Mwau Matilu, Bwana Priska, Kithinji Lucy, Ogollah Francis, Ochieng Samuel, Akinyi Catherine, Adhiambo Maureen, Ogumbo Fred, Sirengo Martin, Boeke Caroline
Centre for Infectious and Parasitic Diseases Control Research, Kenya Medical Research Institute, Busia, Kenya.
Centre for Virus Research, Kenya Medical Research Institute, Nairobi, Kenya.
PLoS One. 2017 Aug 29;12(8):e0183860. doi: 10.1371/journal.pone.0183860. eCollection 2017.
To describe factors associated with mother-to-child HIV transmission (MTCT) in Kenya and identify opportunities to increase testing/care coverage.
Cross-sectional analysis of national early infant diagnosis (EID) database.
365,841 Kenyan infants were tested for HIV from January 2007-July 2015 and results, demographics, and treatment information were entered into a national database. HIV risk factors were assessed using multivariable logistic regression.
11.1% of infants tested HIV positive in 2007-2010 and 6.9% in 2014-2015. Greater odds of infection were observed in females (OR: 1.08; 95% CI:1.05-1.11), older children (18-24 months vs. 6 weeks-2 months: 4.26; 95% CI:3.87-4.69), infants whose mothers received no PMTCT intervention (vs. HAART OR: 1.92; 95% CI:1.79-2.06), infants receiving no prophylaxis (vs. nevirapine for 6 weeks OR: 2.76; 95% CI:2.51-3.05), and infants mixed breastfed (vs. exclusive breastfeeding OR: 1.39; 95% CI:1.30-1.49). In 2014-2015, 9.1% of infants had mothers who were not on treatment during pregnancy, 9.8% were not on prophylaxis, and 7.0% were mixed breastfed. Infants exposed to all three risky practices had a seven-fold higher odds of HIV infection compared to those exposed to recommended practices. The highest yield of HIV-positive infants were found through targeted testing of symptomatic infants in pediatric/outpatient departments (>15%); still, most infected infants were identified through PMTCT programs.
Despite impressive gains in Kenya's PMTCT program, some HIV-infected infants present late and are not benefitting from PMTCT best practices. Efforts to identify these early and enforce evidence-based practice for PMTCT should be scaled up. Infant testing should be expanded in pediatric/outpatient departments, given high yields in these portals.
描述肯尼亚母婴传播艾滋病毒（MTCT）的相关因素，并确定增加检测/护理覆盖率的机会。
对国家早期婴儿诊断（EID）数据库进行横断面分析。
2007年1月至2015年7月期间，对365,841名肯尼亚婴儿进行了艾滋病毒检测，并将检测结果、人口统计学信息和治疗信息录入国家数据库。使用多变量逻辑回归评估艾滋病毒风险因素。
2007 - 2010年，11.1%的婴儿艾滋病毒检测呈阳性，2014 - 2015年为6.9%。女性婴儿感染几率更高（比值比：1.08；95%置信区间：1.05 - 1.11），年龄较大的儿童（18 - 24个月与6周 - 2个月相比：4.26；95%置信区间：3.87 - 4.69），母亲未接受预防母婴传播干预的婴儿（与接受高效抗逆转录病毒治疗相比，比值比：1.92；95%置信区间：1.79 - 2.06），未接受预防用药的婴儿（与接受6周奈韦拉平预防用药相比，比值比：2.76；95%置信区间：2.51 - 3.05），以及混合喂养的婴儿（与纯母乳喂养相比，比值比：1.39；95%置信区间：1.30 - 1.49）。2014 - 2015年，9.1%的婴儿母亲在孕期未接受治疗，9.8%未接受预防用药，7.0%进行混合喂养。与接触推荐做法的婴儿相比，接触所有三种风险行为的婴儿感染艾滋病毒的几率高出七倍。通过对儿科/门诊有症状婴儿进行针对性检测发现艾滋病毒阳性婴儿的比例最高（>15%）；不过，大多数感染婴儿是通过预防母婴传播项目识别出来的。
尽管肯尼亚的预防母婴传播项目取得了显著成效，但一些感染艾滋病毒的婴儿就诊较晚，未从预防母婴传播的最佳做法中受益。应加大力度尽早识别这些婴儿，并推行基于证据 的预防母婴传播做法。鉴于儿科/门诊的检测阳性率较高，应扩大这些科室的婴儿检测范围。
