Maternal Predictors Of Perinatal Transmission Of HIV At Thika Level 5 Hospital
BACKGROUND: Perinatal transmission of Human Immunodeficiency Virus has been shown to be the main route of transmission to children accounting for 90% of new paediatric HIV infection in Kenya. Prevention of perinatal transmission is a major goal in care of HIV positive pregnant women. The country has made commitment to eliminating vertical transmission. By determining the factors that are associated with perinatal transmission, further strategies can be drawn to address these shortcomings. OBJECTIVE: To determine the difference in maternal factors that determine perinatal HIV transmission between HIV infected women with 2 year old children who are confirmed HIV positive and negative between March and August 2013. STUDY DESIGN: This was a cross-sectional study in which 114 HIV positive mother-child pairs were recruited. Those mothers with HIV positive babies (33) were compared with those with HIV negative babies in a subgroup analysis. SETTING: Thika Level 5 Hospital was the site for the study. DATA COLLECTION AND ANALYSIS: Mothers’biodata, antenatal care including CD4 cell count, ARV regimen used, mode of delivery, mode of infant feeding and prophylaxis and ELISA test at 18 months results were entered in the questionnaire (Appendix I) and analyzed using SPSS package. RESULTS: A total of 114 HIV mother child pairs were recruited into the study. The number of mothers 30 years and below and above 30 years was same. Majority of the mothers were married, had attained primary school level and had some form of employment at 75.5%, 57%and 60% respectively. About a third (28.9%) of the 2 year old children in the sample size (33) was HIV positive. There were significant associations between delayed and few attendance of antenatal care, delayed mother ARV initiation and infant prophylaxis and mixed feeding with perinatal HIV acquisition. Multiple logistic regression analysis revealed predictors of perinatal transmission as delayed initiation of ARVs (p value 0.013) and few counselling packages (p value 0.003). CONCLUSION: There was significantly less transmission of HIV to children whose mothers were initiated ARV’S before or during early pregnancy and received counselling on infant prophylaxis and nutrition, couple testing and use of condoms in pregnancy to prevent co infection. RECOMMENDATION: More emphasis should be placed towards empowering all health facilities on programmes initiating ARV treatment or prophylaxis early in the pregnancy, along with couple and infant counselling and postnatal follow up in order to achieve zero infections in the next generation.