How traditional birth attendants are helping Kenya win the fight against pediatric HIV

In 2024, Maureen Adhiambo, 32, became pregnant with her third child. In the third month, she had complications. She went to a traditional birth attendant (TBA), as in her past pregnancies.

“I felt some discomfort on the left side of my tummy, and I visited my traditional birth attendant as usual. Usually, she gives a traditional massage, and the problem goes away. But this time, things were different," says Adhiambo

The TBA asked Adhiambo to visit a hospital. She went to Kabondo Sub-County Hospital in Homabay County.

Adhiambo had given birth to her first two children with the help of her TBA.

During her hospital visit, Adhiambo’s issue was handled. As part of Homabay County’s prevention of mother-to-child transmission (PMTCT) program, they asked her to take an HIV test. The result was negative.

“They asked me to bring my husband along during my second antenatal visit. He took the test, and to our shock, it turned out positive,” narrates Adhiambo.

She started pre-exposure prophylaxis (PrEP) right away. This helped keep her and her unborn child safe from infection. As a result, she delivered an HIV-negative child.

High prevalence rates

For decades, Homabay County has had some of the highest HIV rates in Kenya's western region. Homabay County, once the heart of Kenya’s HIV crisis, is changing. An unexpected group of frontline workers is helping to shift the narrative.

Justus Ochola heads research and innovation at the county's Department of Health. He says that mother-to-child HIV transmission was a big contributor to increased HIV rates in the county.

Ochola stated, “Our mothers prefer traditional birth attendants. This choice has led to the highest rates of mother-to-child HIV transmission in Homabay.”

He said, “Most women who used traditional birth attendants skipped antenatal clinics. This made things worse.”"

Mother-to-child transmission of HIV happens when the virus passes from mother to child during pregnancy, childbirth, or breastfeeding. 

Turning the tide

In Homabay County, traditional birth attendants are changing their role. Once seen as a weak link in stopping pediatric HIV from unskilled home deliveries, they now play a key role in reducing mother-to-child transmission. They refer pregnant women to health facilities for skilled care.

Homabay County created a program to discourage home deliveries. It instead incorporated Traditional Birth Attendants (TBAs) in the maternal health system.

Ochola explains that the county’s PMTCT program hired 2,000 TBAs. Their job is to refer pregnant mothers to health facilities. Each TBA receives Sh200 for every referral.

“We decided that the best way to address home births is not to criticise TBAs. Instead, we should include them in the system. We asked them to connect expectant mothers with health facilities for specialised care,” Ochola said.

Ochola notes that working with TBAs has led to a jump in hospital deliveries. They increased from 48% in 2012 to 84% in 2025. Meanwhile, mother-to-child HIV transmission rates fell from 18% in 2012 to 6.69% in 2025.

“Right now, 99% of pregnant women in the county are tested for HIV. Those who test positive start antiretroviral therapy (ART) right away. This effort is helping Homa Bay eliminate pediatric HIV,” he said.

Homa Bay County has 218 health facilities providing HIV testing and ART services. This is crucial for increasing testing rates, especially among pregnant women.

Grace Atieno, 60, works as a traditional birth attendant for the county. She helps encourage pregnant women to attend antenatal clinics and deliver in hospitals.

"We encourage pregnant women to start antenatal clinics early. This helps identify those who are HIV positive. Then, we can ensure they get treatment to protect their babies from transmission," she says.

Robust PMTCT program

Carolyne Atieno, the reproductive health lead in Kabondo sub-county, says that early antenatal clinic visits are key. They help find HIV-positive mothers. Testing happens from the first trimester until delivery.

Under the Homabay PMTCT program, pregnant mothers with HIV should go to eight antenatal clinic visits. This is double the usual four visits. Eight ANC visits keep a close watch on the baby's safety during pregnancy and birth.

Atieno explains, “For pregnant women who test negative on the first test, we keep testing for up to six months. We also promote PrEP to prevent possible infections.”

Leonard Okumu, the AIDS and STIs Coordinator (CASCO) in Kabondo sub-county, says the strong PMTCT program has helped lower pediatric HIV rates in Homa Bay.

Okumu notes that the test-and-treat approach in Homa Bay has been effective. Every pregnant mother who visits a clinic gets an HIV test. Those who test positive start ART right away to prevent mother-to-baby transmission.

Benta Atieno, 44, is a TBA who has lived with HIV for 17 years. She helps ensure that HIV-positive pregnant mothers go to clinics and follow their treatment.
 

She says, “More HIV-positive pregnant mothers are visiting hospitals and giving birth to healthy, HIV-negative babies.

According to the National Syndemic Diseases Control Council (NSDCC), as of 2025, Homabay’s PMTCT program covered 4166 women against a need of 4304, an average of 96.79% compared to the national coverage of 90.1%.

Country Status

The World Health Organisation (WHO) states that without intervention, the chance of a mother with HIV passing it to her child during pregnancy, labour, delivery, or breastfeeding is between 15% and 45%. WHO cites pregnancy and breastfeeding as periods of high risk of transmission. 

Dr Jonah Onentiah, the HIV & STI prevention lead at NASCOP, reports that 5% of mothers become newly infected with HIV during pregnancy. The rate rises to 17% during breastfeeding. This increases the risk of transmission to infants. 

Dr Onentiah notes that 21% of mothers who are pregnant or breastfeeding and living with HIV do not receive antiretroviral ART, and 47% drop off ART.

In 2023, Kenya launched an action plan dubbed the Kenya Plan to End AIDS in Children by 2027. The plan seeks to prevent new HIV infections among children.  

Data from NSDCC show that Kenya’s PMTCT coverage stands at 90.1%, with the mother-to-child transmission rate standing at 9.26%.

Dr Onentiah said, “If we can ensure that health facilities deliver every single child, particularly in high-prevalence areas like Homabay, then we can end new pediatric HIV infections by 2027."

HIV in focus

This news story has been published as part of our HIV in focus news network. This is a network of writers and journalists from our focus countries, dedicated to delivering news on HIV and sexual health. The network aims to amplify the voices of communities most affected by HIV and share the stories that matter to them.

About the writer

Jackson Okata is a multiple award-winning independent multimedia journalist based in Nairobi, Kenya. Jackson specialises in science, health, agriculture, environment, climate change, women and gender, human rights, political and governance, tech and innovation reporting.