Progress Toward Eliminating Mother to Child Transmission of HIV in Kenya: Review of Treatment Guidelines Uptake and Pediatric Transmission Between 2013 and 2016—A Follow Up

• Published in: Maternal and child health journal Vol. 22; no. 12; pp. 1685 - 1692
• Main Authors: Pricilla, Ruby Angeline, Brown, Melinda, Wexler, Catherine, Maloba, May, Gautney, Brad J., Finocchario-Kessler, Sarah
• Format: Journal Article
• Language: English
• Published: New York Springer US 01-12-2018; Springer Nature B.V
• Subjects: Antiretroviral agents; Disease transmission; From the Field; Gynecology; Hospitals; Infants; Maternal and Child Health; Medicine; Medicine & Public Health; Pediatrics; Population Economics; Public Health; Sociology; Kenya; Preventing mother to child transmission (PMTCT); WHO guidelines; Pediatric HIV transmission; Option B; Gestational week of initiation
• ISSN: 1092-7875; 1573-6628
• DOI: 10.1007/s10995-018-2612-0

Background
Prevention of mother to child transmission of HIV (PMTCT) services are critical to achieve national and global targets of 90% antiretroviral therapy (ART) coverage in PMTCT, and mother to child transmission rates less than 5%. In 2012, Kenya adopted WHO’s recommended ART regimen for PMTCT “Option B+”.
Aims
This study assesses progress made in adopting these new guidelines and associated outcomes.
Methods
We analysed programmatic data of 2604 mother–infant pairs enrolled in the HIV Infant Tracking System (HITSystem) at four government hospitals in Kenya between January, 2013 and December, 2016. We then compared PMTCT trends between 2010 and 2012 and 2013–2016 for the same four government hospitals.
Results
A total of 2,371 (91.1%) received some ART regimen, however; only 911 (56.2%) mothers received ART regimens compliant with WHO Option B+. From 2013 to 2016, the percent of mothers on WHO Option B + doubled from 42 to 84% (p < 0.001), the mean week of ART initiation decreased from 19.0 to 9.7 weeks (p < 0.001), the percent of pregnant women who were already on ART at the time of PMTCT enrolment increased from 5.8 to 31.7% (p < 0.001), and the paediatric transmission rate decreased from 5.9 to 2.5% (p = 0.002).
Conclusion
Comparing data at these four Kenyan hospitals indicates significant progress has been made from 2010 to 2016. To continue these positive gains, concerted focus will be needed to target and improve the integration of new guidelines into clinical practice at the facility level, adherence to treatment and retention in care.