PMID- 22204313
OWN - NLM
STAT- MEDLINE
DCOM- 20120622
LR  - 20211021
IS  - 1758-2652 (Electronic)
IS  - 1758-2652 (Linking)
VI  - 14
DP  - 2011 Dec 28
TI  - Uptake of prevention of mother to child transmission interventions in Kenya: 
      health systems are more influential than stigma.
PG  - 61
LID - 10.1186/1758-2652-14-61 [doi]
AB  - BACKGROUND: We set out to determine the relative roles of stigma versus health 
      systems in non-uptake of prevention of mother to child transmission (PMTCT) of 
      HIV-1 interventions: we conducted cross-sectional assessment of all consenting 
      mothers accompanying infants for six-week immunizations. METHODS: Between 
      September 2008 and March 2009, mothers at six maternal and child health clinics 
      in Kenya's Nairobi and Nyanza provinces were interviewed regarding PMTCT 
      intervention uptake during recent pregnancy. Stigma was ascertained using a 
      previously published standardized questionnaire and infant HIV-1 status 
      determined by HIV-1 polymerase chain reaction. RESULTS: Among 2663 mothers, 2453 
      (92.1%) reported antenatal HIV-1 testing. Untested mothers were more likely to 
      have less than secondary education (85.2% vs. 74.9%, p=0.001), be from Nyanza 
      (47.1% vs. 32.2%, p<0.001) and have lower socio-economic status. Among 318 
      HIV-1-infected mothers, 90% reported use of maternal or infant antiretrovirals. 
      Facility delivery was less common among HIV-1-infected mothers (69% vs. 76%, 
      p=0.009) and was associated with antiretroviral use (p<0.001). Although internal 
      or external stigma indicators were reported by between 12% and 59% of women, 
      stigma was not associated with lower HIV-1 testing or infant HIV-1 infection 
      rates; internal stigma was associated with modestly decreased antiretroviral 
      uptake. Health system factors contributed to about 60% of non-testing among 
      mothers who attended antenatal clinics and to missed opportunities in offering 
      antiretrovirals and utilization of facility delivery. Eight percent of 
      six-week-old HIV-1-exposed infants were HIV-1 infected. CONCLUSIONS: Antenatal 
      HIV-1 testing and antiretroviral uptake was high (both more than 90%) and infant 
      HIV-1 infection risk was low, reflecting high PMTCT coverage. Investment in 
      health systems to deliver HIV-1 testing and antiretrovirals can effectively 
      prevent infant HIV-1 infection despite substantial HIV-1 stigma.
FAU - Kinuthia, John
AU  - Kinuthia J
AD  - Department of Obstetrics and Gynaecology, Kenyatta National Hospital/University 
      of Nairobi, Kenya. kinuthia@u.washington.edu
FAU - Kiarie, James N
AU  - Kiarie JN
FAU - Farquhar, Carey
AU  - Farquhar C
FAU - Richardson, Barbra A
AU  - Richardson BA
FAU - Nduati, Ruth
AU  - Nduati R
FAU - Mbori-Ngacha, Dorothy
AU  - Mbori-Ngacha D
FAU - John-Stewart, Grace
AU  - John-Stewart G
LA  - eng
GR  - P30 AI027757/AI/NIAID NIH HHS/United States
GR  - R24 HD056799/HD/NICHD NIH HHS/United States
PT  - Journal Article
PT  - Research Support, N.I.H., Extramural
PT  - Research Support, Non-U.S. Gov't
DEP - 20111228
PL  - Switzerland
TA  - J Int AIDS Soc
JT  - Journal of the International AIDS Society
JID - 101478566
RN  - 0 (Anti-HIV Agents)
SB  - IM
MH  - Adult
MH  - Anti-HIV Agents/therapeutic use
MH  - Chemoprevention/methods/statistics & numerical data
MH  - Cross-Sectional Studies
MH  - Drug Utilization/statistics & numerical data
MH  - Female
MH  - HIV Infections/drug therapy/*prevention & control/psychology/*transmission
MH  - HIV-1/isolation & purification
MH  - Humans
MH  - Infant
MH  - Infant, Newborn
MH  - Infectious Disease Transmission, Vertical/*prevention & control
MH  - Interviews as Topic
MH  - Kenya
MH  - Patient Acceptance of Health Care/*statistics & numerical data
MH  - Pregnancy
MH  - Prenatal Diagnosis/statistics & numerical data
MH  - *Stereotyping
PMC - PMC3313883
EDAT- 2011/12/30 06:00
MHDA- 2012/06/23 06:00
PMCR- 2011/12/28
CRDT- 2011/12/30 06:00
PHST- 2011/06/17 00:00 [received]
PHST- 2011/12/28 00:00 [accepted]
PHST- 2011/12/30 06:00 [entrez]
PHST- 2011/12/30 06:00 [pubmed]
PHST- 2012/06/23 06:00 [medline]
PHST- 2011/12/28 00:00 [pmc-release]
AID - 1758-2652-14-61 [pii]
AID - 10.1186/1758-2652-14-61 [doi]
PST - epublish
SO  - J Int AIDS Soc. 2011 Dec 28;14:61. doi: 10.1186/1758-2652-14-61.