Predictors of Early ART Initiation Among HIV + Infants in Kenya: A Retrospective Review of HITSystem Data from 2013 to 2017

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From: Maternal and Child Health Journal(Vol. 24, Issue 6)
Publisher: Springer
Document Type: Report
Length: 6,153 words
Lexile Measure: 1590L

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Author(s): Catherine Wexler 1 , Niaman Nazir 2 , Brad Gautney 3 , May Maloba 4 , Melinda Brown 1 , Kathy Goggin 5 6 , Raphael Lwembe 7 , Sarah Finocchario-Kessler 1

Author Affiliations:

(1) grid.412016.0, 0000 0001 2177 6375, Department of Family Medicine, University of Kansas Medical Center, , 3901 Rainbow Blvd., 66160, Kansas City, KS, USA

(2) grid.412016.0, 0000 0001 2177 6375, Department of Preventive Medicine and Public Health, University of Kansas Medical Center, , Kansas City, KS, USA

(3) Global Health Innovations, , Dallas, TX, USA

(4) Global Health Innovations, , Nairobi, Kenya

(5) grid.239559.1, 0000 0004 0415 5050, Health Services and Outcomes Research, Children's Mercy Kansas City, , Kansas City, MO, USA

(6) grid.266756.6, 0000 0001 2179 926X, University of Missouri- Kansas City School of Medicine, , Kansas City, MO, USA

(7) grid.33058.3d, 0000 0001 0155 5938, Center for Virus Research, Kenya Medical Research Institute, , Nairobi, Kenya

1. Significance

Early initiation of ART for infants living with HIV is one of the primary goals of EID services; yet, data on the rates, timing, and factors associated with ART initiation among Kenyan infants are extremely limited. No infant-specific national estimates for ART initiation are available and few studies have evaluated the timing and predictors of ART initiation in infants. This study assesses the proportion of infants initiated on treatment by 12 weeks of age and describes factors associated with early initiation of ART. This data can help policy makers and healthcare providers better tailor engagement to maximize the benefits of EID.


Approximately 50% of the world's 160,000 new pediatric HIV infections each year occur in sub-Saharan Africa (UNAIDS 2019). Most of these children are infected through mother to child transmission (MTCT). In Kenya, MTCT of HIV accounted for approximately 8000 new infant and child infections in 2018 (Ministry of Health 2018; UNAIDS 2018). In the absence of antiretroviral treatment (ART), 20% of infants with HIV will die within the first year of life (Newell et al. 2004). However, ART can significantly improve clinical, immunological, and virologic outcomes and survival in pediatric patients (Cotton et al. 2013; Goetghebuer et al. 2009; Innes et al. 2014; Persaud et al. 2013; Wamalwa et al. 2012), with the landmark CHER study indicating that early initiation of ART (by 12 weeks of age) reduces infant mortality by up to 76% (Violari et al. 2008). Based on these studies, the World Health Organization (WHO) recommended immediate initiation of ART for all infants with HIV, regardless of immunological and clinical stage (World Health Organization 2010). In 2012, Kenyan adopted these guidelines (Ministry of Health 2012) and in 2014 issued a Rapid Advice statement to encourage faster uptake of this practice (Ministry of Health & National AIDS and STI Control Program 2014).

Early infant diagnosis (EID) services are critical for identifying infants living with HIV and linking them to care. In Kenya, EID guidelines recommend the first infant test at 4-6 weeks of age through HIV DNA PCR testing, with periodic retesting through 18 months of age. However, late infant testing (Goggin et al. 2016; Hassan et...

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Gale Document Number: GALE|A622755882