Non-disclosure to male partners and incomplete PMTCT regimens associated with higher risk of mother-to-child HIV transmission: a national survey in Kenya

ABSTRACT

Health worker experience and community support may be higher in high HIV prevalence regions than low prevalence regions, leading to improved prevention of mother-to-child HIV transmission (PMTCT) programs. We evaluated 6-week and 9-month infant HIV transmission risk (TR) in a high prevalence region and nationally. Population-proportionate-to-size sampling was used to select 141 clinics in Kenya, and mobile teams surveyed mother-infant pairs attending 6-week and 9-month immunizations. HIV DNA testing was performed on HIV-exposed infants. Among 2521 mother-infant pairs surveyed nationally, 2423 (94.7%) reported HIV testing in pregnancy or prior diagnosis, of whom 200 (7.4%) were HIV-infected and 188 infants underwent HIV testing. TR was 8.8% (4.0%–18.3%) in 6-week and 8.9% (3.2%–22.2%) in 9-month cohorts including mothers with HIV diagnosed postpartum, of which 53% of infant infections were due to previously undiagnosed mothers. Of 276 HIV-exposed infants in the Nyanza survey, TR was 1.4% (0.4%–5.3%) at 6-week and 5.1% (2.5%–9.9%) at 9-months. Overall TR was lower in Nyanza, high HIV region, than nationally (3.3% vs. 7.2%, P = 0.02). HIV non-disclosure to male partners and incomplete ARVs were associated with TR in both surveys [aOR = 12.8 (3.0–54.3); aOR = 5.6 (1.2–27.4); aOR = 4.5 (1.0–20.0), aOR = 2.5, (0.8–8.4), respectively]. TR was lower in a high HIV prevalence region which had better ARV completion and partner HIV disclosure, possibly due to programmatic efficiencies or community/peer/partner support. Most 9-month infections were among infants of mothers without prior HIV diagnosis. Strategies to detect incident or undiagnosed maternal infections will be important to achieve PMTCT.

KEYWORDS:

• Prevention of mother-to-child transmission of HIV
• pediatric
• surveillance
• antiretroviral therapy
• disclosure

Disclosure statement

No potential conflict of interest was reported by the authors.

Disclaimers

The content is solely the responsibility of the authors and do not necessarily represent the official position of the U.S. Centers for Disease Control and Prevention.

Additional information

Funding

This publication was made possible by support from the Eunice Kennedy Shriver National Institute of Child Health and Human Development; National Center for HIV/AIDS, Viral Hepatitis, STD, and TB Prevention; Office of AIDS Research; Office of Research on Women’s Health; U.S. President’s Emergency Plan for AIDS Relief (PEPFAR) through cooperative agreement [#U2GPS002047] from the U.S. Centers for Disease Control and Prevention (CDC), Division of Global HIV and TB (DGHT). C.J.M. was supported by the University of Washington STD/AIDS Research Training Fellowship [NIH NRSA T32AI007140] and NIH research career development award [K12HD052023: Building Interdisciplinary Research Careers in Women’s Health Program – BIRCWH]. Support for G.J.S. includes a NIH K24 grant [HD054314/HD/NICHD] and the University of Washington (UW) Global Center for Integrated Health of Women Adolescents and Children (Global WACh). Lastly, support by the NIH funded program, UW Center for AIDS Research (CFAR) [P30 AI027757].