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Factors Enhancing Utilization of and Adherence to Prevention of Mother-to-Child Transmission (PMTCT) Service in an Urban Setting in Kenya

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Despite expansive scale-up of prevention of mother-to-child transmission (PMTCT) of HIV services in Kenya over the last decade, Kenya remains one of the countries contributing to high numbers of children living with HIV globally and is among the 22 PMTCT global plan priority countries. Using structured and in-depth interviews this study examined enabling factors that enhance utilization of and adherence to PMTCT services in an urban setting in Kenya. HIV-positive birthmothers (N = 55) whose infants were HIV-negative at the time of the study completed a structured interview and a subset (n = 15) participated in in-depth interviews. The majority of the mothers (98 %) delivered at a health facility and 91 % exclusively breastfed. Further, 91 % attended clinic appointments regularly and 69.1 % strictly adhered to prescribed medication dosage and schedules. However, 18 % had not disclosed their HIV status to anybody, 27 % did not use condom during sex, 95 % did not participate in AIDS support groups and 53 % of their male partners were not involved in PMTCT. Four key themes facilitating PMTCT success emerged from the qualitative data: supportive counseling, striving for motherhood, assurance of confidentiality; and confirmation, affirmation and admiration. HIV/AIDS related stigma and gender imbalances create many missed opportunities for HIV-positive mothers to reach out for support from family and community, apply acquired knowledge and access more affordable care. To be successful, PMTCT programs should be aware of these factors and ensure that mothers are provided with culturally competent care.

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  1. UNAIDS. Global Report: UNAIDS Report on the Global AIDS epidemic: 2012 [Internet]. [Geneva]: UNAIDS; 2012 [cited 2013 Aug 6]. Available from:

  2. United Nations. The Millennium Development Goals Report, 2013 [Internet]. United Nations; 2013. Available from:

  3. UNAIDS. Global report: UNAIDS report on the global AIDS epidemic: 2010. Geneva: Joint United Nations Programme on HIV/AIDS; 2010.

  4. WHO. PMTCT strategic vision 2010-2015 preventing mother-to-child transmission of HIV to reach the UNGASS and Millennium Development Goals: moving towards the elimination of paediatric HIV. [Internet]. Geneva: World health organization; 2010 [cited 2013 Aug 6]. Available from:

  5. Laher F, Cescon A, Lazarus E, Kaida A, Makongoza M, Hogg RS, et al. Conversations with mothers: exploring reasons for prevention of mother-to-child transmission (PMTCT) failures in the era of programmatic scale-up in Soweto, South Africa. AIDS Behav. 2012;16(1):91–8.

    Article  PubMed  Google Scholar 

  6. WHO, UNICEF, UNFPA, UNAIDS. Towards The Elimination of Mother-to-Child Transmission of HIV: Report of a WHO Technical Consultation 9-11 November 2010 Geneva, Switzerland [Internet]. UNAIDS; 2011. Available from:

  7. De Cock KM, Fowler MG, Mercier E, de Vincenzi I, Saba J, Hoff E, et al. Prevention of mother-to-child HIV transmission in resource-poor countries: translating research into policy and practice. JAMA J Am Med Assoc. 2000;283(9):1175–82.

    Article  Google Scholar 

  8. McIntyre J, Lallemant M. The prevention of mother-to-child transmission of HIV: are we translating scientific success into programmatic failure? Curr Opin HIV AIDS. 2008;3(2):139–45.

    Article  PubMed  Google Scholar 

  9. Both J, van Roosmalen J. The impact of prevention of mother to child transmission (PMTCT) programmes on maternal health care in resource-poor settings: looking beyond the PMTCT programme—a systematic review. BJOG Int J Obstet Gynaecol. 2010;117(12):1444–50.

    Article  CAS  Google Scholar 

  10. Kenya Ministry of Public Health and Sanitation, UNICEF. Prevention of Mother-to-Child Transmission of HIV (PMTCT) and Pediatric HIV and AIDS Care and Treatment – Joint IATT Technical Review Mission Report, 2010 [Internet]. United Nations Children’s Fund; 2010. Available from:

  11. Kenya National AIDS Control Council, UNGASS. United Nations General Assembly Special Session on HIV and AIDS (UNGASS) 2010: Country Report—Kenya [Internet]. Nairobi, Kenya; 2010. Available from:

  12. UNAIDS. AIDSinfo: Kenya Epidemiological Status 2001–2011 [Internet]. 2011 [cited 2013 Aug 8]. Available from:

  13. Kagaayi J, Dreyfuss ML, Kigozi G, Chen MZ, Wabwire-Mangen F, Serwadda D, et al. Maternal self-medication and provision of nevirapine to newborns by women in Rakai, Uganda. J Acquir Immune Defic Syndr 1999. 2005;39(1):121–4.

    Article  CAS  Google Scholar 

  14. Songok EM, Fujiyama Y, Tukei PM, Vulule JM, Kiptoo MK, Adungo NO, et al. The use of short-course zidovudine to prevent perinatal transmission of human immunodeficiency virus in rural Kenya. Am J Trop Med Hyg. 2003;69(1):8–13.

    CAS  PubMed  Google Scholar 

  15. Stringer EM, Ekouevi DK, Coetzee D, et al. Coverage of nevirapine-based services to prevent mother-to-child hiv transmission in 4 african countries. JAMA. 2010;304(3):293–302.

    Article  CAS  PubMed  Google Scholar 

  16. Ekouevi DK, Leroy V, Viho A, Bequet L, Horo A, Rouet F, et al. Acceptability and uptake of a package to prevent mother-to-child transmission using rapid HIV testing in Abidjan, Côte d’Ivoire. AIDS Lond Engl. 2004;18(4):697–700.

    Article  Google Scholar 

  17. Mandala J, Torpey K, Kasonde P, Kabaso M, Dirks R, Suzuki C, et al. Prevention of mother-to-child transmission of HIV in Zambia: implementing efficacious ARV regimens in primary health centers. BMC Public Health. 2009;9(1):314.

    Article  PubMed Central  PubMed  Google Scholar 

  18. Manzi M, Zachariah R, Teck R, Buhendwa L, Kazima J, Bakali E, et al. High acceptability of voluntary counselling and HIV-testing but unacceptable loss to follow up in a prevention of mother-to-child HIV transmission programme in rural Malawi: scaling-up requires a different way of acting. Trop Med Int Health TM IH. 2005;10(12):1242–50.

    Article  CAS  Google Scholar 

  19. Meda N, Leroy V, Viho I, Msellati P, Yaro S, Mandelbrot L, et al. Field acceptability and effectiveness of the routine utilization of zidovudine to reduce mother-to-child transmission of HIV-1 in West Africa. AIDS Lond Engl. 2002;16(17):2323–8.

    Article  CAS  Google Scholar 

  20. Perez F, Orne-Gliemann J, Mukotekwa T, Miller A, Glenshaw M, Mahomva A, et al. Prevention of mother to child transmission of HIV: evaluation of a pilot programme in a district hospital in rural Zimbabwe. BMJ. 2004;329(7475):1147–50.

    Article  PubMed Central  PubMed  Google Scholar 

  21. Stringer JS, Sinkala M, Maclean CC, Levy J, Kankasa C, Degroot A, et al. Effectiveness of a city-wide program to prevent mother-to-child HIV transmission in Lusaka, Zambia. AIDS Lond Engl. 2005;19(12):1309–15.

    Article  Google Scholar 

  22. Arulogun OS, Adewole IF, Olayinka-Alli L, Adesina AO. Community gate keepers’ awareness and perception of prevention of mother-to-child transmission of HIV services in Ibadan, Nigeria. Afr J Reprod Health. 2007;11(1):67–75.

    Article  PubMed  Google Scholar 

  23. Omowunmi A, Nkiru O, Yekeen R, Chinyere E, Muinat J, Segun A, et al. Knowledge, attitudes and perceptions of HIV/AIDS among traditional birth attendants and herbal practitioners in Lagos State, Nigeria. Afr J AIDS Res. 2005;3(2):191–6.

    Article  Google Scholar 

  24. Mbonye AK, Hansen KS, Wamono F, Magnussen P. Barriers to prevention of mother-to-child transmission of HIV services in Uganda. J Biosoc Sci. 2010;42(2):271–83.

    Article  CAS  PubMed  Google Scholar 

  25. Panditrao M, Darak S, Kulkarni V, Kulkarni S, Parchure R. Socio-demographic factors associated with loss to follow-up of HIV-infected women attending a private sector PMTCT program in Maharashtra, India. AIDS Care. 2011;23(5):593–600.

    Article  PubMed  Google Scholar 

  26. Mepham S, Zondi Z, Mbuyazi A, Mkhwanazi N, Newell ML. Challenges in PMTCT antiretroviral adherence in northern KwaZulu-Natal, South Africa. AIDS Care. 2011;23(6):741–7.

    Article  CAS  PubMed  Google Scholar 

  27. Otieno PA, Kohler PK, Bosire RK, Brown ER, Macharia SW, John-Stewart GC. Determinants of failure to access care in mothers referred to HIV treatment programs in Nairobi, Kenya. AIDS Care. 2010;22(6):729–36.

    Article  PubMed Central  PubMed  Google Scholar 

  28. Peltzer K, Sikwane E, Majaja M. Factors associated with short-course antiretroviral prophylaxis (dual therapy) adherence for PMTCT in Nkangala district, South Africa. Acta Paediatr Oslo Nor 1992. 2011;100(9):1253–7.

    Google Scholar 

  29. Knafl KA. Patton, M.Q. (1990). Qualitative evaluation and research methods (2nd ed.). Newbury Park, CA: Sage, 532 pp., $28.00 (hardcover). Res Nurs Health. 1991;14 Suppl 1:73–4.

  30. Krippendorff K. Content analysis: an introduction to its methodology […] […]. Thousand Oaks [u.a.: SAGE; 2004.

  31. De Cock KM, Mbori-Ngacha D, Marum E. Shadow on the continent: public health and HIV/AIDS in Africa in the 21st century. Lancet. 2002;360(9326):67–72.

    Article  PubMed  Google Scholar 

  32. Gupta GR, ICRW. Approaches for empowering women in the HIV/Aids Pandemic–a Gender Perspective. Womens Int Netw News. 2001 Winter;27(1):14.

  33. Joy R, Druyts EF, Brandson EK, Lima VD, Rustad CA, Zhang W, et al. Impact of neighborhood-level socioeconomic status on HIV disease progression in a universal health care setting. J Acquir Immune Defic Syndr 1999. 2008;47(4):500–5.

    Article  Google Scholar 

  34. Kiwanuka SN, Ekirapa EK, Peterson S, Okui O, Rahman MH, Peters D, et al. Access to and utilisation of health services for the poor in Uganda: a systematic review of available evidence. Trans R Soc Trop Med Hyg. 2008;102(11):1067–74.

    Article  CAS  PubMed  Google Scholar 

  35. Smith JA, Flowers P, Larkin M. Interpretative phenomenological analysis: theory, method and research. Los Angeles: SAGE; 2009.

    Google Scholar 

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The authors thank the women who participated in the study and appreciate the support provided by St. Mary’s Mission Hospital’s medical staff especially the hospital director, Dr. Konya; the Comprehensive Care Center (CCC) clinical officers, Nicholas Mutuma and Paul Ombima; and the hospital counselor, Agapio Njue.

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Correspondence to Lydia Karuta Murithi.



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Table 3 Qualitative data coding

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Murithi, L.K., Masho, S.W. & Vanderbilt, A.A. Factors Enhancing Utilization of and Adherence to Prevention of Mother-to-Child Transmission (PMTCT) Service in an Urban Setting in Kenya. AIDS Behav 19, 645–654 (2015).

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