Mother-to-child transmission of HIV in Kenya: results from a nationally representative study.

BACKGROUND: Kenya has an estimated 13000 new infant HIV infections that occur annually. We measured the burden of HIV infection among women of childbearing age and assessed access to and coverage of key prevention of mother-to-child transmission interventions. METHODS: The second Kenya AIDS Indicator Survey was a nationally representative 2-stage cluster sample of households. We analyzed data from women aged 15-54 years who had delivered a newborn within the preceding 5 years and from whom we obtained samples for HIV testing. RESULTS: Of 3310 women who had >/=1 live birth in the preceding 5 years 2862 (86.5%) consented to HIV testing in the survey and 171 (6.1%) were found to be infected. Ninety-five percent received prenatal care 93.1% were screened for HIV during prenatal care and of those screened 97.8% received their test results. Seventy-six women were known to be infected in their last pregnancy. Of these 54 (72.3%) received antepartum antiretroviral prophylaxis and 51 (69.1%) received intrapartum prophylaxis; 56 (75.3%) reported their newborns received postpartum prophylaxis. Of the 76 children born to these mothers 63 (82.5%) were tested for HIV at the first immunization visit or thereafter and 8 (15.1%) were HIV infected. CONCLUSIONS: We found a substantial burden of HIV in Kenyan women of childbearing age and a cumulative 5-year mother-to-child transmission rate of 15%. Although screening has improved over the past 5 years fewer than three-quarters of infected pregnant women are receiving antiretroviral prophylaxis. Universal antiretroviral therapy for HIV-infected pregnant women will be essential in achieving Kenyans target to eliminate mother-to-child transmission to <5% by 2015.