Non Adherence to PMTCT Treatment and Loss to Follow Up of HIV Positive Mothers and Babies in Mombasa County, Kenya
Obonyo, Florence F. Adhiambo
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Kenya has more than 2.5 million people living with HIV and AIDS. Mombasa County had a prevalence rate of 7.8% in the year 2009. Globally 390,000 babies were infected with HIV in the year 2010 through mother to child transmission. In Kenya an estimated 37,000 to 40, 000 infants are infected annually in utero. This could be due to loss to follow up and non-adherence to ARVs and Prevention of Mother to Child Transmission (PMTCT) guidelines. The World Health Organization (WHO) recommends Option B triple therapy ART regimens for pregnant women who test HIV positive. The HIV positive mother is given ART for life regardless of the CD4 count or WHO clinical staging. The infant is given AZT or NVP for six weeks after birth if not breastfeeding. In coast province Kenya, only 45.6 % of women were delivered by a skilled health worker in the year 2009. One way to attain high coverage is to give Nevirapine pill to each HIV positive woman in advance to be kept at home and taken at the start of labour and NVP syrup for the baby. The current study investigated factors that contribute to loss to follow up among 322 HIV positive mothers and babies on PMTCT treatment in Mombasa County. A descriptive cross sectional survey was carried out, purposive sampling was done. Of the respondents who were tested 40%, were not aware that they had been tested for HIV in the antenatal clinic. Majority (61 %) of mothers were given the ARVs to keep at home antenatally .Minority of the mothers (41%) did not take the prescribed antiretroviral pills when they gave birth, while 69.9 % of babies were not given the prescribed ARV syrup due to fear of stigma and discrimination. Non adherence was associated with socio demographic characteristic of youth aged below 35 years, (88.2 %) no high school education (64.3%) and home deliveries (26.4%). Only 34.8% were given correct postnatal clinic return dates. In conclusion, some of the respondents did not adhere to PMTCT treatment due to fear of stigma and discrimination, home delivery, young age and no high school education. The study recommends that health workers should do HIV pretest and PMTCT adherence counseling to all antenatal mothers individually, to include importance of hospital delivery, postnatal and comprehensive clinic appointment dates and education of traditional birth attendants to improve adherence rates.