Effectiveness of PMPCT at Naivasha District Hospital: outcomes of HIV exposed infants

Abstract

Background and Significance Effective Prevention of Mother-to-Child Transmission (PMTCT) of HIV/AIDS programme can reduce Mother-to-child transmission (MTCT) of HIV from 30-45% to 2%. Global efforts aim to reduce MTCT to less than 5% by the year 2015. Objective: To evaluate the effectiveness of PMTCT at Naivasha District Hospital through determination of the outcomes of HIV exposed infants, specifically HIV free survival during the first 18 months of life. Methodology This was a retrospective longitudinal study targeting mother-infant pairs seeking HIV care at the comprehensive care clinic. Consenting mothers completed a questionnaire that assessed socio-demographic characteristics and uptake of PMTCT interventions. Infant HIV status was obtained from records and HIV antibody testing at 18 months for previously untested infants. HIV transmission rates and mortality rates among HIV exposed infants were estimated. Kaplan Meier analysis was used to determine HIV free survival pattern. Results One hundred and thirteen mother-infant pairs were enrolled, 99 (87.7%) mothers and 104 (92%) infants received antiretrovirals. Although, 79 (85.6%) infants were breastfed, only 63 (55.8%) were exclusively breastfed for six months. Most 100 (88.5%) infants had HIV deoxyribonucleic acid polymerase chain reaction testing at 6 weeks, 84 (80.8%) had follow up HIV antibody testing at 18 months. Infant HIV infection was 2.7% at 6 weeks and 4.4% between 6 weeks and 18 months giving an overall MTCT rate of 7.1%. Infant mortality rate was 0.9% at 6 weeks and 7.1% between 7 weeks and 18 months giving an overall mortality rate of 8%, and an18 month HIV-free survival rate of 83.9%. Infant HIV free survival was associated with mothers’ knowledge of positive HIV status and CD4 counts before pregnancy. Mixed fed infants were more likely to turn HIV positive by 18 months. Causes of mortality were pneumonia, gastroenteritis, neonatal sepsis and cardiac failure. Conclusion The PMTCT programme reduced HIV infection and mortality in 83.96% of HIV exposed infants. MTCT rates increase substantially after 6 weeks indicating the urgent need for interventions to reduce breast milk transmission. Recommendations The PMTCT programme in Naivasha District Hospital needs to address sub-optimal ARV coverage among HIV positive women and their infants, and to encourage safe breastfeeding by ensuring all HIV positive lactating women are on ARVS for prophylaxis or their own health.