Factors associated with the uptake of prevention of mother to child transmission services among women attending antenatal clinic at coast province general hospital

Abstract

HIV prevalence stands at 9.0% among pregnant women which translates to an annual estimate of 110,000 pregnancies among women living with HIV. This figure ranks Kenya fourth out of the twenty countries with the highest burden of maternal HIV globally. Despite the improvements in HIV testing and provision of maternal ARV, Kenya continues to face challenges in assuring that all women in need of PMTCT services receive the full package of PMTCT interventions that span the continuum of antenatal, intra-partum and postnatal care. The objective of this study was to determine factors that are associated with the uptake of PMTCT services at the antenatal clinic in Coast Province General Hospital, Mombasa County. This was a cross-sectional study focusing on pregnant women (n=196) who had already enrolled for PMTCT at the antenatal clinic in Coast Provincial General Hospital (CPGH), Mombasa County Kenya. Descriptive results were reported for all variables while the association between the main outcome (first PMTCT visit) and explanatory variables was explored using a chi-square test; further bi-variate analyses between the outcome and all the covariates were carried out to test for the magnitude of associations using logistic regression. Data was collected using questionnaires and was entered, cleaned and analyzed using SPSS version 16.0. A total of 199 women were interviewed after the PMTCT visit and they had a mean age of 30 (SD=5) years. About 75% (149) of these were seeking PMTCT services at the CPGH for the first time, while 71% knew of their HIV status in CPGH. About 95% of the patients were satisfied with privacy provided during testing and the provider-client interaction during testing. Clients who had never delivered in CPGH in the past had a significantly (p<0.001) increased odds of utilizing PMTCT by 6 times (OR 6.26; 95% CI 3.09 -12.68) compared to clients who had previously delivered in CPGH. Further clients who had never lost a pregnancy in CPGH and were in the hospital for the first time were 3 times (OR 3.37; 95% CI 1.42 – 8.00) likely to seek PMTCT services in CPGH compared to those who had lost a pregnancy in CPGH. There was a significant association (OR 5.71; 95% CI 2.14 – 15.22). p value <0.001) between family planning use before pregnancy and first PMTCT visit with a 6 times (OR 5.71; 95% CI 2.14 – 15.22) increased odds of not using FP services if utilizing PMTCT services for the first time in CPGH with use of FP before pregnancy as the reference group. Over 90% of the clients reported satisfaction with counselling services, the way queries were addressed and the degree of privacy provided. Clients seeking PMTCT services reported positive experiences and good provider – client relationship. Patients who had not sought reproductive services (delivery, post-abortal care) were more likely to seek for PMTCT services at CPGH, therefore for a successful PMTCT program in CPGH attention needs to paid to the patient experiences as they seek other reproductive services.