Correlates of HIV infection among HIV-exposed infants in low-income settlements Nairobi, Kenya

Abstract

Abstract Background Prevention-of-mother-to-child-transmission of HIV services provide timely catchpoints for universal test-and-treat strategies, improving health outcomes among HIV-exposed infants. We explored factors influencing vertical transmission of HIV among HIV-exposed infants in Nairobi County, Kenya. Methods A longitudinal study design was adopted and cohort of 166 mother-infant pairs were followed-up over 12 months. The study was conducted in three public healthcare facilities. Simple random sampling was used to select participants. Fisher's exact test was used to test for associations while Poisson regression analyzed data at the multivariable level. The study was powered at 0.08 (P < 0.05 at 95% CI). Correlates were assessed at 6 weeks, 6 and 12 months. All ethical approvals were obtained. The outcome measure was infant HIV status over a 12-month follow-up period. Results Infant HIV incidence rate over 12-months was 9 cases per 100 person-years (CI:5.465, 16.290). Maternal non-disclosure of HIV status to partner(s) presented a higher risk of infant HIV positivity relative to mothers who had disclosed their status i.e., at 6 months (relative risk 5.22 CI:1.40, 19.45) and 12 months (relative risk 4.54 CI: 1.62, 12.73). Mothers unaware of their partners’ HIV status had a higher risk of infant HIV positivity relative to mothers who knew their partners’ HIV status i.e., 6 weeks (relative risk 5.3 CI:1.10, 27.98), 6 months (relative risk 4.51 CI:1.13, 17.96) and 12 months (relative risk 5.14 CI:1.66, 16.07). Underweight mothers had a higher risk of infant HIV positivity relative to mothers with a normal body mass index i.e., relative risk 5.82 CI:2.0, 16.89 at 12 months/endpoint. Conclusions Maternal non-disclosure of HIV status and unawareness of their partners’ HIV status increased the risk of infant HIV vertical transmission. Recommendation: Healthcare provider assisted disclosure should be enforced to remove barriers brought about by HIV status non-disclosure. Key messages • Strategies to improve healthcare provider assisted disclosure of HIV status should be enforced to increase partner support, consequently reducing barriers associated with HIV status non-disclosure. • Nutritional support should be offered to all mothers living with HIV during the pregnancy and the breastfeeding period, to reduce the risk of vertical transmission of HIV to their infants.