Factors Influencing Utilization of Prevention of Mother to Child Transmission of HIV among Women Attending Antenatal Care Clinics in Rachuonyo North Sub-County-Homa-Bay County, Kenya

Abstract

The prevention of mother–to –child transmission of HIV uptake in Homa-Bay County and particularly Rachuonyo North sub-county remains sub–optimal despite the HIV prevalence being four times that of average population in Kenya. Information and utilization of services is an important determinant for prevention of transmission of HIV from mother to child. The objectives of the study were to assess the socio-demographic, socio-cultural characteristics, determinants of the appropriate infant feeding options and therapies and to establish the knowledge, attitude and practices of HIV infected women on PMTCT services. Facility based cross sectional study was conducted through simple random sampling technique to select 337 HIV infected pregnant women and 48 HEI mothers attending antenatal clinics from 20 health facilities in Rachuonyo North. Data was entered into MS Excel® (Microsoft, USA) and then exported to SPSS version 17® for analysis which were then analyzed. Results showed that the majority of respondents, had a mean age of 25.7+/-5.23 years (SD = 5.23) with range of 31, whereby 259 (67.3%) were married women. There was significant association between utilization of PMTCT and age (p value < 0.04) marital status (p value < 0.003) and education (P< 0.02). Majority (50.4%, 95% CI: 45.4 – 55.4) of the respondents had their HIV status disclosed to their partners. However, reason for non-disclosure were stigma(37%, 95% CI: 29.7 – 45.0), physical violence (35.1%, 95% CI: 27.9 – 45.0) and divorce/ separation (14%, 95% CI: 9.6 – 20.8).Results further showed that the preferred Infant feeding option was mixed feeding (28%, 95% CI: 24.3 – 33.3) and exclusive breast feeding (26%, 95% CI: 21.8 – 30.6).There was significant association between mixed feeding and attendance of ANC for PMTCT services (P <0.021). Majority of women (66%, 95% CI: 61.3 – 70. 7) were knowledgeable of mother to child HIV transmission and (72.2%, 95% CI: 67.7 – 76.7) attending ANC clinics in government health facilities. Significantly, willingness to test for HIV had association with attitude (P< 0.001). The main barriers impeding women participation on PMTCT awareness programs included cultural practices such as wife inheritance (26.8%, 95% CI: 22.6-31.4), stigma and discrimination (24.7%, 95% CI: 20.6 – 29.2), Care-free sexual rituals (17.1%, 95% CI: 13.7 -21.3). In conclusion, socio-cultural and demographic factors, health system and knowledge are important barriers to utilization of PMTCT services in Rachuonyo North. Therefore, it requires raising more community awareness about PMTCT and HIV. Further research to identify cost effectiveness and clinical impact of PMTCT should be carried out. Finally, advocacy to focused PMTCT services in all facilities to provide full range of comprehensive PMTCT service with a goal towards free pediatric HIV generation.