Determinants of prevention of mother-to-child transmission (PMTCT) service utilization among adolescent girls and young women aged 15–24 years in Migori County, Kenya

Nancy Yienya, Dennis Magu, Caroline Musita

Abstract

Despite efforts to eradicate mother-to-child transmission (MTCT), adolescent girls and young women (AGYW) in sub-Saharan Africa (SSA) continue to be disproportionately impacted by Human Immunodefiency Virus (HIV). In this mixed-methods study, 323 AGYW between the ages of 15 and 24 who attended prenatal and postnatal clinics were assessed for barriers and enablers to prevention of mother-to-child transmission (PMTCT) service utilization at Migori County Referral Hospital, Kenya.  Overall, 66.9% achieved optimal PMTCT utilization. Women aged 20-24 had a higher likelihood of optimal utilization than adolescents aged 15-19 years (AOR≈1.9). Pre-Exposure Prophylaxis (PrEP) use was associated with greater utilization (AOR≈3.0), whereas unknown HIV status and negative health system experiences significantly reduced uptake. Qualitative findings identified multilevel barriers including stigma, financial constraints, confidentiality concerns, long waiting times, and poor provider attitudes. Key enablers included partner support, PrEP use, prior knowledge of HIV status, respectful care, and integrated service delivery. Interventions such as PrEP integration, adolescent-responsive care, and stigma-free, client-centered services are critical to improving PMTCT uptake.

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References

UNAIDS. UNAIDS global AIDS update 2023: The path that ends AIDS. Geneva: UNAIDS; 2023.

UNAIDS. Global HIV & AIDS statistics: Fact sheet. Geneva: UNAIDS; 2023.

Lynch I, Macleod CI, Chiweshe MT, Moore SA. Vulnerable youth or vulnerabilising contexts? A critical review of youth sexual and reproductive health and rights (SRHR) policies in Eastern and Southern Africa. Sex Res Soc Policy. 2025; 22(2):1058-1070.

Paul S, Dayal R, Sharma AJ, Seth K, Ramesh S, Saggurti N. Unpacking vulnerability to sexually transmitted infections (STIs)/human immunodeficiency virus (HIV) among adolescent girls and young women in India: A qualitative study. PLoS One. 2025; 20(11):e0336593.

Obeagu EI. HIV and maternal-fetal immunity: Challenges and strategies for reducing vertical transmission—narratives review. Health Sci Rep. 2025; 8(7):e71076.

Mahy M, Stover J, Kiragu K, Hayashi C, Akwara P, Luo C, et al. What will it take to achieve virtual elimination of mother-to-child transmission of HIV? An assessment of current progress and future needs. Sex Transm Infect. 2010; 86(Suppl 2):ii48-ii55.

Toska E, Laurenzi CA, Roberts KJ, Cluver L, Sherr L. Adolescent mothers affected by HIV and their children: A scoping review of evidence and experiences from sub-Saharan Africa. Glob Public Health. 2020; 15(11):1655-1673.

Humphrey JM, Songok J, Ofner S, Musick B, Alera M, Kipchumba B, et al. Retention in care and viral suppression in the PMTCT continuum at a large referral facility in western Kenya. AIDS Behav. 2022; 26(11):3494-3505.

Alkhawaldeh A, AlBashtawy M, Rayan A, Abdalrahim A, Musa A, Eshah N, et al. Application and use of Andersen's behavioral model as theoretical framework: A systematic literature review from 2012-2021. Iran J Public Health. 2023;52(7):1346-1358.

Creswell JW, Plano Clark VL. Designing and conducting mixed methods research. 3rd ed. Thousand Oaks (CA): Sage Publications; 2018.

Akwataghibe NN, Ogunsola EA, Broerse JE, Popoola OA, Agbo AI, Dieleman MA. Exploring factors influencing immunization utilization in Nigeria: A mixed methods study. Front Public Health. 2019; 7:392.

Wanyenze RK, Goggin K, Finocchario-Kessler S, Beyeza-Kashesya J, Mindry D, Birungi J, et al. Utilization of prevention of mother-to-child transmission (PMTCT) services among pregnant women in HIV care in Uganda: A 24-month cohort of women from pre-conception to post-delivery. BMC Res Notes. 2018;11(1):187.

Oribhabor CB, Anyanwu CA. Research sampling and sample size determination: A practical application. J Educ Res (FUDJER). 2019; 2(1):47-57.

Braun V, Clarke V. Using thematic analysis in psychology. Qual Res Psychol. 2006; 3(2):77-101.

López-Ibáñez C, López-Nicolás R, Blázquez-Rincón DM, Sánchez-Meca J. Reliability generalization meta-analysis: Comparing different statistical methods. Curr Psychol. 2024; 43(20):18275-18293.

Christensen R. Log-linear models and logistic regression. New York: Springer; 1997.

World Medical Association. World Medical Association Declaration of Helsinki: Ethical principles for medical research involving human participants. JAMA. 2025;333(1):71-74.

Kohler PK, Okanda J, Kinuthia J, Mills LA, Olilo G, Odhiambo F, et al. Community-based evaluation of PMTCT uptake in Nyanza Province, Kenya. PLoS One. 2014; 9(10):e110110.

Kenya National Bureau of Statistics. Kenya National Bureau of Statistics statistical abstract. Nairobi: Kenya National Bureau of Statistics; 2023.

Kinuthia J, Kiarie JN, Farquhar C, Richardson BA, Nduati R, Mbori-Ngacha D, et al. Uptake of prevention of mother-to-child transmission interventions in Kenya: Health systems are more influential than stigma. J Int AIDS Soc. 2011;14(1):61.

Tenthani L, Haas AD, Tweya H, Jahn A, van Oosterhout JJ, Chimbwandira F, et al. Retention in care under universal antiretroviral therapy for HIV-infected pregnant and breastfeeding women (Option B+) in Malawi. AIDS. 2014; 28(4):589-598.

Okonofua FE, Ntoimo LFC, Ogu R, Galadanci H, Mohammed G, Adetoye D, et al. Prevalence and determinants of stillbirth in Nigerian referral hospitals: A multicenter study. BMC Pregnancy Childbirth. 2019; 19(1):533.

Kinuthia J, Drake AL, Matemo D, et al. HIV testing uptake among pregnant women attending antenatal care in Kenya. J Int AIDS Soc. 2018; 21(Suppl 4):e25108.

National AIDS and STI Control Programme. Kenya HIV estimates report 2024. Nairobi: Ministry of Health; 2024.

Astawesegn FH, Mannan H, Stulz V, Conroy E. Understanding the uptake and determinants of prevention of mother-to-child transmission of HIV services in East Africa: Mixed methods systematic review and meta-analysis. PLoS One. 2024; 19(4):e0300606.

UNAIDS. Global AIDS update 2024: The urgency of now. Geneva: Joint United Nations Programme on HIV/AIDS; 2024.

Ayisi, Thuita F, Wakoli A. Factors associated with exclusive breastfeeding among infants aged 0-6 months in a peri-urban low-income settlement of Kangemi, Nairobi. East Afr J Health Sci. 2023;3:180-187.

Kinuthia J, Pintye J, Abuna F, Mugwanya KK, Lagat H, Onyango D, et al. Pre-exposure prophylaxis uptake and early continuation among pregnant and post-partum women within maternal and child health clinics in Kenya: Results from an implementation programme. Lancet HIV. 2020;7(1):e38-e48.

World Health Organization. Consolidated guidelines on HIV prevention, testing, treatment, service delivery and monitoring: Recommendations for a public health approach. Geneva: World Health Organization; 2022.

Turan JM, Elafros MA, Logie CH, et al. Challenges and opportunities in examining and addressing HIV-related stigma in healthcare settings. BMC Med. 2021;19:263.

Geldsetzer P, Yapa HM, Vaikath M, et al. A systematic review of barriers to HIV care in sub-Saharan Africa. PLoS Med. 2020;17(1):e1003040.

Dellar RC, Dlamini S, Karim QA. Adolescent girls and young women: Key populations for HIV epidemic control. J Int AIDS Soc. 2015;18:19408.

Ronen K, McGrath CJ, Langat AC, Kinuthia J, Omolo D, Singa B, et al. Gaps in adolescent engagement in antenatal care and prevention of mother-to-child HIV transmission services in Kenya. J Acquir Immune Defic Syndr. 2017;74(1):30-37.

Davey DLJ, Bekker LG, Gomba Y, Coates T, Myer L, Johnson LF. Modelling the potential impact of providing pre-exposure prophylaxis in pregnant and breastfeeding women in South Africa. AIDS. 2019;33(8):1391-1395.

Omonaiye O, Kusljic S, Nicholson P. Women's experiences of PMTCT services in sub-Saharan Africa: A systematic review. BMC Public Health. 2021;21:1117.

Futterman D, Shea J, Besser M, Stafford S, Desmond K, Comulada WS, et al. Mamekhaya: A pilot study combining a cognitive-behavioral intervention and mentor mothers with PMTCT services in South Africa. AIDS Care. 2010;22(9):1093-1100.

Aluisio A, Richardson BA, Bosire R, John-Stewart G, Mbori-Ngacha D, Farquhar C. Male antenatal attendance and HIV testing are associated with decreased infant HIV infection and increased HIV-free survival. J Acquir Immune Defic Syndr. 2011;56(1):76-82.

Osoti AO, John-Stewart G, Kiarie J, Richardson B, Kinuthia J, Krakowiak D, et al. Home visits during pregnancy enhance male partner HIV counselling and testing in Kenya: A randomized clinical trial. AIDS. 2014;28(1):95-103

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