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

Ronen, Keshet PhD; McGrath, Christine J. MPH, PhD; Langat, Agnes C. MBChB, MMed, MPH; Kinuthia, John MBChB, MMed, MPH; Omolo, Danvers MSc; Singa, Benson MBChB, MPH; Katana, Abraham K. MBChB, MSc; Ng'Ang'A, Lucy W. MBChB, MMed; John-Stewart, Grace MD, MPH, PhD

JAIDS Journal of Acquired Immune Deficiency Syndromes: January 1st, 2017 - Volume 74 - Issue 1 - p 30–37
doi: 10.1097/QAI.0000000000001176
Implementation Science

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. Antenatal care (ANC) attendance, HIV testing, and antiretroviral (ARV) use were compared between adolescent (age ≤19 years) and adult mothers using χ2 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 [adjusted odds ratio (95% confidence interval) = 0.54 (0.37 to 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 antiretroviral therapy before 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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*Departments of Global Health and Epidemiology, University of Washington, Seattle, WA;

Department of Obstetrics and Gynecology, University of Texas Medical Branch, Galveston, TX;

Centers for Disease Control and Prevention (CDC), Nairobi, Kenya;

§Department of Obstetrics and Gynecology, Kenyatta National Hospital, Nairobi, Kenya;

Center for Microbiology Research and Center for Clinical Research, Kenya Medical Research Institute, Nairobi, Kenya; and

Departments of Global Health, Epidemiology, Medicine and Pediatrics, University of Washington, Seattle, WA.

Correspondence to: Keshet Ronen, PhD, Department of Global Health, University of Washington, Box 359931, 325 9th Avenue, Seattle, WA 98104 (e-mail:

Supported by President's Emergency Plan for AIDS Relief through the Centers for Disease Control and Prevention under the terms of COAG#U2GPS002047, and the National Institutes of Health (T32 CA080416 to K.R., K24 HD054314 and P30 AI027757 to G.J.S., T32 AI007140 and K12HD052023 to C.J.M.), as well as the University of Washington Global Center for Integrated Health of Women Adolescents and Children.

Presented in part at the 8th International AIDS Society Conference on HIV Pathogenesis, Treatment and Prevention, July 19–22, 2015, Vancouver, BC, and at the 7th International Workshop on HIV Pediatrics, July 17–18, 2015, Vancouver, BC.

The authors have no conflicts of interest to disclose.

The findings and conclusions in this article are those of the authors and do not necessarily represent the official position of the U.S. Centers for Disease Control and Prevention or the Government of Kenya.

Supplemental digital content is available for this article. Direct URL citations appear in the printed text and are provided in the HTML and PDF versions of this article on the journal's Web site (

Received April 20, 2016

Accepted August 05, 2016

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