Médecins Sans Frontières' Prevention of Mother to Child Transmission (PMTCT) Program in the Informal Settlement of Kibera, Nairobi, Kenya

Background: Kibera is an informal settlement near Nairobi characterized by a large mobile population and impoverished living conditions. In 2006 the Kenyan Ministry of Health and Médecins Sans Frontières integrated free prevention of mother to child transmission (PMTCT) services into existing maternal and child heath care at two primary health care clinics in Kibera. The objectives of this study were to describe 1) the uptake of PMTCT interventions, 2) loss to follow-up (LTFU) from the program, and 3) the vertical transmission rate of HIV.

Methods: Retrospective analysis of routinely collected data from 942 pregnancies enrolled in PMTCT between February 2006 and December 2008.

Results: Median gestational age at enrollment was 24 weeks. Eighty five percent of women delivered in a health facility, 92% were on antiretroviral therapy, and 84% of infants received complete HIV prophylaxis. Self-report of exclusive breastfeeding decreased from 52% at delivery to 19% at six months. Final HIV status was determined for 270 infants; 16 (6%) were HIV positive. Thirty seven percent of women were LTFU. Forty five percent of the LTFU occurred after the first antenatal visit when most women learned their HIV status.

Conclusion: Implementation of a PMTCT program was feasible and had favorable outcomes in the slum environment of Kibera. When mothers remained in PMTCT until delivery, compliance with prophylaxis was high and vertical transmission of HIV was relatively low. Complete adherence to PMTCT remains a challenge. Retention of mothers, administration of infant prophylaxis, and consistent feeding practices are areas for program improvement.