Abstract
IntroductionFacility-based assessments of prevention of mother-to-child HIV transmission (PMTCT) programs may overestimate population coverage. There are few community-based studies that evaluate PMTCT coverage and uptake.MethodsDuring 2011, a cross-sectional community survey among women who gave birth in the prior year was performed using the KEMRI-CDC Health and Demographic Surveillance System in Western Kenya. A random sample (n = 405) and a sample of women known to be HIV-positive through previous home-based testing (n = 247) were enrolled. Rates and correlates of uptake of antenatal care (ANC), HIV-testing, and antiretrovirals (ARVs) were determined.ResultsAmong 405 women in the random sample, 379 (94%) reported accessing ANC, most of whom (87%) were HIV tested. Uptake of HIV testing was associated with employment, higher socioeconomic status, and partner HIV testing. Among 247 known HIV-positive women, 173 (70%) self-disclosed their HIV status. Among 216 self-reported HIV-positive women (including 43 from the random sample), 82% took PMTCT ARVs, with 54% completing the full antenatal, peripartum, and postpartum course. Maternal ARV use was associated with more ANC visits and having an HIV tested partner. ARV use during delivery was lowest (62%) and associated with facility delivery. Eighty percent of HIV infected women reported having their infant HIV tested, 11% of whom reported their child was HIV infected, 76% uninfected, 6% declined to say, 7% did not recall; 79% of infected children were reportedly receiving HIV care and treatment.ConclusionsCommunity-based assessments provide data that complements clinic-based PMTCT evaluations. In this survey, antenatal HIV test uptake was high; most HIV infected women received ARVs, though many women did not self-disclose HIV status to field team. Community-driven strategies that encourage early ANC, partner involvement, and skilled delivery, and provide PMTCT education, may facilitate further reductions in vertical transmission.
Highlights
Facility-based assessments of prevention of mother-to-child HIV transmission (PMTCT) programs may overestimate population coverage
PMTCT programs involve a cascade of interventions, which begins with HIV counseling and testing of pregnant women at initiation of antenatal care (ANC), and provision of ARVs throughout pregnancy, peripartum, and in the postpartum period to prevent vertical HIV transmission
Enrollment A random sample of 523 women who delivered in the previous year was identified, 437 (83.6%) were located, and 405 (92.7% of those located) agreed to participate (Figure 1)
Summary
Facility-based assessments of prevention of mother-to-child HIV transmission (PMTCT) programs may overestimate population coverage. There are few community-based studies that evaluate PMTCT coverage and uptake. PMTCT programs involve a cascade of interventions, which begins with HIV counseling and testing of pregnant women at initiation of antenatal care (ANC), and provision of ARVs throughout pregnancy, peripartum, and in the postpartum period to prevent vertical HIV transmission. [5] The Kenya Ministry of Health has made great strides to increase PMTCT coverage, with provision of ARVs to HIV-infected pregnant women increasing from 20% uptake in 2005 [6] to 69% in 2011. Most PMTCT assessments are clinic-based, and few studies sample a broader population of mothers which includes those who never accessed clinics. A study from Uganda noted markedly lower estimates of antenatal HIV testing in community-based assessment than in clinic-based assessment. [15] Another recent study in Cameroon, Cote D’Ivoire, South Africa, and Zambia found that facility-based estimates of PMTCT coverage exceeded coverage estimates observed in the community [16]
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