Survival rate of HIV-exposed infants in Homa Bay County, Kenya: a prospective cohort study

Augustine Gatimu Njuguna; Simon Muturi Karanja; Peter Wanzala

doi:10.18203/2394-6040.ijcmph20260667

Authors

Augustine Gatimu Njuguna Department of Public Health, Jomo Kenyatta University of Science and Technology, Nairobi, Kenya
Simon Muturi Karanja Department of Public Health, Jomo Kenyatta University of Science and Technology, Nairobi, Kenya
Peter Wanzala Kenya Medical Research Institute graduate school, Nairobi, Kenya

DOI:

https://doi.org/10.18203/2394-6040.ijcmph20260667

Keywords:

HIV-exposed infants, Homa Bay, Kenya, PMTCT, Spatial epidemiology, Survival analysis

Abstract

Background: Mother-to-child transmission (MTCT) of HIV is a significant public health concern in sub-Saharan Africa, accounting for most pediatric HIV infections. Despite investments in prevention programs, disparities in infant HIV-free survival persist. Homa Bay County, in Kenya, bears one of the highest HIV burdens in the country.

Methods: A prospective cohort of 326 infants born to HIV-positive mothers followed for up to 18 months aimed to determine the survival rate of HEIs in Homa Bay County. Data were analyzed using Kaplan-Meier survival curves to estimate survival probabilities, Cox proportional hazards regression to identify risk factors, and Bayesian spatial survival models to assess geographic clustering of outcomes.

Results: variation in HIV-free survival across sub-counties, Homa Bay Town recorded the lowest infant HIV positivity, 2.9%, higher rates observed in Karachuonyo (14.3%), Suba (14.0%), and Rangwe (10.5%). Time-to-seroconversion varied; early infections were observed in Homa Bay Town (≈5 weeks), consistent with intrauterine or intrapartum transmission; later infections were noted in Mbita and Rangwe (≈37-39 weeks), suggestive of breastfeeding-related transmission. Kaplan-Meier analysis confirmed significant differences between sub-counties (log-rank p<0.05), spatial models identified high-risk clusters in Karachuonyo, Suba, and Rangwe, with a protective effect in Ndhiwa.

Conclusions: Findings highlight uneven, geographically clustered patterns of infant survival, shaped by maternal adherence to antiretroviral therapy, health system capacity, and socio-cultural practices. Tailored, spatially targeted PMTCT interventions are essential to reduce transmission and improve outcomes for HIV-exposed infants.

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