Roll-out of prevention of mother-to-child transmission of Human Immunodeficiency Virus in rural Kenya
Background: Prevention of mother-to-child transmission of HIV (PMCT) was first introduced in Kenya on a pilot basis in 1999 and scaled up from 2001 as an integrated HIV/AIDS prevention program within maternal child health services (MCH).
Methodology: An indigenous professional non-governmental organization (NGO) partnered with 12 District Health management teams (DHMTs) to scale-up integration of prevention of PMCT into MCH services to reach 80% of the pregnant women accessing care. DHMTs were empowered to provide standard training, delivery and support of PMCT services while the NGO partner provided technical support for training, security of critical consumables, support-supervision, commodity management and monitoring and evaluation. Results of the scale-up, uptake of HIV counselling and testing (HCT) and anti-retroviral prophylaxis over a one-year period are presented.
Results: PMCT services were provided in 341 facilities including 194 newly initiated sites. A total of 89,393 women found out their HIV status, 94% through antenatal testing and 6% maternity testing. Uptake of antenatal HCT was 73% with four-fifths of the women finding out their status at first antenatal visit. Uptake of HCT was significantly higher at District and sub-District hospitals compared to lower level facilities, and in low HIV prevalence Districts compared to high prevalence Districts (p< 0.001). Facilities in high HIV prevalence regions were 18 times more likely to deliver ARV prophylaxis compared to low prevalence Districts. Conclusion: Standardized approaches and partnership with the development partner enhanced PMCT scale-up. Further operational research is required to enhance quality of PMCT services at lower level facilities