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

Matilu Mwau,Lucy Kithinji,Priska Bwana,Catherine Akinyi,Francis Ogollah,Caroline Boeke,Martin Sirengo,Maureen Adhiambo,Samuel Ochieng,Fred Ogumbo,Sarah L Pett

doi:10.1371/journal.pone.0183860

Matilu Mwau, Lucy Kithinji + Show 9 more

Open Access

https://doi.org/10.1371/journal.pone.0183860

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Abstract

ObjectiveTo describe factors associated with mother-to-child HIV transmission (MTCT) in Kenya and identify opportunities to increase testing/care coverage.DesignCross-sectional analysis of national early infant diagnosis (EID) database.Methods365,841 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.Results11.1% 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.ConclusionDespite 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.

Highlights

Without antiretroviral therapy (ART), approximately 50% of HIV-infected infants die by the age of two[1]
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 prevention to mother-to-child transmission of HIV (PMTCT) intervention, infants receiving no prophylaxis, and infants mixed breastfed
With PMTCT/early infant diagnosis of HIV (EID) program growth and more patients in care, there has been a decrease in risky practices over time, but even the recent data suggests that some infants are not reached in time for prevention; these findings would likely be more striking in other countries in sub-Saharan Africa where PMTCT programs are not as strong

Summary

Introduction

Without antiretroviral therapy (ART), approximately 50% of HIV-infected infants die by the age of two[1]. Due in large part to this gap, an estimated 33% of HIV-infected pregnant women are not on treatment and early infant diagnosis of HIV (EID) testing coverage by two months of age in exposed infants was 72% in 2014[4]. Better understanding of these gaps and the remaining risk factors for HIV infection among infants who get tested is essential to eliminate MTCT in Kenya and neighboring countries

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