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Ongoing challenges in providing PMTCT in Kenya and Malawi
Lesley Odendal, 2014-01-24 06:50:00

Ongoing systemic issues are affecting the implementation of the 2010 World Health Organisation (WHO) guidelines on prevention of mother-to-child transmission (PMTCT) programmes in Kenya, according to a study presented at the 17th International Conference on AIDS and STIs in Africa (ICASA), held in Cape Town, South Africa, from 7 to 11 December 2013.

Kenya adopted WHO guidelines in 2012 that recommend the initiation of antiretroviral therapy during pregnancy and four visits to an antenatal clinic to maximise the support that can be given in order to successfully prevent HIV transmission. Nevertheless, around 40,000 infants are born with HIV each year in Kenya, despite improvements in the availability of antiretroviral therapy and PMTCT services.

A total of 503 pregnant women were recruited from two PMTCT clinics in Nairobi during their first antenatal clinic visit, as part of a randomised control trial which used mobile phone messaging to improve linkage to antenatal care, adherence to PMTCT medication, postnatal follow-up and to strengthen health information systems.

The data presented evaluated the extent to which study participants received care in compliance with national guidelines:

  • The proportion of women with HIV who attended four or more antenatal clinic visits.
  • The proportion of women not requiring antiretroviral therapy for their own health who initiated AZT by week 20 of pregnancy.
  • The proportion of women given single-dose nevirapine tablets at first contact with the PMTCT service.
  • The proportion of women counselled regarding HIV results, disclosure and partner testing.
  • The proportion of women who received contraception counselling.
  • The proportion of women screened for TB and opportunistic infections.

The study found that 443 (88.8%) of the women had less than four antenatal clinic visits, as recommended in the 2010 WHO PMTCT guidelines. It also found that 185 (36.8%) of the women were more than 28 weeks into gestation at their first antenatal clinic visit, compared to 259 (51.5%) at 21-28 weeks gestation and 59 (11.7%) who were at 20 weeks gestation or less. The 2010 WHO PMTCT guidelines recommend that as early as 14 weeks, HIV-positive pregnant women should start taking AZT and be counselled on adherence. Only 19.8% (n = 82) of the women received single-dose nevirapine at their first visit to the clinic to take them home with them, as recommended by the guidelines.

In the study, 60.8% (n = 306) of the women with HIV disclosed their HIV status to their partners immediately; 8.5% (n = 43) disclosed within the first year after diagnosis; and 5.2% (n = 26) disclosed their status more than one year after diagnosis. A quarter of the women (25.5%, n = 128) did not respond to a question about their disclosure to their partner in the survey.

Half of the women (50.1%) said their current pregnancy was planned; 31.3% discussed contraception methods with the healthcare provider; and 34.5% of the women had received contraception information after their previous pregnancy.

Although some aspects of the PMTCT programme are fairly successful, the researchers concluded, serious deficiencies are apparent in other areas. The lack of difference in results between clinical sites suggests that these problems are systemic rather than facility-specific.

Source:1