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Published in: BMC Public Health 1/2015

Open Access 01-12-2015 | Research article

Outcomes of prevention of mother to child transmission of the human immunodeficiency virus-1 in rural Kenya—a cohort study

Authors: Eunice Wambui Nduati, Amin Shaban Hassan, Miguel Garcia Knight, Daniel Muli Muema, Margaret Nassim Jahangir, Shalton Lwambi Mwaringa, Timothy Juma Etyang, Sarah Rowland-Jones, Britta Christina Urban, James Alexander Berkley

Published in: BMC Public Health | Issue 1/2015

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Abstract

Background

Success in prevention of mother-to-child transmission (PMTCT) raises the prospect of eliminating pediatric HIV infection. To achieve global elimination, however, strategies are needed to strengthen PMTCT interventions. This study aimed to determine PMTCT outcomes and identify challenges facing its successful implementation in a rural setting in Kenya.

Methods

A retrospective cohort design was used. Routine demographic and clinical data for infants and mothers enrolling for PMTCT care at a rural hospital in Kenya were analysed. Cox and logistic regression were used to determine factors associated with retention and vertical transmission respectively.

Results

Between 2006 and 2012, 1338 infants were enrolled and followed up for PMTCT care with earlier age of enrollment and improved retention observed over time. Mother to child transmission of HIV declined from 19.4 % in 2006 to 8.9 % in 2012 (non-parametric test for trend p = 0.024). From 2009 to 2012, enrolling for care after 6 months of age, adjusted Odds Ratio [aOR]: 23.3 [95 % confidence interval (CI): 8.3–65.4], presence of malnutrition ([aOR]: 2.3 [95 % CI: 1.1–5.2]) and lack of maternal use of highly active antiretroviral therapy (HAART) (aOR: 6.5 [95 % CI: 1.4–29.4]) was associated with increased risk of HIV infection. Infant’s older age at enrollment, malnutrition and maternal HAART status, were also associated with drop out from care. Infants who were not actively followed up were more likely to drop out from care (adjusted Hazard Ratio: 6.6 [95 % CI: 2.9–14.6]).

Discussion

We report a temporal increase in the proportion of infants enrolling for PMTCT care before 3 months of age, improved retention in PMTCT and a significant reduction in the proportion of infants enrolled who became HIV-infected, emphasizing the benefits of PMTCT.

Conclusion

A simple set of risk factors at enrollment can identify mother-infant pairs most at risk of infection or drop out for targeted intervention.
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Metadata
Title
Outcomes of prevention of mother to child transmission of the human immunodeficiency virus-1 in rural Kenya—a cohort study
Authors
Eunice Wambui Nduati
Amin Shaban Hassan
Miguel Garcia Knight
Daniel Muli Muema
Margaret Nassim Jahangir
Shalton Lwambi Mwaringa
Timothy Juma Etyang
Sarah Rowland-Jones
Britta Christina Urban
James Alexander Berkley
Publication date
01-12-2015
Publisher
BioMed Central
Published in
BMC Public Health / Issue 1/2015
Electronic ISSN: 1471-2458
DOI
https://doi.org/10.1186/s12889-015-2355-4

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