Factors influencing mother-to-child transmission-free survival among exposed infants in Homa Bay County: a qualitative analysis

Abstract

Background: Prevention of mother-to-child transmission programs significantly reduce the transmission of Human Immunodeficiency Virus (HIV) from mothers to children. However, uptake remains low in high-prevalence areas such as Homa Bay County, Kenya. Socio-economic, cultural, and logistical factors limit integration of prevention of mother-to-child transmission into maternal and child health services. Methods: This study explored barriers and enablers to uptake of prevention of mother-to-child transmission services among human immunodeficiency virus-positive mothers. Data were collected from 13 key informant interviews with healthcare providers and eight focus group discussions with human immunodeficiency virus-positive mothers across seven sub-counties of Homa Bay County. The Gioia methodology guided thematic analysis to identify first-order concepts, second-order themes, and aggregate dimensions. Results: Participants identified major barriers including stigma, economic hardship, transportation challenges, cultural norms, misinformation, and gaps in the referral system. Enablers of service uptake included male partner involvement, effective service delivery models, peer support systems, and community sensitization. Emotional and nutritional support, alongside consistent health education, were considered essential to improving adherence to prevention of mother-to-child transmission protocols. Conclusions: Improving uptake of prevention of mother-to-child transmission in high human immunodeficiency virus-prevalence settings requires addressing both systemic and sociocultural barriers. Interventions should enhance male participation, community engagement, service integration, and referral coordination. These findings support need for multifaceted, context-sensitive strategies to strengthen prevention of mother-to-child transmission outcomes in Homa Bay County.