HIV Transmission To Infants In Relation To Mode Of Feeding And Mother’s Immunological Status In Kirinyaga County, Kenya

ABSTRACT

Ailments such as malaria, measles, pneumonia, common cold and HIV/AIDS are the major cause of death in infants and children. worldwide, it was estimated that 1.8 million children below 15 years were HIV infected by 2017. Over 90% were infected through mother to child transmission (MTCT) during pregnancy, at birth and during breast-feeding. During that period, Kenya had about 12,940 children who had the infection and 1,480 of these were from Kirinyaga County. The Kenyan government has put intervention measures to reduce these infections by ensuring availability of highly active anti-retroviral therapy (HAART) and promoting delivery by elective caesarean section. These measures are intended to decrease HIV transmission rate to below 2% and reduce new pediatric HIV infections by 90% by 2030. The current study was aimed at investigating HIV transmission to infants in relation to mode of infant feeding, use of anti-retroviral therapy (ART) during pregnancy and mothers‟ immunity in Kirinyaga County. This was a cross-sectional study involving data collection from 303 HIV-positive pregnant women offered prenatal services in Kerugoya County Referral Hospital. These women gave birth to live infants and accessed local program on prevention of Mother to child transmission (PMTCT) of HIV for 18 months. Use of anti-retroviral drugs and mode of feeding the infant during the first six months of life were considered as the main possible determinants of HIV transmission. CD4-count and viral load test were performed on all women after delivery to evaluate ART treatment and monitor the mothers‟ immunity. HIV testing on infants was performed 6 weeks after birth using polymerase chain reaction (PCR). Antibody tests were done at 9th and 18th months using rapid test with either Unigold or Determine strips. In cases where antibody tests were positive while the first PCR was negative, confirmatory PCR test was performed. Categorical data was analysed using Chi-square test with 95% confidence interval as the set confidence limit. Out of 303 infants, 2 died before 9 months of age, 14 were HIV-positive by end of study period. All the 14 infants who got the infection were exclusively breast-fed. Results showed that exclusive breast-feeding (EBF) had a significant effect in HIV transmission (χ²=4.167; df=1; p= 0.045) compared to exclusive replacement feeding (ERF), which had no transmission. Low CD4 cell count was not significantly associated with HIV transmission (χ²=2.966; df=1; p=0.085) although MTCT was higher in babies born of mothers with low CD4 count. Anti-retro viral regimen being taken by mothers did not influence risk of transmission (χ2=1.944; df=1; p = 0.132) although there were more MTCT from mothers who were on Zidovudine+ Lamivudine+ Nevirapine (AZT+3TC+NVP) combination compared to other regimes. In conclusion, vertical transmission of HIV did not occur to infants who were replacement fed nor to those delivered through cesarean section. The study recommends use of exclusive-replacement feeding. This should however be made Affordable, Feasible, Accessible, Safe and Sustainable (AFASS) to HIV positive mothers. Expectant HIV-positive women should be monitored closely for ARV adherence and adverse drug reactions (ADR‟s) during antenatal and breast-feeding period. More studies need to be done regarding the ARV combination used by the mothers during Breast-feeding period.