Uptake of interventions in prevention of mother to child transmission of HIV among HIV positive mothers delivering in Kenyatta National Hospital

Abstract

Perinatalhuman immunodeficiency virus transmission has been shown to be a major routeof Human Immunodeficiency virus(HIV)transmission in children and it accounts for90% of new HIV infection in Kenya (2, 6). Prevention of perinatal HIV transmission is a major goal in care of HIV pregnant women. Awareness on perinatal HIV transmission has been shown here to be high but this has not translated into decrease in pediatric HIV infection from perinatal HIV transmission. In Kenya, VCT services, provision of ARVs and condoms (male) are free. By determining the Uptake of interventions to prevention of mother to child transmission of HIV 1 (PMTCT), the gaps can be identified to allow effective interventions to be adopted. OBJECTIVE; To determine the uptake of interventions to prevent mother to child transmission of human immunodeficiency virus (PMTCT) among HIV positive women delivering in Kenyatta National Hospital. Design: Analytic cross-sectional study. Setting: Kenyatta National Hospital maternity wards. Participants: All consenting HIV positive postnatal women in the maternity wards of Kenyatta National Hospital. Materials and methods: A structured questionnaire was administered through face to face interviews to the eligible and consenting post delivery mothers in the maternity wards. More information was obtained from the patient's file. Data was analyzed using SPSS software. Main outcome measure: Uptake of interventions in PMTCT of HIV. Results: This was a-cross sectional survey where 280 respondents were recruited and participated in the study. Majority were unbooked (56.5%) and had attained secondary school education and above. Over 90% of clients had received counseling on various aspectsofPMTCT ofHIY.CD4 testing was low (58.6%) while the disclosure rate high (83.2%) with the major reason for non-disclosure being fear of stigma. Only 43.9% of the clients had their partners testing positive and 46.1% did not know their partners HIV status. The uptakes for interventions were low for elective caesarian Section (36.8%) &formula feeding (41.4%) but high for Post-Exposure Prophylaxis (98.2%) and antiretroviral for prevention of mother to child transmission ofHIV (70%).Intention to use family planning methods was 94.6% (dual-20.4%, condoms-26.1 %). Replacement feeding and elective caesarian section uptakes were higher in the booked than unbooked clients. Antenatal clinic attendance at Kenyatta National Hospital was associated with higher chances of using ARVs for PMTCT(p<O.OOl),ECS(p<O.OOl)and , PEP(p=0.048).Disclosure of HIV status was associated with increased chances oftaking ARVs for PMTCT (p<0.001) , ECS(p<O.OOl) and replacement feeding (p=0.002).Counseling was associated with higher chances of taking ARVs(p<O.OOl),ECS(p<O.OOl)and replacement feeding(p=0.002). Conclusions: PMTCT interventions uptake still low in unbooked clients and clients who do not disclose their HIV status. Safe delivery and infant feeding counseling also needs emphasis.