751 HIV mother-baby pairs were enrolled in the 24 health facilities: 78.1% received Highly Active Antiretroviral Therapy (HAART), 14.2% received Zidovudine (AZT), 1.7% received Single-dose Nevirapine (SdNVP), and 4.3% received no prophylaxis. MTCT rates were 5.5%, 7.4% and 5.6% at 6 weeks, 9 to <18 months and 18-24 months, respectively. MTCT rate at 18-24 months showed a significant difference (p<0.001) across PMTCT regimens. Women with CD4 cells between 350 to 500 cells/mm3 were about twice as likely to have HIV-negative babies compared to those with CD4 cells count <350cells/mm3. Women on TB treatment are less likely to have HIV-negative babies compared to those without TB. Exclusive breastfeeding at 6 weeks was associated with lower MTCT rates.  Feeding option at 6 weeks is a strong predictor of HIV status (p<0.001) as compared to babies on exclusive breastfeeding (EBF). Conclusion: Most of the mother-baby pairs received HAART. AZT depicted the lowest MTCT rate at 18-24 months.  Higher CD4 counts, no TB signs, and EBF at 6 weeks were associated with lower MTCT rates at 18-24 months Key words:  Antiretroviral prophylaxis, Mother-To-Child Transmission of HIV rates

The quality of PMTCT services and uptake of ARV prophylaxis amongst HIV positive pregnant women in Kakamega district, Kenya

Background: The success of a PMTCT programme depends on the quality of services offered at health facilities.  Indicators of quality include the competence and attitude of the counsellor and uptake of ARV prophylaxis. Objective: This study looked at the relationship between quality of prevention of mother to child transmission of HIV (PMTCT) services and the maternal ARV prophylaxis uptake in Kakamega district, Kenya. Methods: The study was a cross-sectional study. Thirty health facilities and health care workers were sampled using multistage sampling. From these health facilities, 119 HIV positive pregnant women were sampled by convenience sampling. The PMTCT counsellors and HIV positive pregnant were interviewed using a structured questionnaire. Statistical analysis: Descriptive data analysis was carried out on all variables. Categorical variables across groups were compared using the Fisher Exact test. Logistic regression was used to identify determinants of uptake of ARV prophylaxis at facility level Results: About 86.7% of the health facilities sampled had satisfactory quality of PMTCT services and 89% of HIV positive pregnant women reported that they received satisfactory PMTCT counselling services. About 90% of the counsellors have received PMTCT training and the mean score in a knowledge test was 77.2%. However, providers generally had a negative attitude towards their clients.  On regression analysis, there was no significant association between various aspects of quality and infant ARV prophylaxis uptake.  Uptake at facility level was determined by the district and type of health facility. Conclusion: The quality of service in the sampled facilities was generally good but this did not influence the level of uptake of maternal or infant ARV prophylaxis. Key words: Prevention of Mother to Child Transmission (PMTCT), ARV prophylaxis, HIV-positive pregnant women