Mother-to-child transmission of HIV in Kenya: A cross-sectional analysis of the national database over nine years.
PLoS One
; 12(8): e0183860, 2017.
Article
em En
| MEDLINE
| ID: mdl-28850581
ABSTRACT
OBJECTIVE:
To describe factors associated with mother-to-child HIV transmission (MTCT) in Kenya and identify opportunities to increase testing/care coverage.DESIGN:
Cross-sectional analysis of national early infant diagnosis (EID) database.METHODS:
365,841 Kenyan infants were tested for HIV from January 2007-July 2015 and results, demographics, and treatment information were entered into a national database. HIV risk factors were assessed using multivariable logistic regression.RESULTS:
11.1% of infants tested HIV positive in 2007-2010 and 6.9% in 2014-2015. Greater odds of infection were observed in females (OR 1.08; 95% CI1.05-1.11), older children (18-24 months vs. 6 weeks-2 months 4.26; 95% CI3.87-4.69), infants whose mothers received no PMTCT intervention (vs. HAART OR 1.92; 95% CI1.79-2.06), infants receiving no prophylaxis (vs. nevirapine for 6 weeks OR 2.76; 95% CI2.51-3.05), and infants mixed breastfed (vs. exclusive breastfeeding OR 1.39; 95% CI1.30-1.49). In 2014-2015, 9.1% of infants had mothers who were not on treatment during pregnancy, 9.8% were not on prophylaxis, and 7.0% were mixed breastfed. Infants exposed to all three risky practices had a seven-fold higher odds of HIV infection compared to those exposed to recommended practices. The highest yield of HIV-positive infants were found through targeted testing of symptomatic infants in pediatric/outpatient departments (>15%); still, most infected infants were identified through PMTCT programs.CONCLUSION:
Despite impressive gains in Kenya's PMTCT program, some HIV-infected infants present late and are not benefitting from PMTCT best practices. Efforts to identify these early and enforce evidence-based practice for PMTCT should be scaled up. Infant testing should be expanded in pediatric/outpatient departments, given high yields in these portals.
Texto completo:
1
Coleções:
01-internacional
Base de dados:
MEDLINE
Assunto principal:
Complicações Infecciosas na Gravidez
/
Infecções por HIV
/
Transmissão Vertical de Doenças Infecciosas
/
Fármacos Anti-HIV
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Nevirapina
/
Terapia Antirretroviral de Alta Atividade
Tipo de estudo:
Diagnostic_studies
/
Guideline
/
Observational_studies
/
Prevalence_studies
/
Prognostic_studies
/
Risk_factors_studies
Limite:
Female
/
Humans
/
Infant
/
Newborn
/
Pregnancy
País/Região como assunto:
Africa
Idioma:
En
Ano de publicação:
2017
Tipo de documento:
Article