Outcomes of HIV-Exposed Children in Western Kenya: Efficacy of Prevention of Mother to Child Transmission in a Resource-Constrained Setting

• DOI: 10.1097/qai.0b013e3181d8ad51
• Publication Date: 2010-03-18T09:34:33Z
• Authors: Winstone M Nyandiko; Boaz Otieno-Nyunya; Beverly Musick; Sherri Bucher-Yia...; Pamela Akhaabi; Karin Lane; Constantin T Yian...; Kara Wools-Kalous...
• Keywords: Male; infant feeding; 610; HIV Infections; child survival; Cohort Studies; 03 medical and health sciences; 0302 clinical medicine; children; Pregnancy; Antiretroviral Therapy, Highly Active; Animals; Humans; Pregnancy Complications, Infectious; Developing Countries; Retrospective Studies; pMTCT; Incidence; 1. No poverty; HIV; Infant; ARV prophylaxis; Kenya; Survival Analysis; Infectious Disease Transmission, Vertical; 3. Good health; Treatment Outcome; Female

To compare rates of mother to child transmission HIV and infant survival in women-infant dyads receiving different interventions a prevention Mother Child Transmission (pMTCT) program western Kenya.Retrospective cohort study using prospectively collected data stored an electronic medical record system.Eighteen clinics Kenya.HIV-exposed infants enrolled between February 2002 July 2007, at any the United States Agency for International Development-Academic Model Providing Access Healthcare partnership clinics.Combined endpoint (CE) status mortality 3 18 months.Descriptive statistics, chi Fisher exact test, multivariable modeling.Between 2477 HIV-exposed children were registered care by pMTCT before months age. Median age enrollment was 6.1 weeks; 50.4% male. By months, 31 (1.3%) dead 183 (7.4%) lost follow-up. One thousand (40%) underwent DNA Polymerase Chain Reaction virologic test median 8.3 weeks: 5% infected, 89% uninfected, 6% indeterminate. Of 968 with specific results or CE infection death reached 84 (8.7%) infants. The 3-month significantly impacted (A) maternal prophylaxis [51 752 (6.8%) combination antiretroviral therapy (cART); 8 69 (11.6%) single-dose nevirapine (sdNVP); 25 147 (17%) no (P < 0.001)] (B) feeding method 889 (91.8%) mother-infant pairs which choice documented [5 29 (17.2%) exclusive breastfeeding; 13 110 (11.8%) mixed feeding; 54 750 (7.2%) formula = 0.041)]. 1201 > age: 41 (3.4%) deceased 329 (27.4%) 621 831 (74.7%) tested, 65 (10.5%) infected resulting 103 659 (15.6%). differed [52 441 cART; 96 (13.5%) sdNVP; 38 122 (31.2%) group but not 638 (96.8%) [7 35 (20%) breastfeeding, 14 63 (22.2%) mixed, 74 540 (13.7%) 0.131)]. On multivariate analysis, sdNVP (odds ratio: 0.4; 95% confidence interval: 0.2 0.8) cART 0.3; 0.6) associated fewer CE. At CE.Though ascertainment bias is likely, strongly suggest benefit reducing infection, do show 18-months from use formula. There high rate loss follow up, adherence testing protocol less than 50% indicating need address barriers related testing, improve outreach follow-up services.