AEGiS-15IAC: Challenges with implementation and scaling up of prevention of mother to child transmission of HIV-1 Infection (PMTCT) in rural Kenya.

15th International AIDS Conference

Bangkok, Thailand - July 11-16, 2004

Challenges with implementation and scaling up of prevention of mother to child transmission of HIV-1 Infection (PMTCT) in rural Kenya.

Int Conf AIDS 2004 Jul 11-16; 15:(abstract no. ThOrB1350)

Sawe FK, Foglia G, Ngeno CH, Birx D, Robb M
United States Army Medical Research Unit, Kericho, Kenya

ISSUES: Less than 1% of pregnant women in Sub Sahara Africa (SSA) have access to PMTCT services yet it accounts for more than 90% of all children that were infected through MTCT of HIV infections in the world. Insufficient capacity of health sectors are major obstacles to PMTCT service delivery in many countries.

DESCRIPTION: The Kericho PMTCT of HIV infection program is located 300 km northwest of Nairobi, Kenya. It commenced in August 01 in three hospitals and has now expanded to a total of 23 health facilities. Antenatal clients are offered PMTCT services with routine reproductive health care. Fifty-six nurses have been trained in PMTCT counseling with some recieving further training in rapid HIV antibody testing and "training of trainers". There were 20,256 new antenatal cases. 9,847 (49%) pregnant women were offered PMTCT counseling, out of which 9,407 (96%) accepted to be tested. 7,771 (83%) of those tested received their results. 871 (9.3%) of the pregnant women were HIV infected and 608 (70%) of them and 339 (39%) of their infants were given Nevirapine. The percentage of pregnant women offered counselling has increased from an initial 4% in the first 4 months of the program to approximately 100% in the last 11 months.

LESSONS LEARNED: Short-course ARV prophylactic regimens, suitable for reducing peripartum HIV-1 infection in resource-poor countries, can be successfully upscaled, however, safe infant feeding options remains a major challenge.

RECOMMENDATIONS: PMTCT services should be made available to paternal partners. There is a need for intrapartum and immediate postpartum testing in women who had no access to VCT services during pregnancy. Single dose infant Nevirapine vials that can be administered by the mothers soon after birth need to be developed. Trials are needed in SSA to evaluate interventions to reduce breastfeeding transmission, such as, extended postpartum ARV prophylaxis to the mother and/or infant.

Keywords: AEGIS, HIV Infections, Nevirapine, Mothers, Breast Feeding, Rural Population, Counseling, Research Design, Poverty, Acquired Immunodeficiency Syndrome, Maternal-Child Health Centers, Kenya, Africa, Africa, Northern, Child, Infant, Pregnant Women, Humans, Female, Pregnancy, prevention & control

040711
ThOrB1350