Determinants of prevention of mother to child HIV transmission outcomes among women at the Homa bay county referral Hospital, Kenya

Abstract

Homa Bay County had 10% of the children 0-14 years diagnosed with HIV in Kenya in 2017. The county also reported 9.7% of the national annual AIDS-related mortalities among children and 8.8% of new HIV infections among children for the same age group nationally in the same year. Different determinants have been related to varying Prevention of Mother-to-Child Transmission (PMTCT) OF HIV outcomes across different regions. However, the Homa Bay County's determinants have not been investigated. This study assessed maternal, health systems, and male involvement related determinants of PMTCT outcomes among PMTCT mothers at the Homa Bay County Referral Hospital. The research used a descriptive cross-sectional study on a sample of 274 mothers drawn from 4129 women of reproductive age attending care and treatment at the study setting. Eligible participants were required to have been on PMTCT follow up at the study setting and with documented HIV test results (PMTCT outcome) for their child. Simple random sampling was used to sample study participants until the required sample size was achieved. Purposive sampling was used to identify participants for Key Informant Interviews. A mixed-method approach was used to collect quantitative and qualitative data. Quantitate data were collected using a structured questionnaire, while qualitative data were collected using interview guides customized for Key Informants. All the sampled participants; 274, were accessible. However, one (1) questionnaire was rejected because of incompleteness; hence, data is reported for 273 participants. A majority of the participants; 158(57.9%) were aged between 30 to 39 years with the mean age being 32.16 (± 5.54 SD) years. In terms of PMTCT outcome, 10(3.7%) of the participants had a HIV sero-positive child. Chi-square (χ²)test established existence of statistically significant associations between maternal factors; reason for missing scheduled clinic visit, missing to take ART medications, reasons for missing to take ART medications, and missing to provide ART prophylaxis to infant/child, and PMTCT outcome at α ≤ 0.05 (χ²:p=0.002, p=0.005, p=0.006, and p=0.05) respectively. Reason for missing scheduled clinic visit and reason for missing to take ART medications demonstrated higher likelihood (odds) of determining PMTCT outcome (OR=5.122, 95% CI: 0.139-189.53; p=0.002) and (OR=5.751, 95% CI: 0.615-53.781; p=0.006) respectively. Statistically significant associations were further evident between health systems factors; provision of routine pre-conception counseling and provision and discussion of infant diagnosis results with health care provider and PMTCT outcome (χ²: p=0.018 and p=0.000) respectively. Provision and discussion of infant diagnosis results with health care provider had a higher likelihood (odds) of determining PMTCT outcome (OR=1.530, 95% CI: 0.361-6.486; p=0.000). In terms of male involvement, statistically significant associations were evident of male partner knowing HIV status of participant(s) and male partners reaction to discussions on HIV transmission to infant/child (χ²: p=0.000 and p=0.000) respectively. Nonetheless, male partner knowing HIV status of participant(s) had higher odds of determining PMTCT outcome (OR=6.0, 95% CI: 0.655-54.997; p=0.000). Qualitative data were analyzed manually based on emerging themes and presented verbatim with the quantitative findings. The findings of this study identify determinants with higher likelihood of determining PMTCT outcomes. This may help in formulation of interventions geared towards reducing the high MTCT rates in Homa Bay County.