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

BMC Public Health

Research Article

Eunice Wambui Nduati¹  Shalton Lwambi Mwaringa¹  Amin Shaban Hassan¹  Timothy Juma Etyang¹  Daniel Muli Muema¹  Britta Christina Urban²  James Alexander Berkley³  Margaret Nassim Jahangir⁴  Sarah Rowland-Jones⁵  Miguel Garcia Knight⁵ 

[1] Kenya Medical Research Institute/Wellcome Trust Research Programme, Centre for Geographic Medicine Research Coast, Kilifi, Kenya;Kenya Medical Research Institute/Wellcome Trust Research Programme, Centre for Geographic Medicine Research Coast, Kilifi, Kenya;Liverpool School of Tropical Medicine, Liverpool, UK;Kenya Medical Research Institute/Wellcome Trust Research Programme, Centre for Geographic Medicine Research Coast, Kilifi, Kenya;Nuffield Department of Clinical Medicine, University of Oxford, Oxford, UK;Kilifi County Hospital, Kilifi, Kenya;Nuffield Department of Clinical Medicine, University of Oxford, Oxford, UK;

关键词: HIV;    Prevention of mother to child transmission;    Vertical transmission;    Retention;   

DOI  :  10.1186/s12889-015-2355-4

 received in 2015-04-13, accepted in 2015-09-25,  发布年份 2015

来源: Springer

【 摘 要 】

BackgroundSuccess 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.MethodsA 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.ResultsBetween 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]).DiscussionWe 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.ConclusionA simple set of risk factors at enrollment can identify mother-infant pairs most at risk of infection or drop out for targeted intervention.

【 授权许可】

CC BY   
© Nduati et al. 2015