Maternal health care utilization among HIV-positive female adolescents in Kenya

Context: Given the health risks of HIV/AIDS and the risks of teenage pregnancy in general, pregnant HIV-positive adolescents in Kenya need maternal health care services that account for their HIV status. However, research on their access to and use of these services is scant. Methods: To examine maternal health care utilization, pregnancy history data collected in 2009 on 506 pregnancies among 393 HIV-positive female adolescents aged 15-19 enrolled in HIV/AIDS programs in Kenya were analyzed. Multilevel logit models were used to identify the variables associated with use of prenatal care, prevention of mother-to-child transmission (PMTCT) of HIV, skilled attendance at pregnancy outcomes and postnatal/postabortion care. Results: Use of PMTCT services was less common than use of prenatal care among HIV-positive adolescents (67% of pregnancies vs. 84%). These adolescents made four or more prenatal care visits in only 45% of pregnancies. In addition, use of skilled care during or after abortion or miscarriage was low (20%). The odds of receiving PMTCT services and skilled assistance (for any pregnancy outcome) were higher in Nairobi than in other regions (odds ratios, 3.8 and 2.7, respectively). HIV-positive adolescents were less likely to use maternal health care for higher-order pregnancies than for lower-order pregnancies (0.4-0.6). They were, however, more likely to receive prenatal care and PMTCT services when their husband rather than someone else was responsible for the pregnancy (3.7 and 4.9, respectively). Conclusion: Pregnant, HIV-positive adolescents need maternal health care services-including PMTCT care-that take into account parity, paternity dynamics and regional variations in use