Maternal and Pediatric adherence to antiretroviral treatment as a predictor of the children’s HIV serological status in Nairobi City County

Abstract

Antiretroviral (ARV) drugs are administered to Human Immunodeficiency Virus (HIV) positive women and their children to prevent Mother to Child Transmission (MTCT) and treat maternal and pediatric HIV disease. Early Infant Diagnosis (EID) identifies HIV infected children using Polymerase Chain Reaction (PCR) tests that are followed by Antiretroviral Therapy (ART) in children who test PCR positive. Most HIV exposed children in Kenya do not receive PCR tests due to inadequate and poor access to testing facilities, low knowledge and prohibitive costs that are associated with the testing. The lack of HIV diagnosis through PCR tests and insufficient pediatric adherence to ARV’s pose barriers to the success of Antiretroviral Therapy (ART) in children. This case-control study investigated the use of maternal ARV adherence as a means of identifying children at high risk of MTCT. The study further determined the factors that enhance maternal and pediatric ARV treatment adherence in order to uncover therapeutic gaps through which intervention measures should be targeted. Children with known PCR test results were purposively recruited into the study where maternal and pediatric ARV adherence was assessed using standardized structured questionnaires. Data was summarized and analyzed using the Statistical Package for Social Sciences (SPSS) version 20 where Pearson’s Chi-square and Fishers exact tests were applied to determine the association between independent and dependent variables. Odds Ratio (OR) at 95% confidence interval was used to test the strength of associations between variables with a significance threshold of P < 0.05. A total of 122 women were assessed in this study out of whom 59 (48%) reported non-adherence to maternal ARV treatment. Mothers to cases skipped their ARV medications 3 times more than mothers to controls (OR 3.15, 95% CI 1.09-9.07, P < 0.03) a difference that rose 10 times (OR 10.45, 95% CI 1.39-78.33, P < 0.02) on multivariate analysis. Exposure to low maternal ARV adherence was highly predictive of the children’s PCR test result with an Odds Ratio of 3.5. Significantly higher maternal ARV adherence (P < 0.0001) was reported in women whose ART was initiated before or early in pregnancy and those taking Nevirapine