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.