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
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by ensuring all HIV positive lactating women are on ARVS for prophylaxis or their own
health.