Gaps in Adolescent Engagement in Antenatal Care and Prevention of Mother-to-Child HIV Transmission Services in Kenya

Keshet Ronen, Christine J. McGrath, Agnes C. Langat, John Kinuthia, Danvers Omolo, Benson Singa, Abraham K. Katana, Lucy W. NgʼAngʼA, Grace John-Stewart

Research output: Contribution to journalArticle

16 Citations (Scopus)

Abstract

BACKGROUND:: Rates of pregnancy and HIV infection are high among adolescents. However, their engagement in prevention of mother-to-child HIV transmission (PMTCT) services is poorly characterized. We compared engagement in the PMTCT cascade between adult and adolescent mothers in Kenya. METHODS:: We conducted a nationally representative cross-sectional survey of mother-infant pairs attending 120 maternal child health clinics selected by probability-proportionate-to-size-sampling, with a secondary survey oversampling HIV-positive mothers in 30 clinics. ANC attendance, HIV testing and ARV use were compared between adolescent (age ≤19) and adult mothers using Chi-square tests and logistic regression. RESULTS:: Among 2521 mothers, 278 (12.8%) were adolescents. Adolescents were less likely than adults to be employed (16.5% vs. 37.9%), married (66.1% vs. 88.3%), have intended pregnancy (40.5% vs. 58.6%), or have disclosed their HIV status (77.5% vs. 90.7%) (p<0.01 for all). Adolescents were less likely than adults to attend ≥4 ANC visits (35.2% vs. 45.6%, p=0.002). This effect remained significant when adjusting for employment, household crowding, pregnancy intention, gravidity and HIV status (aOR[95% CI]=0.54[0.37-0.97], p=0.001). Among 2359 women without previous HIV testing, 96.1% received testing during pregnancy; testing levels did not differ between adolescents and adults. Among 288 HIV-positive women not on ART prior to pregnancy, adolescents were less likely than adults to be on ARVs (65.0% vs. 85.8%, p=0.01) or to have infants on ARVs (85.7% vs. 97.7%, p=0.005). CONCLUSIONS:: Adolescent mothers had poorer ANC attendance and uptake of ARVs for PMTCT. Targeted interventions are needed to improve retention of this vulnerable population in the PMTCT cascade.

Original languageEnglish (US)
JournalJournal of Acquired Immune Deficiency Syndromes
DOIs
StateAccepted/In press - Sep 1 2016

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Prenatal Care
Kenya
Mothers
HIV
Pregnancy
Gravidity
Pregnancy in Adolescence
Crowding
Vulnerable Populations
Pregnancy Rate
Chi-Square Distribution
HIV Infections
Cross-Sectional Studies
Logistic Models

ASJC Scopus subject areas

  • Infectious Diseases
  • Pharmacology (medical)

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Gaps in Adolescent Engagement in Antenatal Care and Prevention of Mother-to-Child HIV Transmission Services in Kenya. / Ronen, Keshet; McGrath, Christine J.; Langat, Agnes C.; Kinuthia, John; Omolo, Danvers; Singa, Benson; Katana, Abraham K.; NgʼAngʼA, Lucy W.; John-Stewart, Grace.

In: Journal of Acquired Immune Deficiency Syndromes, 01.09.2016.

Research output: Contribution to journalArticle

Ronen, Keshet ; McGrath, Christine J. ; Langat, Agnes C. ; Kinuthia, John ; Omolo, Danvers ; Singa, Benson ; Katana, Abraham K. ; NgʼAngʼA, Lucy W. ; John-Stewart, Grace. / Gaps in Adolescent Engagement in Antenatal Care and Prevention of Mother-to-Child HIV Transmission Services in Kenya. In: Journal of Acquired Immune Deficiency Syndromes. 2016.
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abstract = "BACKGROUND:: Rates of pregnancy and HIV infection are high among adolescents. However, their engagement in prevention of mother-to-child HIV transmission (PMTCT) services is poorly characterized. We compared engagement in the PMTCT cascade between adult and adolescent mothers in Kenya. METHODS:: We conducted a nationally representative cross-sectional survey of mother-infant pairs attending 120 maternal child health clinics selected by probability-proportionate-to-size-sampling, with a secondary survey oversampling HIV-positive mothers in 30 clinics. ANC attendance, HIV testing and ARV use were compared between adolescent (age ≤19) and adult mothers using Chi-square tests and logistic regression. RESULTS:: Among 2521 mothers, 278 (12.8{\%}) were adolescents. Adolescents were less likely than adults to be employed (16.5{\%} vs. 37.9{\%}), married (66.1{\%} vs. 88.3{\%}), have intended pregnancy (40.5{\%} vs. 58.6{\%}), or have disclosed their HIV status (77.5{\%} vs. 90.7{\%}) (p<0.01 for all). Adolescents were less likely than adults to attend ≥4 ANC visits (35.2{\%} vs. 45.6{\%}, p=0.002). This effect remained significant when adjusting for employment, household crowding, pregnancy intention, gravidity and HIV status (aOR[95{\%} CI]=0.54[0.37-0.97], p=0.001). Among 2359 women without previous HIV testing, 96.1{\%} received testing during pregnancy; testing levels did not differ between adolescents and adults. Among 288 HIV-positive women not on ART prior to pregnancy, adolescents were less likely than adults to be on ARVs (65.0{\%} vs. 85.8{\%}, p=0.01) or to have infants on ARVs (85.7{\%} vs. 97.7{\%}, p=0.005). CONCLUSIONS:: Adolescent mothers had poorer ANC attendance and uptake of ARVs for PMTCT. Targeted interventions are needed to improve retention of this vulnerable population in the PMTCT cascade.",
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AU - Langat, Agnes C.

AU - Kinuthia, John

AU - Omolo, Danvers

AU - Singa, Benson

AU - Katana, Abraham K.

AU - NgʼAngʼA, Lucy W.

AU - John-Stewart, Grace

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N2 - BACKGROUND:: Rates of pregnancy and HIV infection are high among adolescents. However, their engagement in prevention of mother-to-child HIV transmission (PMTCT) services is poorly characterized. We compared engagement in the PMTCT cascade between adult and adolescent mothers in Kenya. METHODS:: We conducted a nationally representative cross-sectional survey of mother-infant pairs attending 120 maternal child health clinics selected by probability-proportionate-to-size-sampling, with a secondary survey oversampling HIV-positive mothers in 30 clinics. ANC attendance, HIV testing and ARV use were compared between adolescent (age ≤19) and adult mothers using Chi-square tests and logistic regression. RESULTS:: Among 2521 mothers, 278 (12.8%) were adolescents. Adolescents were less likely than adults to be employed (16.5% vs. 37.9%), married (66.1% vs. 88.3%), have intended pregnancy (40.5% vs. 58.6%), or have disclosed their HIV status (77.5% vs. 90.7%) (p<0.01 for all). Adolescents were less likely than adults to attend ≥4 ANC visits (35.2% vs. 45.6%, p=0.002). This effect remained significant when adjusting for employment, household crowding, pregnancy intention, gravidity and HIV status (aOR[95% CI]=0.54[0.37-0.97], p=0.001). Among 2359 women without previous HIV testing, 96.1% received testing during pregnancy; testing levels did not differ between adolescents and adults. Among 288 HIV-positive women not on ART prior to pregnancy, adolescents were less likely than adults to be on ARVs (65.0% vs. 85.8%, p=0.01) or to have infants on ARVs (85.7% vs. 97.7%, p=0.005). CONCLUSIONS:: Adolescent mothers had poorer ANC attendance and uptake of ARVs for PMTCT. Targeted interventions are needed to improve retention of this vulnerable population in the PMTCT cascade.

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