| dc.description.abstract | In Kenya, the rise in mother to child transmission (MTCT) of HIV from 8.3% in 2016 to 11.5%
in 2018, compared to the global target of <5%, particularly, among medium and low HIV burden
counties, including Kericho is a worrying public health concern. Kericho County recorded an
increase in MTCT of HIV from 8.1% in 2014 to 14.5% in 2018, the reason for this increase is
not fully understood.Determinants of MTCT of HIV are multi-factorial, with complex pathways
which have not been fully explored.In this study determinants of MTCT of HIV among exposed
infants at the Kericho County referral hospital were assessed. Specifically, to assess maternal
sociodemographic and infant related determinants; maternal clinical determinants and predictors
of MTCT among HIV exposed infants. Using a cross-sectional study design, 102out of 129 HIV
positive postnatal mother-child pairs in the hospital were selected by simple random sampling,
consented and surveyed using interviewer administered questionnaires and clinical information
abstracted from patient records. Data was analyzed using Chi square tests followed by binary
logistic regression to show associations of maternal sociodemographic determinants; infant
related characteristics and maternal clinical determinants with infant‟s HIV status. The mean age
of mothers was 28.5 years (SD=6.2). HIV prevalence among infants enrolled was 13.7% with
median age at infants‟ HIV diagnosis being 8 weeks (IQR 4–12). Of all infants, 97% were
initiated on prophylaxis immediately after birth and 92.2% exclusively breast fed. Findings
revealed risk of MTCT significantly increase for infants whose mothers had low monthly income
(p= 0.025), CD4 count above 500 cells/ml (p= <0.042), viral load >50 copies/ml (p= <0.001),
infants that had delayed age (>6 weeks) at HIV diagnosis (p= <0.001), late initiation of infant
prophylaxis (p= <0.001), early mixed feeding in the first 3 days after birth (p= <0.001) and
mixed infant feeding within the first 6 months (p= 0.007). Early mixed feeding increased odds of
HIV transmission by 7 -fold (OR= 7.12, p= 0.019) and delay in infants age at HIV diagnosis
significantly increased MTCT risk (OR= 0.04, p= 0.005).Presence of stigma (OR= 0.073, p=
0.003) increased the likelihood of MTCT while high perceived self-efficacy (OR= 8.15, p=
0.008) was protective. These findings indicate need to improve mother‟s income levels and
implement PMTCT interventions addressing delays in infant testing and initiation of
prophylaxis, avoidance of mixed infant feeding, strengthening maternal viral load and CD4
monitoring, stigma reduction and building self-efficacy. | en_US |
