Evaluation of PMTCT interventions and outcomes among HIV-positive pregnant and breastfeeding women and their HIV-exposed infants in Homa Bay County, Kenya, 2016-2019
Overview
Introduction
The Kenya national and county governments Ministries of Health have made a series of investments through policy and programs to accelerate elimination of mother to child transmission. Significant gains have been made in identifying HIV infected pregnant women during antenatal care visits. In 2016, Elizabeth Glaser Pediatric AIDS Foundation, implemented the Timiza90 project, a five-year U.S. President’s Emergency Plan for AIDS Relief (PEPFAR)-funded project through a cooperative agreement with the US Centers for Disease Control & Prevention (CDC). Timiza90 project supported Prevention of Mother to Child Transmission (PMTCT)/pediatric treatment, through the scale-up of integrated Antiretroviral Therapy (ART)/Maternal Newborn and Child Health (MNCH) services, including interventions aimed at improving quality of services and increasing uptake.
Methods
A retrospective study was conducted with the aim of tracking HIV-related health outcomes for the mother-baby pair and determine the association between demographic, clinical, and program factors and these health outcomes. Medical records were abstracted from 13 health facilities that serve HIV-infected pregnant and breastfeeding women and their HIV exposed infants (HEIs) within Homabay county, Kenya, between Oct 2016 and Jan 2019, using a standardized case report form/chart abstraction tool.
Results
Of the 947 HIV positive pregnant women seen in antenatal care from October 2016 to January 2019 in 13 high volume facilities in Homa Bay county, a total of 857(90.5%) mothers were enrolled into PMTCT. The participants had a median gestational age of 22 weeks (IQR: 16, 28) at first ANC, with only 152(18.8%) mothers attending first ANC before 14 weeks gestation. About two thirds (634) of the mothers had at least three ANC visits before delivery and 626(86%) delivered in a health facility. In total, 652(77.6%) had been on ART for more than 3 months at enrollment into PMTCT. Most of the mothers (84.4%) were alive and active in care when the infants started HEI follow-up. Of all the 808 documented pregnancy outcomes from 857 mothers, there were a total of 774(95.8%) live births and 34(4.2%) stillbirths. The majority (98.9%) of the infants took ARV prophylaxis while 606(78.3%) infants exclusively breastfed for 6 months. At the end of study follow-up, 693(89.5%) children were alive and on follow-up, 15(1.9%) had been lost to follow-up, 63(8.1%) had been transferred-out and 3 (0.4%) had died; 12 of the live infants were HIV positive at the end of study follow up.
Conclusion
Late ANC attendance, lack of couple counseling, mixed feeding and home delivery remain a challenge among women living with HIV and are potential factors to Mother to Child Transmission (MTCT) and it is critical to enhance counselling on birth planning and preparedness in the context of HIV and PMTCT. Encouraging partner involvement would improve utilization of antenatal and postnatal services for PMTCT.
Rose Masaba (PI), Stephen Siamba, Gordon Okomo, Jacob Khaoya, James Ngerere Ndimbii, Godfrey Woelk
Kenya
Prevention of Mother-to-Child Transmission