Prevention of mother-to-child transmission of HIV in Kenya: challenges to implementation
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Date
2014Author
Plessis, Elsabé du
Shaw, Souradet Y
Gichuhi, Mary
Gelmon, Larry
Estambale, Bensen B
Lester, Richard
Kimani, Joshua
Avery, Lisa S
Language
enMetadata
Show full item recordAbstract
Background:
The prevention of mother-to-child transmission of human immunodeficiency virus (HIV) is lauded as
one of the more successful HIV prevention measures. However, despite some gains in the prevention of mother-to-
child transmission of HIV (PMTCT) in sub-Saharan Africa, mother-to-child transmission rates are still high. In Kenya,
mother-to-child transmission is considered one of the greatest health challenges and scaling up PMTCT services is
crucial to its elimination by 2015. However, guideline implementation faces barriers that challenge scale-up of
services. The objective of this paper is to identify barriers to PMTCT implementation in the context of a
randomized control trial on the use of structured mobile phone messages in PMTCT.
Methods:
The preliminary analysis presented here is based on survey data collected during enrolment in PMTCT
services at one of two health facilities in Nairobi, Kenya, with overall number of antenatal care (ANC) visits
determined from 48 hour follow up data.
Results:
Data was collected for 503 women. Despite significant differences in the type of facility and sample
characteristics between sites, all women presented to care at 20 weeks gestation or later and 88.8% attended less
than four ANC visits. PMTCT counselling at first visit had high coverage (86%), however less than a third of women
(31.34%) reported receiving contraception counselling. Although 60.8% of women had reportedly disclosed their
status to their partners, only 40% were aware of their partner
’
s status. Very few women had been tested for TB
(10%) or received single dose nevirapine during their first antenatal care appointment (20%).
Conclusion:
Revised PMTCT guidelines aim to reduce the inequity between PMTCT services in high and low
resource settings in efforts to eliminate mother-to-child transmission. However, guideline implementation in low
resource settings continues to be confronted with challenges related to late presentation, less than four ANC visits,
low screening rates for opportunistic infections, and limited contraception counselling. These challenges are further
complicated by lack of disclosure to partners. Effective scale up and implementation of PMTCT services requires
that such ongoing program challenges be identified and appropriately addressed within the local context.
Citation
du Plessis, E., Shaw, S. Y., Gichuhi, M., Gelmon, L., Estambale, B. B., Lester, R., ... & Avery, L. S. (2014). Prevention of mother-to-child transmission of HIV in Kenya: challenges to implementation. BMC health services research, 14(Suppl 1), S10.Publisher
University of Nairobi
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- Faculty of Health Sciences (FHS) [10385]