Teen mothers have most HIV-positive babies — research

Teenage mothers living with HIV are more likely to pass the virus to their babies compared to older women, a new analysis done in Nairobi shows.

Experts said many of them fail to take ARV tablets every day and do not attend all antenatal clinics.

The result is that some babies contract the virus during pregnancy, birth or while breastfeeding.

It is possible to completely prevent mother-to-child HIV transmission (nowadays called vertical transmission so as not to stigmatise mothers).

Medics who studied the patterns also noted higher vertical infections in young women recently diagnosed with HIV.

“There is a need to create a special package of care for the younger mothers aged 18–24 and mothers with recent HIV diagnoses (that is less than two years since HIV positive diagnosis). The special package should have more rigorous adherence and nutritional counselling, with close monitoring of these mother-infant pairs,” they said.

The study was carried out in Nairobi where 166 infants born to mothers living with HIV were recruited at six weeks and observed over 12 months to see if they ever contracted HIV and why.

The researchers said nine per cent of the babies contracted the virus.

“Maternal age influenced infant HIV-free survival over the 12 months follow-up period,” they said. “Younger mothers aged between 18–24 years had a higher hazard ratio of infant HIV vertical transmission relative to their older counterparts 36–47 years.”

This is not unique to Kenya. The authors said studies in Rwanda, Malawi, Eswatini, and DRC also showed babies of young mothers were more likely to contract HIV.

The authors are Peter Wanzala of the Kenya Medical Research Institute, Simon Karanja and Gideon Kikuvi of the Jomo Kenyatta University of Agriculture and Technology and Elizabeth Kiilu of the University of Bradford, UK.

The study was conducted in Mathare North health centre, Mbagathi county hospital, and Kibera South health centre in Nairobi county.

“These study sites were chosen because approximately 60–70 per cent of urban dwellers in Kenya are believed to be living in informal settlements with a 12 per cent prevalence of HIV compared to a five per cent prevalence among non-slum dwellers,” the authors said.

They also noted babies who contracted the virus were mostly born to unemployed mothers and those from low income households.

“Poverty increases the chances of infant HIV vertical transmission,” they said.

The study, ‘Prognostic factors influencing HIV-free survival among infants enrolled for HIV early infant diagnosis services in selected hospitals in Nairobi County’, is published in Plos One journal.

In Kenya, the elimination of vertical transmission of HIV is guided by the Kenya framework for eMTCT (Elimination of Mother to Child Transmission) of HIV and syphilis, Guidelines on Use of antiretroviral drugs for preventing HIV infection in Kenya.

The guidelines stipulate that HIV-positive mothers must continue with their highly active antiretroviral therapy (HAART) regimen throughout the pregnancy and breastfeeding periods.

Newborns born to mothers living with HIV must be tested for the virus four to six weeks of life or at the earliest opportunity thereafter. This is not done immediately at birth because most babies have mothers' antibodies.

In the current study, mothers who had a recent HIV-positive diagnosis (within two years of HIV diagnosis) had a higher risk of passing on the virus to their newborns, compared to mothers who had lived with HIV for a period of more than two years.

“Diagnosis during pregnancy poses a challenge for disclosure and sometimes drug compliance and consequently increases the risk of infant HIV vertical transmission,” the authors said.

In fact, women who did not disclose their status to their husbands were more likely to experience infant HIV vertical transmission relative to mothers who had disclosed their status.

That is because male partner involvement through participation in ANC attendance has been associated with enhanced uptake of prevention of vertical transmission of HIV services.