Determinants Of Mother To Child Transmission (Mtct) Of HIV Among Seropositive Mothers At Thika Level 5 Hospital, In Kiambu County, Kenya

Abstract

Background: In Kenya, Human Immune-deficiency Virus (HIV) prevalence is still high (6.9%) compared to national average of 6%. Despite Kenya’s prevention of mother to child transmission of HIV (PMTCT) efforts to reduce mother to child transmission (MTCT) of HIV rates to <5% by 2015, the transmission rate is still high, about 14%. The high maternal and MTCT prevalence have been associated with increased fetal and maternal deaths, morbidities and other adverse pregnancy outcomes even globally. Objective: To establish determinants of MTCT of HIV among seropositive post-natal mothers at Thika Level 5 hospital, in Kiambu County, Kenya. Specifically, the study sought to examine the influence of socio-demographic characteristics of seropositive mothers, maternal factors, and infant related factors on MTCT of HIV. Materials and Methods: This was a cross-sectional descriptive study of 94 seropositive mothers at Thika level 5 hospital. Interviewer-administered questionnaire and abstracted medical review record were used to collect relevant data. The questionnaire was pretested before being used during the actual data collection exercise. Descriptive statistics were used to describe data. The Chi-square of independence was used to test the association between the study variables and MTCT of HIV. Multiple logistic regression was used to explore relationships between variables while adjusted odds ratios were used to test associations between study variables and establish determinants of MTCT of HIV and thus formed the basis for testing the study hypotheses. Results: The study found out that mothers’ type of residence whether urban or rural influences MTCT of HIV. Mothers whose residences were in rural areas were more than two times likely to transmit HIV to their babies than those whose residences were in urban areas (AOR: 2.36; 95% CI: 1.45-8.52]. In addition, the World Health Organization (WHO) clinical stage was found to influence the MTCT of HIV at Thika Level 5 hospital. As compared to mothers who enrolled for ARV treatment in the first and second trimester, mothers who enrolled for ARV treatment at the third trimester were more than 2 times likely to transmit HIV to their children (AOR: 2.3; 95% CI: 1.9-13.7, p < 0.05). In addition, mothers who enrolled to PMTCT care during WHO clinical stage II were more than three times likely to transmit HIV to their children compared to those who enrolled to PMTCT at WHO stage I (AOR: 3.4; 95% CI: 1.5-8.4, p < 0.05). Regarding types of ARV prophylaxis given to infants after birth, infants who were provided no ARV prophylaxis and those provided NVP only, were about 7 times and 6 times significantly more likely to contract HIV from their mothers than those infants provided with Nevirapine (NVP) and Zidovudine (AZT) (AOR:7.26; 95%CI:2.84-21.03] and (AOR: 6.12; 95%CI: 2.09-14.23). Conclusion: Socio-demographic, maternal-related factors and infant related factors should be monitored by health care providers when taking care of seropositive postnatal mothers to prevent occurrences of HIV MTCT. Dissemination: The results of the study will be presented to the School of Nursing of the University of Nairobi. Two manuscripts based on the study objectives will be prepared and published in a peer-reviewed journal for the wider audience and access.