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. 2017 Aug 29;12(8):e0183860.
doi: 10.1371/journal.pone.0183860. eCollection 2017.

Mother-to-child transmission of HIV in Kenya: A cross-sectional analysis of the national database over nine years

Matilu Mwau  1   2 , Priska Bwana  2 , Lucy Kithinji  2 , Francis Ogollah  2 , Samuel Ochieng  2 , Catherine Akinyi  1 , Maureen Adhiambo  1 , Fred Ogumbo  1 , Martin Sirengo  3 , Caroline Boeke  4
Affiliations

Mother-to-child transmission of HIV in Kenya: A cross-sectional analysis of the national database over nine years

Matilu Mwau et al. PLoS One. .

Abstract

Objective: To describe factors associated with mother-to-child HIV transmission (MTCT) in Kenya and identify opportunities to increase testing/care coverage.

Design: Cross-sectional analysis of national early infant diagnosis (EID) database.

Methods: 365,841 Kenyan infants were tested for HIV from January 2007-July 2015 and results, demographics, and treatment information were entered into a national database. HIV risk factors were assessed using multivariable logistic regression.

Results: 11.1% of infants tested HIV positive in 2007-2010 and 6.9% in 2014-2015. Greater odds of infection were observed in females (OR: 1.08; 95% CI:1.05-1.11), older children (18-24 months vs. 6 weeks-2 months: 4.26; 95% CI:3.87-4.69), infants whose mothers received no PMTCT intervention (vs. HAART OR: 1.92; 95% CI:1.79-2.06), infants receiving no prophylaxis (vs. nevirapine for 6 weeks OR: 2.76; 95% CI:2.51-3.05), and infants mixed breastfed (vs. exclusive breastfeeding OR: 1.39; 95% CI:1.30-1.49). In 2014-2015, 9.1% of infants had mothers who were not on treatment during pregnancy, 9.8% were not on prophylaxis, and 7.0% were mixed breastfed. Infants exposed to all three risky practices had a seven-fold higher odds of HIV infection compared to those exposed to recommended practices. The highest yield of HIV-positive infants were found through targeted testing of symptomatic infants in pediatric/outpatient departments (>15%); still, most infected infants were identified through PMTCT programs.

Conclusion: Despite impressive gains in Kenya's PMTCT program, some HIV-infected infants present late and are not benefitting from PMTCT best practices. Efforts to identify these early and enforce evidence-based practice for PMTCT should be scaled up. Infant testing should be expanded in pediatric/outpatient departments, given high yields in these portals.

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Conflict of interest statement

Competing Interests: The authors declare no competing interests. The IT infrastructure was funded by Hewlett-Packard but the infrastructure funder had no role in study design, data collection and analysis, decision to publish, or preparation of the manuscript. The infrastructure funding does not alter our adherence to PLOS ONE policies on sharing data and materials.

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