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

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 Urban; James Alexander Berkley

doi:10.1186/s12889-015-2355-4

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

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 Urban
, James Alexander Berkley

Tropical Disease Biology

Wellcome Trust Research Laboratories Nairobi
University of Oxford
Kilifi County Hospital

Research output: Contribution to journal › Article › peer-review

34 Citations (Scopus)

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.

Original language	English
Article number	1008
Pages (from-to)	1008
Journal	BMC International Health and Human Rights
Volume	15
Issue number	1
DOIs	https://doi.org/10.1186/s12889-015-2355-4
Publication status	Published - 3 Oct 2015

UN SDGs

This output contributes to the following UN Sustainable Development Goals (SDGs)

SDG 2 Zero Hunger
SDG 3 Good Health and Well-being

Keywords

HIV
Prevention of mother to child transmission
Retention
Vertical transmission

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Urban-BMC-2015Final published version, 779 KBLicence: CC BY

Cite this

Nduati, E. W., Hassan, A. S., Knight, M. G., Muema, D. M., Jahangir, M. N., Mwaringa, S. L., Etyang, T. J., Rowland-Jones, S., Urban, B., & Berkley, J. A. (2015). Outcomes of prevention of mother to child transmission of the human immunodeficiency virus-1 in rural Kenya-a cohort study. BMC International Health and Human Rights, 15(1), 1008. Article 1008. https://doi.org/10.1186/s12889-015-2355-4

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abstract = "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.",

keywords = "HIV, Prevention of mother to child transmission, Retention, Vertical transmission",

author = "Nduati, \{Eunice Wambui\} and Hassan, \{Amin Shaban\} and Knight, \{Miguel Garcia\} and Muema, \{Daniel Muli\} and Jahangir, \{Margaret Nassim\} and Mwaringa, \{Shalton Lwambi\} and Etyang, \{Timothy Juma\} and Sarah Rowland-Jones and Britta Urban and Berkley, \{James Alexander\}",

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Nduati, EW, Hassan, AS, Knight, MG, Muema, DM, Jahangir, MN, Mwaringa, SL, Etyang, TJ, Rowland-Jones, S, Urban, B & Berkley, JA 2015, 'Outcomes of prevention of mother to child transmission of the human immunodeficiency virus-1 in rural Kenya-a cohort study.', BMC International Health and Human Rights, vol. 15, no. 1, 1008, pp. 1008. https://doi.org/10.1186/s12889-015-2355-4

TY - JOUR

T1 - Outcomes of prevention of mother to child transmission of the human immunodeficiency virus-1 in rural Kenya-a cohort study.

AU - Nduati, Eunice Wambui

AU - Hassan, Amin Shaban

AU - Knight, Miguel Garcia

AU - Muema, Daniel Muli

AU - Jahangir, Margaret Nassim

AU - Mwaringa, Shalton Lwambi

AU - Etyang, Timothy Juma

AU - Rowland-Jones, Sarah

AU - Urban, Britta

AU - Berkley, James Alexander

PY - 2015/10/3

Y1 - 2015/10/3

N2 - 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.

AB - 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.

KW - HIV

KW - Prevention of mother to child transmission

KW - Retention

KW - Vertical transmission

U2 - 10.1186/s12889-015-2355-4

DO - 10.1186/s12889-015-2355-4

M3 - Article

SN - 1472-698X

VL - 15

SP - 1008

JO - BMC International Health and Human Rights

JF - BMC International Health and Human Rights

IS - 1

M1 - 1008

ER -

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

Abstract

UN SDGs

Keywords

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