Factors associated with Mother to child transmission of HIV in a Semi-arid County in Kenya, 2014-201

Abstract

Introduction: To eliminate mother-to-child-transmission of HIV eMTCT) a rate of <5% was recommended by the WHO in 2015. The rate was 8.3% for Kenya and 8.8% for Kajiado County in 2016. To identify causes of these higher rates, we described  factors associated with HIV transmission among HIV exposed infants (HEI) in Kajiado. Methods: We reviewed HEI 2014-2017 records downloaded from the national early-infant-diagnosis (EID) database. A case was defined as any record of HEI undergoing EID in Kajiado in 2014–2017. Dependent variable was HIV test result and the independent variables were demographic and clinical characteristics. To describe the study population means were calculated for continuous variables and proportions for categorical variables. We performed Multivariate logistic regression to study the factors associated with MTCT while controlling for other factors and we reported the Prevalence OR and their 95% Confidence Intervals. Results: We reviewed 4,195 HEI records. Males were 1,999 (47.7%); median age was 2 months (range of 1.5 – 6months) and 199 (4.7%) tested positive for HIV. Antiretroviral (ARV) prophylaxis was not provided to 308 (7.34%) infants and 291 (6.94%) mothers of the infants. Exclusive-breastfeeding was offered to 2,976 (70.9%) infants and 320 (7.6%) had mixed-feeding. Odds of having a positive HIV result was higher in infants not on ARV prophylaxis compared to those who received ARV prophylaxis (POR: 8.3; 95% CI: 5.9 –11.5); in infants whose mothers received no ARV prophylaxis compared to those whose mothers received ARV prophylaxis (POR: 6.8; 95% CI: 4.9 – 9.6) and in those mixed-fed compared to those who received exclusive breastfeeding (POR: 2.4; 95% CI: 1.3 – 4.3). In infants not on ARV prophylaxis (aOR: 2.86; 95% CI: 1.02 – 6.93); infants whose mothers received no ARV prophylaxis (aOR: 2.45; 95% CI: 1.52 – 3.92) and those mixed-fed (aOR: 2.00; 95% CI: 1.05 – 3.79) were independently associated with a positive HIV result. Conclusion: Transmission was higher where infants missed ARV prophylaxis or had mixed-feeding. Infant prophylaxis and exclusive breastfeeding by HIV positive women should be encouraged.