Community-based evaluation of PMTCT uptake in Nyanza Province, Kenya

• Published in: PloS one Vol. 9; no. 10; p. e110110
• Main Authors: Kohler, Pamela K, Okanda, John, Kinuthia, John, Mills, Lisa A, Olilo, George, Odhiambo, Frank, Laserson, Kayla F, Zierler, Brenda, Voss, Joachim, John-Stewart, Grace
• Format: Journal Article
• Language: English
• Published: United States Public Library of Science 31.10.2014; Public Library of Science (PLoS)
• Subjects: Acquired immune deficiency syndrome; Adolescent; Adult; AIDS; Analysis; Anti-HIV Agents - therapeutic use; Antiretroviral agents; Antiviral agents; Assessments; Children; Communities; Data Collection; Demographics; Disease control; Disease prevention; Disease transmission; Female; HIV; HIV Infections - diagnosis; HIV Infections - drug therapy; HIV Infections - transmission; HIV tests; Human immunodeficiency virus; Humans; Infectious Disease Transmission, Vertical - prevention & control; Kenya; Medicine and health sciences; Patient Acceptance of Health Care - statistics & numerical data; Postpartum; Pregnancy; Pregnancy Complications, Infectious - diagnosis; Pregnancy Complications, Infectious - drug therapy; Prenatal Diagnosis; Research and Analysis Methods; Residence Characteristics; Socioeconomics; Womens health; Young Adult; Kenya; Atlanta Georgia; Cameroon; United States > US; Africa; Uganda; Georgia
• ISSN: 1932-6203; 1932-6203
• DOI: 10.1371/journal.pone.0110110

Facility-based assessments of prevention of mother-to-child HIV transmission (PMTCT) programs may overestimate population coverage. There are few community-based studies that evaluate PMTCT coverage and uptake. During 2011, a cross-sectional community survey among women who gave birth in the prior year was performed using the KEMRI-CDC Health and Demographic Surveillance System in Western Kenya. A random sample (n = 405) and a sample of women known to be HIV-positive through previous home-based testing (n = 247) were enrolled. Rates and correlates of uptake of antenatal care (ANC), HIV-testing, and antiretrovirals (ARVs) were determined. Among 405 women in the random sample, 379 (94%) reported accessing ANC, most of whom (87%) were HIV tested. Uptake of HIV testing was associated with employment, higher socioeconomic status, and partner HIV testing. Among 247 known HIV-positive women, 173 (70%) self-disclosed their HIV status. Among 216 self-reported HIV-positive women (including 43 from the random sample), 82% took PMTCT ARVs, with 54% completing the full antenatal, peripartum, and postpartum course. Maternal ARV use was associated with more ANC visits and having an HIV tested partner. ARV use during delivery was lowest (62%) and associated with facility delivery. Eighty percent of HIV infected women reported having their infant HIV tested, 11% of whom reported their child was HIV infected, 76% uninfected, 6% declined to say, 7% did not recall; 79% of infected children were reportedly receiving HIV care and treatment. Community-based assessments provide data that complements clinic-based PMTCT evaluations. In this survey, antenatal HIV test uptake was high; most HIV infected women received ARVs, though many women did not self-disclose HIV status to field team. Community-driven strategies that encourage early ANC, partner involvement, and skilled delivery, and provide PMTCT education, may facilitate further reductions in vertical transmission.