Early infant diagnosis and treatment of HIV among exposed and infected infants in Babadogo and Kariobangi Slums, Nairobi County, Kenya

Studies indicate that by the end of 2010 there were about 34 million people living with HIV worldwide and 2.7 million new infections which consisted of 390 000 estimated children under the age of 15 years, mainly through Mother-to-Child Transmission. An estimated 1.5 million people are living with HIV in Kenya whose total population of 38,765,000 and an HIV prevalence rate of 6.3%. Although Early Infant Diagnosis (EID) and HIV treatment for HIV exposed infants are readily available and provided free of charge in public health facilities, only 35% of HIV exposed infants received EID before the age of 6 weeks in Kenya in 2012 while only 21% of children living with HIV were receiving antiretroviral therapy in Kenya in 2010. Nairobi province has the second highest HIV prevalence (8.2%) particularly in Babadogo (15%) and Kariobangi (9.4%) slums.The general objective of the study was to establish the determinants of early infant diagnosis and treatment of HIV exposed and infected infants in Babadogo and Kariobangi slums in Nairobi County. The specific objectives of the study were to determine the mother's knowledge and practices on Prevention of Mother to Child Transmission of HIV, to identify the determinants of early infant diagnosis of HIV in exposed infants and to establish the determinants of timely treatment initiation for HIV infected infants in Babadogo and Kariobangi slums.Permission to carry out the research was sought from Kenyatta University Ethical Review Committee, the Ministry of Education Science and Technology and the Nairobi City Council. Informed consent was sought from the respondents after they had been informed about the objectives of the study. A descriptive cross-sectional design was used in this study. Semi-structured interview schedule, focus group discussion guide and a key informant interview schedule were the instruments of data collection. These tools were pre-tested among HIV positive mothers with infants in Dandora Health Centre. Quantitative data was analyzed using the Statistical Package for Social Scientists (SPSS) version 20. Hypothesis testing was done using chi-square and Fisher's exact test and significance established at p<0.05. Multiple logistic regression was used to identify the independent predictors of EID at 6 weeks. The study findings indicated an average level of knowledge on PMTCT (53.8%) among the respondents. The main determinants of EID at 6 weeks were maternal knowledge on PMTCT (x2=52.981,df=2, P=0.000),maternal practices on PMTCT such as the type of PMTCT intervention received during pregnancy (x2=29.478, df=2, p=0.0000) and the place of delivery (x2=33.793, df=2, p=0.000). The main predictors of EID at 6 weeks were delivering in a health facility (public or private) (OR=0.171; 0.065-0.451; p=0.000)and receiving psychosocial support (OR=0.173; 0.075-0.398; p=0.000). The Fischer's exact test showed no statistical association between the independent variables and timely treatment initiation. The study concluded that level of knowledge on PMTCT and in particular EID among the study population was low and recommends integration of PMTCT and pediatric HIV care and treatment services into the MNCH setting as well as establishment of effective linkages and referral mechanisms between PMTCT and treatment services.