Early diagnosis in infants born to HIV-positive adolescent compared to adult mothers in Kisumu, Kenya

Thesis (Master's)--University of Washington, 2019Although many countries have made great efforts to establish prevention of mother to child HIV transmission (PMTCT) services, globally 160,000 children are newly infected with HIV each year. Early infant diagnosis (EID) of HIV is critical to the survival of HIV-positive infants. While adolescent girls, defined by WHO as 10-19 years olds, represent a growing proportion of persons living with HIV, accumulating data show that adolescents have poor engagement in HIV care, retention, antiretroviral adherence, and treatment outcomes. Less is known about adolescent uptake of PMTCT of HIV services including early infant diagnosis. A retrospective cohort study was conducted among 967 HIV positive pregnant women in Kisumu, Kenya followed up between October 2016 and September 2018 to assess EID uptake. Early infant HIV diagnosis completion rates were measured by linking maternal HIV exposed infant (HEI) data with antenatal care (ANC) data using mothers’ unique patient identifiers. Completion of the six-week EID testing, which has been standard of care since 2006, was compared between adolescent and adult mothers using a generalized linear model with a Poisson link. A total of 967 HIV positive pregnant women were included in the study, of whom 63 (6.5%) were adolescent mothers aged 10-19. The mean age for adolescent mothers was 17.8 years (Standard Deviation (SD) 1.6) and that of adult mothers was 28.3 years (SD 4.9). Twenty-four (38.1%) of the adolescent mothers were not married, while 97 (10.7%) of older women were not married. The rate of EID uptake was not significantly different for adolescent mothers compared to adult mothers (risk ratio (RR): 0.977; 95% Confidence Interval [CI) 0.875, 1.090). HIV positive mothers on ART for a longer period of time had a higher rate of EID uptake compared to those on ART for a shorter period of time after controlling for facility type, mothers age, parity and nevirapine use by infants, (Adjusted RR (aRR)= 1.056; 95% CI 1.002, 1.114). Use of nevirapine by the infants born to these women trended toward statistical significance in the rate of EID uptake after adjusting for facility type, mothers age, parity and mother’s number of years on ART, (aRR = 1.152; 95% CI 0.994, 1.335, p=0.061) Results showed that being an adolescent mother was not associated with failure to access early infant HIV diagnosis 6 weeks after birth. An infant taking nevirapine and a mother on ART for a longer period of time had a higher likelihood of EID uptake, showing that linking HIV-positive women and retaining them in HIV care for treatment may have an impact on improving early infant HIV diagnosis for their exposed infants