Child Transmission Research Articles

“I desire to have an HIV-free baby”: pregnant and breastfeeding mothers’ perceptions of Viral load testing and suppression in HIV care in southwestern Uganda

IntroductionViral suppression is a critical component for preventing mother-to-child transmission of HIV(MTCT). Mothers’ perceptions of viral load suppression is crucial in the attainment of successful outcomes in preventing mother to child transmission of HIV. We therefore aimed to explore the experiences and perceptions of women on viral suppression.MethodsThis was a qualitative sub-study embedded in a cluster-randomized trial (NCT04122144) designed to improve viral load outcomes among pregnant and breastfeeding mothers living with HIV in four level III/IV health facilities in South-western Uganda. Thirty-two in-depth interviews were conducted with pregnant and breastfeeding women with HIV from 1st March 2020 to 30th September 2020 to explore their understanding and interpretation of viral suppression. Interviews were audio-recorded, transcribed, and coded in Dedoose software for analysis.ResultsA total of 32 Women living with HIV were enrolled in this qualitative study. WLHIV explained viral suppression in the context of attaining good health and having HIV-free babies. Adherence to ART was presented as a key avenue to viral suppression. The level of engagement with providers was presented as a key attribute of attaining viral suppression. The participants narrated their experiences with viral load testing within the routine services. However, they revealed experiencing some proximate barriers to suppression including anticipated stigma, challenges with non-disclosure of HIV status, pregnancy distress, and distance to the health facility.ConclusionThe understanding and interpretation of viral suppression among pregnant and breastfeeding mothers living with HIV provides a basis for adopting behaviors leading to prevention of vertical transmission of HIV. Health care workers can support women by providing clear and culturally appropriate education about viral suppression, adherence strategies and creating a supportive and non-judgmental environment.

Improving Access to PMTCT Through the Involvement of Traditional Birth Attendants in Program Activities in the Far North Region of Cameroon: A Retrospective Cohort Study.

Majority of deliveries occurring in the Cameroon part of the Lake Chad basin is assisted by traditional birth attendants (TBA). The aim of the present study was to assess if training and involving TBA in community-based Prevention of Mother to Child Transmission (PMTCT) interventions can contribute in improving targeted population access to these interventions. This was a retrospective cohort study that assessed among mothers of children aged 0-24 months the effect of training and involving TBA in PMTCT activities. The exposed mother-child pairs were those inhabiting communities were TBA were trained and involved during the 24 previous months in PMTCT activities (exposed communities) while the non-exposed groups where those living in communities with no study intervention. Data were collected in households selected by stratified cluster random sampling from children's mothers or guardians using a face-to-face administered questionnaire (undocumented) and from antenatal booklets (documented) used in health facilities to record antenatal care. A total of 637 mothers-children couples were included, 416 (65.3%) in the exposed group and 221 (34.7%) in the control group. Exposed mother-child pairs had significantly higher documented access to mother antenatal HIV testing compared to the couples living in non-exposed communities with adjusted relative risk (ARR) of 4.20 (2.52-6.99). The mean number of antenatal consultations was significantly higher in the exposed group (Student T-test =6.00, p= 0.000). However, this exposure to community with trained TBA increased but not significantly the proportion of pregnant women who benefit from antenatal consultations (ARR=0.94 (0.70-1.25), p=0.678) and those who withdraw their HIV test results (X2 = 0.271, p=0.786). The training and involvement of TBA in delivering PMTCT interventions at the community level can improve population access to these interventions. The consistency of these findings should be tested in other communities in needs and with other health care interventions.

Uptake of early infant HIV diagnosis and its associated factors in Tanzania: an analytical cross-sectional study

The uptake of early infant HIV diagnosis services is crucial for preventing mother to child transmission of virus, and timely management. However, the uptake of the services remains a global challenge, despite major advances in HIV testing. This study investigated the uptake of early infant HIV diagnosis and its associated factors among mothersof exposed infants. The results showed that the uptake of early infant HIV diagnosis was 76%. Factors associated with the uptake are caregivers being married, have higher income level and having adequate knowledge on early infant HIV diagnosis.

Use and non-adherence to antiretroviral therapy among Refugee HIV positive pregnant mothers aged 18–49 years in Kyangwali refugee camp, Western Uganda

IntroductionRefugee HIV positive mothers experience significant obstacles in accessing, utilizing and adhering to antiretroviral therapy (ART). Identifying ART non-adherence can help in the development of interventions aimed at improving adherence and subsequently effectiveness of ART among the refugee mothers. We describe the use and the factors associated with non-adherence to ART among Refugee HIV positive pregnant mothers aged 18–49 years in Kyangwali Refugee Camp, Uganda.MethodsWe conducted a cross-sectional study among HIV positive pregnant mothers aged 18–49 years in Kyangwali refugee camp between May and June 2023. Using a structured questionnaire, we collected data on use, and factors associated with non-adherence to ART. We used modified Poisson regression analysis to determine factors associated with non-adherence to ART.ResultsOf the 380 participants enrolled, 192 (50.5%) were married, mean age 32.1 years. Overall, 98.7; 95% Confidence Interval (CI) [97.5–99.8%] were using ART and 27.4; 95% CI [22.9–31.9%] were non-adherent. Non-adherence was associated with: Initiating Prevention of Mother to Child Transmission (PMTCT) care in the third trimester of pregnancy (adjusted Prevalence ration(aPR): 2.06; 95% CI: 1.27–3.35), no need to get permission to seek PMTCT services aPR 1.61; 95% CI [1.07–2.42] and poor attitude of PMTCT providers aPR 1.90; 95% CI [1.20–3.01].Conclusion and recommendationsNon-adherence to ART was generally high; therefore limiting the effectiveness of the PMTCT program in this setting. Refugee context specific education interventional programs aimed at early initiation into HIV care, strong social and psychological support from families, communities and health care providers are vital to improve adherence in this setting.

Performance of Prevention of Mother to Child Transmission Projects: Evidence from Hospitals in Nyeri County, Kenya

Performance of Prevention of Mother to Child Transmission Projects: Evidence from Hospitals in Nyeri County, Kenya

Examining barriers to antiretroviral therapy initiation in infants living with HIV in sub-Saharan Africa despite the availability of point-of-care diagnostic testing: a narrative systematic review.

Antiretroviral therapy (ART) initiation in infants living with HIV before 12 weeks of age can reduce the risk of mortality by 75%. Point-of-care (POC) diagnostic testing is critical for prompt ART initiation; however, despite its availability, rates of ART initiation are still relatively low before 12 weeks of age. This systematic review describes the barriers to ART initiation in infants before 12 weeks of age, despite the availability of POC. This systematic review used a narrative synthesis methodology. We searched PubMed and Scopus using search strategies that combined terms of multiple variants of the keywords "early infant initiation on antiretroviral therapy," "barriers" and "sub-Saharan Africa" (initial search 18th January 2023; final search 1st August 2023). We included qualitative, observational and mixed methods studies that reported the influences of early infant initiation on ART. We excluded studies that reported influences on other components of the Prevention of Mother to Child Transmission cascade. Using a deductive approach guided by the updated Consolidated Framework of Implementation Research, we developed descriptive codes and themes around barriers to early infant initiation on ART. We then developed recommendations for interventions for the identified barriers using the action, actor, target and time framework from the codes. Of the 266 abstracts reviewed, 52 full-text papers were examined, of which 12 papers were included. South Africa had most papers from a single country (n = 3) and the most reported study design was retrospective (n = 6). Delays in ART initiation beyond 12 weeks in infants 0-12 months were primarily associated with health facility and maternal factors. The most prominent barriers identified were inadequate resources for POC testing (including human resources, laboratory facilities and patient follow-up). Maternal-related factors, such as limited male involvement and maternal perceptions of treatment and care, were also influential. We identified structural barriers to ART initiation at the health system, social and cultural levels. Improvements in the timely allocation of resources for POC testing operations, coupled with interventions addressing social and behavioural barriers among both mothers and healthcare providers, hold a promise for enhancing timely ART initiation in infants. This paper identifies barriers and proposes strategies for timely ART initiation in infants.

Assessment of Factors Influencing the Uptake of Elimination of Mother to Child Transmission Services Among Pregnant and Breastfeeding Mothers in Shangombo District, Zambia

Assessment of Factors Influencing the Uptake of Elimination of Mother to Child Transmission Services Among Pregnant and Breastfeeding Mothers in Shangombo District, Zambia

Investigating the Pregnancy and Post-Partum Health Experiences of Women Living with HIV

IntroductionPregnancy and the postpartum period is a difficult time for women living with HIV (WLWH) and postpartum engagement with HIV care is often reduced, with implications for health and well-being. We aimed to explore the postpartum health experiences of WLWH in relation to engagement in HIV care.MethodsThe NESTOR (iNvESTigating the pregnancy and pOst-paRtum health experience of women living with HIV) study was a UK based qualitative semi-structured interview study. 61 eligible women were identified. We used a purposive sampling technique to recruit women with differing levels of engagement in HIV care. Interviews were conducted via telephone or video call. Interviews were audio recorded and fully transcribed. We used a thematic approach for data analysis, and two researchers independently coded the data and established the key themes.Results11 of 61 (18%) eligible women participated in the interviews, and the three main themes were ‘infant feeding decisions’, ‘managing the risk of mother to child transmission’, and ‘managing the knowledge of their HIV status’. These themes offer detailed insights into the significant psychological and emotional challenges these women had experienced, and the practical support from healthcare professionals in both HIV and maternity services that had enabled them to navigate those challenges.DiscussionThere have been life-changing developments in the treatment and care for people living with HIV. However, even in the U = U (undetectable = untransmittable) era, traditional concerns about breastfeeding, risk of transmission to the infant and stigma continue to shape the postpartum experience of WLWH. As these impact on their emotional and psychological wellbeing, support in these areas needs to be prioritised.

Epidemiology of an overlapping and parallel infection of Sexually Transmitted Infections among pregnant women in North-east Ethiopia: Its implication for prevention of mother to child transmission.

The burden of parallel and overlapping infections of Sexually Transmitted Infections (STIs), particularly HIV, syphilis, hepatitis B (HBV), and hepatitis C virus (HCV) are disproportionately higher among pregnant women globally, leading to unwanted consequences. These infections pose significant public health challenges as they can be transmitted vertically to the offspring. This study aimed to determine the sero-epidemiological patterns and predictors of STIs (HIV, syphilis, HBV, and HCV) among pregnant women attending antenatal care clinics at ten health facilities in North-eastern Ethiopia. An institution-based multi-center cross-sectional study was conducted from May to November 2022 among 422 pregnant women selected using simple random sampling technique. Semi-structured questionnaire was used to collect socio-demographic characteristics and predictor variables of STIs through face-to-face interviews. Venous blood was collected and it was tested for anti-HIV, HBsAg, anti-HCV, and anti-Treponemal antibodies using immunochromatographic test kits. Multinomial logistic regression analysis was used to identify associated factors of STIs. Variables with an adjusted odds ratio (AOR) and a p-value <0.05 were considered statistically significant. The overall prevalence of STIs was 23.9% (95% CI = 20.08-28.25). The prevalence of parallel infections of HIV, hepatitis B, hepatitis C, and syphilis were 6.4%, 9%, 1.7%, and 6.9%, respectively. The overlapping infections for HIV-HBV was 4% but HIV-HCV overlapping infection wasn't found. Increased age, tattooing, multiple sexual partners, exposure to unsafe sex, and RH status were independent factors of HBV. Likewise, increased age, rural residence, illiteracy, and tattooing were independently associated with HCV. Moreover, rural residence and a history of tattooing were independent predictors for the acquisition of HIV, whereas multiple sexual partners and RH status were found to be significant predictors of syphilis infection among pregnant women. The magnitude of overlapping and parallel STD infections is still continued to be a problem among pregnant women. Moreover, there were overlapping infections of HBV-HIV. Therefore, continuous screening of pregnant women for HIV, syphilis, hepatitis B, and C infections should be performed, and special attention should be given to pregnant women who have co-infections.

Evaluation of CD4 Count in HIV Infected Pregnant Women at Kibagabaga Level Two Teaching Hospital

CD4 count measures the degree of immunosuppression in HIV-positive patients and is used to monitor HIV infection progression in human body. HIV is a virus that attacks the body’s immune system and if not treated, can lead to AIDS The rate of CD4 cells destruction is directly proportional to progressive replication of HIV. Pregnant women infected with HIV have high risk of mother to child transmission of HIV infection and are prone to excessive immunosuppression and increased viral load if their CD4 cell count is not properly maintained. Pregnancy may influence CD4 cells count reduction or don’t, that’s why this study focused on evaluation of CD4 count in HIV infected pregnant women. The objectives of this study were to determine the association between pregnancy trimesters and CD4 count among HIV infected pregnant women at KDH. The study was a cross sectional study which included 46 patients who visited kibagabaga level two teaching hospital in 5 months. Data were obtained by collecting venous blood of patients, testing their CD4 count and use of a questionnaire to evaluate the risk factors associated with changes in CD4 count. Data collected were analysed using statistical package for social sciences (SPSS) software version 22.0 and Microsoft word, the presentation of results was done using tables. Variables with p-value less than or equal to 0.05 were considered statistically significant. The study showed that there is an association between pregnancy trimesters and CD4 count among HIV infected pregnant women where 21(45.6%) women were in third trimester and had the highest CD4 count compared to women in the 2nd trimester 14(30.4%) followed by women in 1st trimester 11(24%) with p-value of 0.04 which is statistically significant. In evaluated CD4 count changes, associated risk factors were, antiretroviral treatment intake, diet intake, education level, pregnancy trimester, and closely spaced pregnancies. Which were found to have p-values 0.00, 0.00, 0.04, 0.04 and 0.01 that were statistically significant respectively. Keywords: HIV, CD4 Count, Pregnant women

A RETROSPECTIVE STUDY OF FETOMATERNAL OUTCOME IN HIV POSITIVE PREGNANT WOMEN

Background: In present scenario Acquired immunodeficiency syndrome is one of the worst global health concerns. HIV has a dramatic impact on the health of mother and children. Parent to child transmission of HIV is a major route of new infection in children Methods: A retrospective study was conducted in Jklon hospital, kota from May 2021 to April 2022. All HIV positive pregnant women who were on ART or not and delivered in our hospital were selected. Maternal and fetal outcome variables were analysed. Results: Total deliveries during the study period were 9046. Out Of these HIV positive pregnant women were 36, prevalence being 0.3%. Primigravida were found to be 41.66% during the study period from may 2021 to April 2022. 47.22% were diagnosed HIV positive during pregnancy, vaginal deliveries were 77.77%% and caesarean section was 22.22%. birth weight &lt;2kg in 8.3% and IUFD were 8.3%. Nevirapine prophylaxis were given to 91.66% of neonate Conclusions: our result suggest that Early diagnosis and initiation of therapy will prevent transmission to their children and better fetomaternal outcome. In patients who are on ART education and counselling can alter maternal and neonatal outcome. Awareness and information is important to increase access to PPTCT services. Team approach involving an experienced obstetrician, neonatologist and physician gives hope of having a healthy uninfected baby for HIV infected mothers.

Understanding the Factors Promoting Mother to Child Transmission of HIV/AIDS in Nigeria

Mother-to-child transmission (MTCT) of HIV/AIDS remains a significant public health challenge in Nigeria. This review aimed to identify and understand key factors promoting MTCT and assess the effectiveness of current prevention interventions. A systematic literature search was conducted across multiple databases using relevant keywords and approximately 57 individual literatures was reviewed. Studies focusing on MTCT in Nigeria published after 2015 were included. Eligible studies were critically appraised for quality and relevance. Findings indicate significant knowledge gap (such as misconceptions about transmission routes, limited understanding of prevention methods, delay in seeking testing and care and inconsistent adherence to Antiretroviral therapy) among pregnant women regarding HIV transmission, persistent stigma and discrimination hindering access to PMTCT services, and challenges within the healthcare system such as geographical disparities and inadequate provider training. Cultural practices, including breastfeeding and postnatal rituals, further exacerbate MTCT risk. Male partner involvement emerges as a crucial yet often overlooked aspect of PMTCT. Existing interventions showed moderate effectiveness, highlighting the need for tailored approaches. Strengthening multi-level interventions addressing social, economic, and cultural determinants, alongside culturally sensitive approaches and increased male engagement, are crucial to address MTCT and improve maternal and child health outcomes in Nigeria. Future research should focus on developing and evaluating interventions tailored to specific contexts and populations.

The Analysis of Factors Influencing Behavior of Pregnant Mother in Performing Prevention Mother to Child HIV Transmission (PMTCT) in PHC Pesantren I Kediri

Background: Mother to child transmission of HIV can be prevented, but the incident of HIV in children from year to year continues to increase. Purpose: The research objective is to analyze the factors influencing behavior of pregnant mothers in performing Prevention Mother to Child HIV Transmission (PMTCT). Method: The research design was analytic observational with cross sectional approach. The population was all of pregnant mothers in working area of PHC Pesantren I Kediri. The samples were 63 respondents using simple random sampling. Data were collected using questionnaires given to pregnant mothers at the time of antenatal care in PHC Pesantren I Kediri and then analyzed using logistic regression. Results: The results showed that variable X1 (role of officer) with p = 0.104; OR = 4.609, Variable X2 (knowledge) with p = 0.004; OR = 31.057, Variable X3 (attitude) with p = 0.030; OR = 8.993, Variable X4 (husband support) with p = 0.015; OR = 4.789, Variable X5 (house distance) with p = 0.720; OR = 1.232 and Variable X6 (interest) with p = 0.014; OR = 2.863. In conclusion, the factors influencing Y (behavior of pregnant mothers in performing PMTCT examination) were knowledge and attitude, with the most dominant factor was knowledge with the influence of 31.057. Conclusion: Shows that,The low level of mother’s knowledge about PMTCT, uncooperative mother’s attitude, lack of husband support and lack of mother’s interest caused the low coverage of PMTCT examination in PHC Pesantren I Kediri. The health promotion efforts need more intensive so that the success of PMTCT program can be achieved.

Pregnant Women’s Complience in Preventing Mother to Child Transmission (PMTCT) Examination

Pregnant Women’s Complience in Preventing Mother to Child Transmission (PMTCT) Examination

Trends and predictors of unmet need for family planning among women living with HIV in Zambia: implications for elimination of vertical transmission of HIV

BackgroundPrevention of vertical (mother to child) transmission of HIV is one of the key strategies towards HIV epidemic control. Despite considerable progress over the past decade in Zambia, the country is yet to reach global and national target for elimination of vertical transmission of HIV. Avoidance of unintended pregnancy among women living with HIV is one of the cost-effective interventions in a comprehensive approach to prevent vertical transmission of HIV. Therefore, this study aimed at ascertaining trends in and predictors of unmet need for family planning among women living with HIV in Zambia.MethodsThe study employed a repeated cross sectional (RCS) study design, using data from the three (3) most recent consecutive rounds of the Zambia Demographic and Health Survey (ZDHS) conducted in 2007, 2013/2014 and 2018. The study used data from a total of 27,153 women aged 15–49 years over the three survey periods among whom 4,113 had an HIV positive result following a rigorous HIV testing algorithm of the demographic and health surveys, and these constituted our sample size of women living with HIV. We used descriptive statistics and logistic regression analyses to respectively ascertain trends in and predictors of unmet need for family planning among women living with HIV.ResultsOver the three survey points, unmet need for family planning among women living with HIV has largely remained unchanged from 20.8% in 2007 to 20.5% in 2013/14 and 21.1% in 2018 DHS. Residence, age of women, household wealth, woman’s parity, employment, and age of spouse emerged as significant predictors of unmet need for family planning among women living with HIV in Zambia.ConclusionPreventing HIV infection in a child preserves life, contributes to improving quality of life from its early stages and averts lifetime costs of HIV treatment and associated healthcare costs. There is need to consider optimization of interventions to prevent vertical transmission of HIV including shaping programming regarding preventing unintended pregnancies among women living with HIV. Among other aspects, policy and practice need to strengthen SRH/HIV integration and better target rural residents, younger women, those with high parity and consider positive male engagement to reduce unmet need for family planning among women living with HIV.

Antiviral treatment for the prevention of mother to child transmission of hepatitis B virus infection

Antiviral treatment for the prevention of mother to child transmission of hepatitis B virus infection

A Qualitative Study of Caregivers of Children Living with HIV/AIDS in Ghana: Diagnosis History, Health-seeking Behaviour, and Care Expectations

Caregivers of Children Living with HIV/AIDS experience severe burdens in Africa amidst unmet needs while seeking care from hospitals. This study aimed to explore the diagnosis history, health-seeking behaviour, and care provided by hospitals and whether the services meet caregivers’ expectations. We used a qualitative approach and conducted individual in-depth interviews among purposively sampled caregivers of children living with HIV/AIDS from three hospitals. We achieved data sufficiency after interviewing nine participants. Audio-recorded interviews were transcribed verbatim and thematically analyzed manually through Collaizi’s steps. Four themes developed including; history of pregnancy and poor HIV testing, effective care for caregivers and CLWH, attitude of healthcare providers, and unmet expectations of care. Healthcare providers showed positive attitudes towards caregivers and provided services (counselling, dispensing Anti-retrovirals, health monitoring, and coordination of clinical care). Expectations bordered on financial support (for food, education, health care), and treatment for opportunistic infections. Findings indicate gaps in HIV voluntary testing for pregnant women, enrollment in Prevention of Mother to Child Transmission (PMTCT), and unmet needs. It is imperative to improve coverage of testing for pregnant women and efforts made to meet their needs. Financial support, provision of food security, and assistance for caregivers are essential for care.

Altered TLR7 Expression-Mediated Immune Modulation Is Supportive of Persistent Replication and Intrauterine Transmission of HBV.

Hepatitis B Virus (HBV) is posing as a serious public health threat mainly due to its asymptomatic nature of infection in pregnancy and vertical transmission. Viral sensing toll-like receptors (TLR) and Interleukins (IL) are important molecules in providing an antiviral state. The study aimed to assess the role of TLR7-mediated immune modulation, which might have an impact in the intrauterine transmission of HBV leading to mother to child transmission of the virus. We investigated the expression pattern of TLR7, IL-3, and IL-6 by RT-PCR in the placentas of HBV-infected pregnant women to see their role in the intrauterine transmission of HBV. We further validated the expression of TLR7 in placentas using Immunohistochemistry. Expression analysis by RT-PCR of TLR7 revealed significant downregulation among the Cord blood (CB) HBV DNA positive and negative cases with mean ± standard deviation (SD) of 0.43 ± 0.22 (28) and 1.14 ± 0.57 (44) with p = 0.001. IL-3 and IL-6 expression revealed significant upregulation in the CB HBV DNA-positive cases with p = 0.001. Multinomial logistic regression analysis revealed that TLR7 and IL-3 fold change and mother HBeAg status are important predictors for HBV mother to child transmission. Immunohistochemistry revealed the decreased expression of TLR7 in CB HBV DNA-positive cases. This study reveals that the downregulation of TLR7 in the placenta along with CB HBV DNA-positive status may lead to intrauterine transmission of HBV, which may lead to vertical transmission of HBV.

Trend of HIV Prevalence in Antenatal Women in a Tertiary Care Hospital in the Western Region of India.

Background The severity of AIDS and the social and personal implications of HIV makes the epidemiological study of HIV more difficult. Surveillance studies remain the mainstay of understanding thetrends of HIV infection. In this study, we aimed to determine the trend in the prevalence of HIV in the antenatal women attending our hospital situated in the western region of India over the period of the last nine years and theART adherence and the viral loads of the cluster of positive patients identified from this antenatal HIV testing. Methodology A retrospective study was conducted by collecting data fornine years from January 2015 to December 2023 from the PPTCT (Prevention of Parent to Child Transmission) Centre and ART (Anti-Retroviral Treatment) Centre of the hospital. All pregnant women attending antenatal clinics and being admitted to the labor room are counseled for HIV testing as per the National AIDS Control Organisation (NACO) guidelines of India. The data of the total antenatal women counseled for HIV testing and who tested HIV positivewere collected. The HIV prevalence rate was derived and the trend of HIV prevalence in antenatal women attending the hospital was determined over the study period. The data on ART adherence and the viral load of these HIV-positive women detected antenatally and their seropositive spouseand children were collected and analyzed. Results A total of 22,584 antenatal women were counseled for HIV testing during the study period. No women opted out and there was 100% testing of these 22,584 antenatal women for HIV. Fifty antenatal women tested positive for HIV, resulting in an overall HIV prevalence of 0.22% (50/22,584) during the study period. There was adeclining trend of HIV prevalence among antenatal women from 2020 to 2023 (from 0.37% to 0.19%). Of the 50 seropositive antenatal women, 42remained bookedat our ART Centre for treatment. Thirty (71%) women are still adhered to taking ART. Of their 20 seropositive spouses, 14 (70%) have remained adhered to ART. Twenty-eight (93%) female patients on ART and 13 (93%) spouses on ART have suppressed viral loads. Two children of these seropositive mothers had tested HIV positive. ART adherence and suppressed viral load were seen in both seropositive children. Conclusion The study reflects a decline in antenatal seroprevalence in recent years in our region. The antenatal HIV prevalence trends have major implications on mother-to-child transmission and these positive antenatal cases serveas index cases bringing the testing opportunity for the so-called identified as the non-high-risk population. ART adherence of positive female patients, after the completion of the antenatal period, remains the challenge in our region, which requires improvement in the outreach activities and increased motivation and awareness of these patients regarding the importance of taking lifelong ART.

Understanding mother-to-child transmission of HIV among mothers engaged in HIV care in Kenya: a case report

BackgroundMother-to-child transmission of HIV, which may occur in utero, during birth, or through breastmilk, is now largely preventable with the advancement of HIV testing and treatment for women and their infants. Globally, great progress has been recorded over the years, with a 58% decline in new infections in children from 2010 to 2022. Currently, Kenya is among the countries with the highest rates of mother-to-child transmission of HIV despite consistent efforts to promote prevention of mother to child transmission strategies.MethodsThis case report presents the experiences of a woman, engaged in HIV care in Kenya, whose baby contracted HIV. The data used to describe this case come from surveys, provider notes, health records, observational notes, notes from phone call consultations, and one in-depth interview. All data sources were carefully reviewed, compared and complied to describe the timeline of events and context of the participant’s experience.ResultsWe found multiple factors which may have contributed to this case of mother-to-child transmission of HIV. Antenatal care was initiated late in pregnancy (during the third trimester), and as a result, HIV diagnosis and treatment also occurred late in pregnancy. In addition, a lack of coordination between the clinic providing antenatal care and HIV treatment, and the hospital providing labor and delivery services led to breastfeeding initiation prior to the administration of infant HIV prophylaxis medications. Finally, poor maternal adherence to HIV medications went undetected and unaddressed until it was revealed by routine viral load monitoring three months after initiating HIV treatment (more than two months postpartum).ConclusionsOur case report shows the continued need for more intensive and integrated care for mothers living with HIV and their infants including support for pregnant women newly diagnosed with HIV, coordination of perinatal and HIV care, provisions for routine monitoring of HIV medication adherence, intensive follow-up care including point of care testing for HIV exposed infants and in person breastfeeding support. Our case report contributes an important perspective especially in light of the current UNAIDS Global AIDS Strategy which recently inspired the Global Alliance to end AIDS in Children.