At least 200,000 pregnant women in Kenya missed HIV testing in 2023, significantly increasing the risk of mother-to-child transmission (MTCT) of HIV. This development has raised fresh concerns about the country’s efforts to eliminate vertical HIV transmission.
Despite a general decline in infant HIV infections over the past five years, recent data shows a troubling reversal. In 2023 alone, 3,742 babies representing 7.3 percent of all live births to women living with HIV were infected.
One of the key reasons behind the missed testing is the failure by many women to attend antenatal care (ANC) clinics or the decision to decline HIV testing even when they do visit. Non-attendance at the first ANC visit remains one of the most significant barriers to early HIV detection and treatment, which are essential to preventing the spread of the virus from mother to child.
HIV can be transmitted during pregnancy, childbirth, or breastfeeding. However, when expectant mothers receive early HIV testing and start antiretroviral therapy (ART), the risk of transmission can be drastically reduced to below five percent. In many high-income countries, rates are even lower, dropping to under one percent due to early intervention and consistent follow-up care.
Kenya’s national guidelines recommend an opt-out approach to HIV testing during the first antenatal visit, with repeat testing encouraged in the third trimester. While this strategy has helped improve detection rates in the past, the fact that testing remains voluntary means some women still fall through the cracks. Those who decline testing at their first visit are encouraged to reconsider in later appointments, but not all return to the clinic.
Out of the 3,742 infant HIV infections reported in 2023, a significant number resulted from lapses in ART adherence. Specifically, 684 infections occurred after mothers stopped taking their antiretroviral drugs during pregnancy, while 727 babies were infected during breastfeeding due to similar interruptions in treatment. Another 585 infants contracted HIV from mothers who became infected during pregnancy or the breastfeeding period, highlighting the importance of continued HIV prevention even for initially HIV-negative mothers.
There were also striking regional differences in mother-to-child transmission rates. Some counties recorded MTCT rates well above the national average. Wajir had the highest rate at 33.5 percent, followed by Mandera, Samburu, West Pokot, and Isiolo all of which exceeded 20 percent. In contrast, counties like Migori, Kisumu, Murang’a, and Nairobi recorded significantly lower rates, with MTCT levels under seven percent.
The national goal is to reduce vertical HIV transmission to below five percent across the board. Achieving this target will require a multi-faceted approach that includes stronger community outreach programs, increased awareness about the importance of early and regular antenatal visits, and support systems to ensure that mothers adhere consistently to their ART regimens.
Addressing cultural, logistical, and healthcare access barriers will also be crucial. Outreach efforts in high-burden counties, improved training for healthcare workers, and community-level advocacy can help bridge gaps in service delivery and encourage more women to seek timely testing and treatment. Ensuring that no pregnant woman is left behind in HIV prevention could be a decisive factor in safeguarding the next generation from a preventable disease.
