Determinants of mother to child transmission of HIV among exposed infants in Kericho County Referral Hospital, Kenya

Abstract

In Kenya, the rise in mother to child transmission (MTCT) of HIV from 8.3% in 2016 to 11.5% in 2018, compared to the global target of <5%, particularly, among medium and low HIV burden counties, including Kericho is a worrying public health concern. Kericho County recorded an increase in MTCT of HIV from 8.1% in 2014 to 14.5% in 2018, the reason for this increase is not fully understood.Determinants of MTCT of HIV are multi-factorial, with complex pathways which have not been fully explored.In this study determinants of MTCT of HIV among exposed infants at the Kericho County referral hospital were assessed. Specifically, to assess maternal sociodemographic and infant related determinants; maternal clinical determinants and predictors of MTCT among HIV exposed infants. Using a cross-sectional study design, 102out of 129 HIV positive postnatal mother-child pairs in the hospital were selected by simple random sampling, consented and surveyed using interviewer administered questionnaires and clinical information abstracted from patient records. Data was analyzed using Chi square tests followed by binary logistic regression to show associations of maternal sociodemographic determinants; infant related characteristics and maternal clinical determinants with infant‟s HIV status. The mean age of mothers was 28.5 years (SD=6.2). HIV prevalence among infants enrolled was 13.7% with median age at infants‟ HIV diagnosis being 8 weeks (IQR 4–12). Of all infants, 97% were initiated on prophylaxis immediately after birth and 92.2% exclusively breast fed. Findings revealed risk of MTCT significantly increase for infants whose mothers had low monthly income (p= 0.025), CD4 count above 500 cells/ml (p= <0.042), viral load >50 copies/ml (p= <0.001), infants that had delayed age (>6 weeks) at HIV diagnosis (p= <0.001), late initiation of infant prophylaxis (p= <0.001), early mixed feeding in the first 3 days after birth (p= <0.001) and mixed infant feeding within the first 6 months (p= 0.007). Early mixed feeding increased odds of HIV transmission by 7 -fold (OR= 7.12, p= 0.019) and delay in infants age at HIV diagnosis significantly increased MTCT risk (OR= 0.04, p= 0.005).Presence of stigma (OR= 0.073, p= 0.003) increased the likelihood of MTCT while high perceived self-efficacy (OR= 8.15, p= 0.008) was protective. These findings indicate need to improve mother‟s income levels and implement PMTCT interventions addressing delays in infant testing and initiation of prophylaxis, avoidance of mixed infant feeding, strengthening maternal viral load and CD4 monitoring, stigma reduction and building self-efficacy.