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Community-based evaluation of PMTCT uptake in Nyanza Province, Kenya.

Kohler PK, Okanda J, Kinuthia J, Mills LA, Olilo G, Odhiambo F, Laserson KF, Zierler B, Voss J, John-Stewart G - PLoS ONE (2014)

Bottom Line: ARV use during delivery was lowest (62%) and associated with facility delivery.Eighty percent of HIV infected women reported having their infant HIV tested, 11% of whom reported their child was HIV infected, 76% uninfected, 6% declined to say, 7% did not recall; 79% of infected children were reportedly receiving HIV care and treatment.In this survey, antenatal HIV test uptake was high; most HIV infected women received ARVs, though many women did not self-disclose HIV status to field team.

View Article: PubMed Central - PubMed

Affiliation: Global Health and Psychosocial & Community Health, University of Washington, Seattle, Washington, United States of America.

ABSTRACT

Introduction: Facility-based assessments of prevention of mother-to-child HIV transmission (PMTCT) programs may overestimate population coverage. There are few community-based studies that evaluate PMTCT coverage and uptake.

Methods: During 2011, a cross-sectional community survey among women who gave birth in the prior year was performed using the KEMRI-CDC Health and Demographic Surveillance System in Western Kenya. A random sample (n = 405) and a sample of women known to be HIV-positive through previous home-based testing (n = 247) were enrolled. Rates and correlates of uptake of antenatal care (ANC), HIV-testing, and antiretrovirals (ARVs) were determined.

Results: Among 405 women in the random sample, 379 (94%) reported accessing ANC, most of whom (87%) were HIV tested. Uptake of HIV testing was associated with employment, higher socioeconomic status, and partner HIV testing. Among 247 known HIV-positive women, 173 (70%) self-disclosed their HIV status. Among 216 self-reported HIV-positive women (including 43 from the random sample), 82% took PMTCT ARVs, with 54% completing the full antenatal, peripartum, and postpartum course. Maternal ARV use was associated with more ANC visits and having an HIV tested partner. ARV use during delivery was lowest (62%) and associated with facility delivery. Eighty percent of HIV infected women reported having their infant HIV tested, 11% of whom reported their child was HIV infected, 76% uninfected, 6% declined to say, 7% did not recall; 79% of infected children were reportedly receiving HIV care and treatment.

Conclusions: Community-based assessments provide data that complements clinic-based PMTCT evaluations. In this survey, antenatal HIV test uptake was high; most HIV infected women received ARVs, though many women did not self-disclose HIV status to field team. Community-driven strategies that encourage early ANC, partner involvement, and skilled delivery, and provide PMTCT education, may facilitate further reductions in vertical transmission.

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Related in: MedlinePlus

Sampling and Enrollment.
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pone-0110110-g001: Sampling and Enrollment.

Mentions: A random sample of 523 women who delivered in the previous year was identified, 437 (83.6%) were located, and 405 (92.7% of those located) agreed to participate (Figure 1). Among 275 women known to be HIV infected through prior HBCT, 247 (89.8%) consented to participate. However, only 173 (70%) of those enrolled reported to fieldworkers that they were HIV-positive and subsequently answered questions about PMTCT. Thus, the HIV-infected sample includes 43 women from the random community sample and 173 women from the HBCT sample to total 216 women.


Community-based evaluation of PMTCT uptake in Nyanza Province, Kenya.

Kohler PK, Okanda J, Kinuthia J, Mills LA, Olilo G, Odhiambo F, Laserson KF, Zierler B, Voss J, John-Stewart G - PLoS ONE (2014)

Sampling and Enrollment.
© Copyright Policy
Related In: Results  -  Collection

Show All Figures
getmorefigures.php?uid=PMC4215877&req=5

pone-0110110-g001: Sampling and Enrollment.
Mentions: A random sample of 523 women who delivered in the previous year was identified, 437 (83.6%) were located, and 405 (92.7% of those located) agreed to participate (Figure 1). Among 275 women known to be HIV infected through prior HBCT, 247 (89.8%) consented to participate. However, only 173 (70%) of those enrolled reported to fieldworkers that they were HIV-positive and subsequently answered questions about PMTCT. Thus, the HIV-infected sample includes 43 women from the random community sample and 173 women from the HBCT sample to total 216 women.

Bottom Line: ARV use during delivery was lowest (62%) and associated with facility delivery.Eighty percent of HIV infected women reported having their infant HIV tested, 11% of whom reported their child was HIV infected, 76% uninfected, 6% declined to say, 7% did not recall; 79% of infected children were reportedly receiving HIV care and treatment.In this survey, antenatal HIV test uptake was high; most HIV infected women received ARVs, though many women did not self-disclose HIV status to field team.

View Article: PubMed Central - PubMed

Affiliation: Global Health and Psychosocial & Community Health, University of Washington, Seattle, Washington, United States of America.

ABSTRACT

Introduction: Facility-based assessments of prevention of mother-to-child HIV transmission (PMTCT) programs may overestimate population coverage. There are few community-based studies that evaluate PMTCT coverage and uptake.

Methods: During 2011, a cross-sectional community survey among women who gave birth in the prior year was performed using the KEMRI-CDC Health and Demographic Surveillance System in Western Kenya. A random sample (n = 405) and a sample of women known to be HIV-positive through previous home-based testing (n = 247) were enrolled. Rates and correlates of uptake of antenatal care (ANC), HIV-testing, and antiretrovirals (ARVs) were determined.

Results: Among 405 women in the random sample, 379 (94%) reported accessing ANC, most of whom (87%) were HIV tested. Uptake of HIV testing was associated with employment, higher socioeconomic status, and partner HIV testing. Among 247 known HIV-positive women, 173 (70%) self-disclosed their HIV status. Among 216 self-reported HIV-positive women (including 43 from the random sample), 82% took PMTCT ARVs, with 54% completing the full antenatal, peripartum, and postpartum course. Maternal ARV use was associated with more ANC visits and having an HIV tested partner. ARV use during delivery was lowest (62%) and associated with facility delivery. Eighty percent of HIV infected women reported having their infant HIV tested, 11% of whom reported their child was HIV infected, 76% uninfected, 6% declined to say, 7% did not recall; 79% of infected children were reportedly receiving HIV care and treatment.

Conclusions: Community-based assessments provide data that complements clinic-based PMTCT evaluations. In this survey, antenatal HIV test uptake was high; most HIV infected women received ARVs, though many women did not self-disclose HIV status to field team. Community-driven strategies that encourage early ANC, partner involvement, and skilled delivery, and provide PMTCT education, may facilitate further reductions in vertical transmission.

Show MeSH
Related in: MedlinePlus