Determinants Of Human Immunodeficiency Virus (HIV) Transmission Among Children Born To HIV-Infected Mothers On Pmtct Program In Kilifi County: A Case Control Study

BackgroundElimination and prevention of mother to child human immunodeficiency virus (HIV) transmission remains a global public health concern. Identification of significant risk factors of mother to child transmission is essential in reducing the burden of pediatric HIV in terms of cost of treatment, morbidity and mortality. Only a few studies have been done to demonstrate the importance of Prevention of Mother to Child Transmission (PMTCT) cascade, including the indicators and how missing one of the crucial steps of the cascade could increase the risk of infant HIV transmission. This study seeks to determine maternal risk factors related to HIV transmission among children born to HIV-infected mothers enrolled in PMTCT program in Kilifi County between July 2018 and June 2019. MethodsThis was a retrospective unmatched case control study. Systematic random sampling was used to select medical records of 183 exposed infants (61 cases and 122 controls). A structured tool was used to collect data. Proportions and frequency distribution was done in univariate analysis and in bivariate analysis, chi-square and logistic regression (odds ratio) was used to determine any association and strength of association between categorical variables. ResultsReceiving maternal HAART in ANC was established as the major determinant of a favorable HEI outcome in this study. Infants whose mothers had received maternal HAART in ANC were 52.55 (14.89 - 185.48) times more likely to be HIV negative compared to those whose mothers did not receive maternal HAART in ANC. Disclosure of HIV status by the mother at ANC was 3.18 (1.28 - 7.90) times more likely to determine a favorable outcome of the HEI compared to non-disclosure. When adjusted for other factors, it was 6.27 (1.20 - 20.05) times more likely to determine a favorable outcome. ConclusionThe study established the importance of PMTCT service delivery in reduction of vertical transmission of HIV. Women who defaulted on the PMTCT cascade services had higher odds of having a HIV positive infant compared to women who accessed all the PMTCT services at the recommended time.