Study setting
The study took place at six clinical sites in western Kenya that offered antenatal, postnatal, and PMTCT care: Moi Teaching and Referral Hospital; Uasin Gishu District Hospital; Huruma Sub-County Hospital; Kitale County Referral Hospital; Chulaimbo Sub-County Hospital; and Matayos Sub-County Hospital. These clinics provide government-funded public healthcare and are part of the Academic Model Providing Access to Healthcare (AMPATH) program. PMTCT care is free of charge, including ART. Three of the sites are in Eldoret, Kenya’s fifth most populated urban area. Two sites are in smaller towns, and the Kitale County Referral Hospital serves primarily a rural population. Western Kenya has a heterogeneous epidemic of HIV, and the estimated female adult HIV prevalence ranges from 5.5 to 17.4%