Assessment of performance of prevention of mother to child hiv transmission programme and effects of antiretroviral drugs on selected haematological and biochemical parameters

Mother-to-child transmission of HIV (MTCT) accounts for over 95% of paediatric HIV infections in Kenya. In order to reduce the proportion of paediatric HIV infections, Kenya introduced prevention of mother-to-child transmission (PMTCT) programme in 2001 as a key intervention strategy. Principal services of PMTCT programme include voluntary counseling and testing (VCT), antiretroviral drugs (ARVs), safer delivery practices (SDP), infant feeding services (IFS) and family planning (FP) services which reduce the. proportion of infants infected with HIV worldwide. The 2005/6-2009/1 0 Kenya National AIDS Strategic Plan (KNASP) seeks to expand PMTCT services countrywide to increase access to ARVs for HIV positive pregnant mothers from 10% to over 50% and reduce the proportion of HIV positive babies born to HIV -positive mothers from 33% to 23% by 2010. To date, however, concerns about the increasing spread of paediatric HIV infections raise questions about the effectiveness of the programme in Kenya. There is also concern about the side effects of ARVs used in PMTCT programme. This study aimed at addressing these concerns by assessing the performance of the PMTCT programme at Pumwani Maternity Hospital (PMH) in Nairobi, Nakuru Provincial General Hospital (NPGH) and Bomet District Hospital (BDH). The study also established the effects of ARVs on biochemical, haematological and hormonal parameters among female subjects on anti-HIV treatment. To assess the performance of the 5 PMTCT services, the study interviewed 117 hospital staff and PMTCT clients and reviewed 2005 programme reports. To assess the effects of ARVs, blood samples from 48 study subjects were evaluated for hormonal (estradiol and progesterone) values while haematological and biochemical parameters were retrospectively analyzed from patients' clinical and laboratory records for 2005. Pearson correlation coefficient was used to assess relationships between the measured weight, haematological and biochemical parameters in the various study groups. The results showed that, all the PMTCT services were relatively distributed with respect to study facilities. Of the women who attended ANC for the first time in 2005, 72% agreed to an HIV test and 18.4% tested positive. Out of 51 post-delivery clients, 90% were through vaginal delivery and 10% elective caesarean section. Maternal nevirapine uptake of 66% was observed while 56% of infants born to infected mothers were administered nevirapine after birth. Exclusive formula feeding was practiced by 56% of the postnatal mothers mostly resident in urban settings while 42% exclusively breastfed their infants, all from the rural hospital. Estradiol levels among infected subjects were significantly elevated when compared with referent subjects (p<0.05). Weight and CD4+ levels among patients on treatment was significantly higher than HIV -naive subjects (p<0.05), while CD4+ count was significantly correlated with AST (p=0.016). Based on the uptake of the service indicators, the programme was making important progress towards attaining the KNASP targets. However, the country risks falling short of those targets due to numerous service delivery constraints because of the extensive variation in human capacity distribution to which quality service delivery uptake is dependent and inadequate infrastructure including policy limitation. Furthermore, the study revealed a weak M&E system characterized by inadequate staff, supplies and equipment. The implications of these constraints in slowing the observed progress suggest that future programme expansion should include them as key areas of interventions.