214861 Médecins Sans Frontières' Prevention of Mother to Child Transmission (PMTCT) Program in the Informal Settlement of Kibera, Nairobi, Kenya

Tuesday, November 9, 2010 : 2:30 PM - 2:48 PM

Kerry A. Thomson, MPH, CHES , Operational Centre Brussels, Médecins Sans Frontières, Denver, CO
J. Wangui Munge, Clinical Officer , Operational Centre Brussels, Médecins Sans Frontières, Nairobi, Kenya
Eline C. van Kooij, MD , Julius Center, University Medical Center Utrecht, Utrecht, Netherlands
Anthony J. Reid, MD, MSC, FCFP , Operational Centre Brussels, Médecins Sans Frontières, Orillia, ON, Canada
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.

Learning Areas:
Conduct evaluation related to programs, research, and other areas of practice

Learning Objectives:
1. Describe the uptake of and lost to follow up from PMTCT interventions offered by Médecins Sans Frontières (MSF) in Kibera, Kenya. 2. Identify the rate of vertical HIV transmission between mothers and infants enrolled in the MSF Kibera PMTCT program. 3. Discuss challenges of implementing PMTCT in the slum environment of Kibera.

Keywords: HIV/AIDS, Maternal and Child Health

Presenting author's disclosure statement:

Qualified on the content I am responsible for because: I am qualified to present because I was the field epidemiologist who oversaw operational research for the MSF-OCB Kibera Project. I designed this study, conducted the analysis, and interpreted the results.
Any relevant financial relationships? No

I agree to comply with the American Public Health Association Conflict of Interest and Commercial Support Guidelines, and to disclose to the participants any off-label or experimental uses of a commercial product or service discussed in my presentation.

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