Gaps in Adolescent Engagement in Antenatal Care and Prevention of Mother-to-Child HIV Transmission Services in Kenya

BACKGROUND:Rates of pregnancy and HIV infection are high among adolescents. However, their engagement in prevention of mother-to-child HIV transmission (PMTCT) services is poorly characterized. We compared engagement in the PMTCT cascade between adult and adolescent mothers in Kenya. METHODS:We cond...

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Published in:	Journal of acquired immune deficiency syndromes (1999) Vol. 74; no. 1; pp. 30 - 37
Main Authors:	Ronen, Keshet, McGrath, Christine J, Langat, Agnes C, Kinuthia, John, Omolo, Danvers, Singa, Benson, Katana, Abraham K, NgʼAngʼA, Lucy W, John-Stewart, Grace
Format:	Journal Article
Language:	English
Published:	United States Copyright Wolters Kluwer Health, Inc. All rights reserved 01-01-2017 Lippincott Williams & Wilkins Ovid Technologies
Subjects:	Adolescent Adult Anti-Retroviral Agents - therapeutic use Cross-Sectional Studies Disease prevention Disease transmission Female HIV HIV Infections - prevention & control Human immunodeficiency virus Humans Infant Infant, Newborn Infectious Disease Transmission, Vertical - prevention & control Kenya Lentivirus Maternal & child health Pregnancy Prenatal care Prenatal Care - statistics & numerical data Retroviridae Teenagers Young Adult Kenya
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Summary:	BACKGROUND:Rates of pregnancy and HIV infection are high among adolescents. However, their engagement in prevention of mother-to-child HIV transmission (PMTCT) services is poorly characterized. We compared engagement in the PMTCT cascade between adult and adolescent mothers in Kenya. METHODS:We conducted a nationally representative cross-sectional survey of mother–infant pairs attending 120 maternal child health clinics selected by probability proportionate to size sampling, with a secondary survey oversampling HIV-positive mothers in 30 clinics. Antenatal care (ANC) attendance, HIV testing, and antiretroviral (ARV) use were compared between adolescent (age ≤19 years) and adult mothers using χ tests and logistic regression. RESULTS:Among 2521 mothers, 278 (12.8%) were adolescents. Adolescents were less likely than adults to be employed (16.5% vs. 37.9%), married (66.1% vs. 88.3%), have intended pregnancy (40.5% vs. 58.6%), or have disclosed their HIV status (77.5% vs. 90.7%) (P < 0.01 for all). Adolescents were less likely than adults to attend ≥4 ANC visits (35.2% vs. 45.6%, P = 0.002). This effect remained significant when adjusting for employment, household crowding, pregnancy intention, gravidity, and HIV status [adjusted odds ratio (95% confidence interval) = 0.54 (0.37 to 0.97), P = 0.001]. Among 2359 women without previous HIV testing, 96.1% received testing during pregnancy; testing levels did not differ between adolescents and adults. Among 288 HIV-positive women not on antiretroviral therapy before pregnancy, adolescents were less likely than adults to be on ARVs (65.0% vs. 85.8%, P = 0.01) or to have infants on ARVs (85.7% vs. 97.7%, P = 0.005). CONCLUSIONS:Adolescent mothers had poorer ANC attendance and uptake of ARVs for PMTCT. Targeted interventions are needed to improve retention of this vulnerable population in the PMTCT cascade.
Bibliography:	ObjectType-Article-1 SourceType-Scholarly Journals-1 ObjectType-Feature-2 content type line 23
ISSN:	1525-4135 1944-7884 1944-7884
DOI:	10.1097/QAI.0000000000001176