Improving access to HIV testing for pregnant women in community birth centres in Nigeria: an evaluation of the Prevention of Mother-to-Child Transmission program

Author:

Nwanja Esther1ORCID,Akpan Uduak2,Toyo Otoyo2,Nwaokoro Pius3,Badru Titilope3,Gana Bala2,Nwanja Ifeyinwa2,Ayabi Oruayefe2,Ayeni Bishop2,Xavier Emem4,Idemudia Augustine2,Sanwo Olusola3,Khamofu Hadiza3,Bateganya Moses5

Affiliation:

1. AHNi, 67, Bennett Bassey Street (Unit C), Ewet Housing Estate, Uyo, Akwa Ibom State, Nigeria

2. AHNi, Abuja, Nigeria

3. FHI 360, Abuja, Nigeria

4. Akwa Ibom State Ministry of Health, Nigeria

5. FHI 360, Durham, NC, USA

Abstract

Background: The elimination of mother-to-child HIV transmission requires access to HIV testing services (HTS) for pregnant women. In Akwa Ibom, Nigeria, 76% of pregnant women receive antenatal care from traditional birth attendants and may not have access to HIV testing. Objectives: This study examines the contribution of traditional birth attendants and other healthcare workers in community birth centres in improving access to HTS among pregnant women and their HIV-exposed infants. Design: A retrospective cross-sectional study of previously collected programme data at two points in time to evaluate the prevention of mother-to-child transmission (PMTCT) programme. Methods: We assessed programme records before and after introducing an intervention that engaged traditional birth attendants and other healthcare workers in community birth centres to expand access to HTS among pregnant women and their HIV-exposed infants in Akwa Ibom State, Nigeria. Data were abstracted from the programme database for the preintervention period (April 2019 to September 2020) and the intervention period (October 2020 to March 2022). Data abstracted include the number of pregnant women tested for HIV, those diagnosed with HIV, the number of HIV-exposed infants who had samples collected for early infant diagnosis and those diagnosed with HIV. The data were analysed descriptively and inferentially. Results: Before the intervention, 39,305 pregnant women and 2248 HIV-exposed infants were tested for HIV. After the intervention, the number of pregnant women tested increased to 127,005 and the number of HIV-exposed infants tested increased to 2490. Among pregnant women, the postintervention testing increased by 3.2-fold, with community birth centres reporting 63% of all tests. The intervention also resulted in an 11% increase in HIV-exposed infants benefitting from early infant diagnosis with community birth centres reporting 5% of all tests. Of those diagnosed with HIV, 24% of pregnant women and 12% of infants were diagnosed at community birth centres. Conclusion: Community-based HIV testing for pregnant women can reduce mother-to-child transmission and improve early diagnosis and treatment of exposed infants. Collaboration with birth attendants is crucial to ensure testing opportunities are not missed. Prospective research is needed to understand the clinical outcomes of intervention programmes in the community.

Publisher

SAGE Publications

Subject

Pharmacology (medical),Infectious Diseases

Reference36 articles.

1. Joint United Nations Programme on HIV/AIDS 2021. Progress towards the Start Free, Stay free, AIDS Free targets. 2020 report, https://reliefweb.int/report/world/progress-towards-start-free-stay-free-aids-free-targets-2020-report (accessed May 2022).

2. Joint United Nations Programme on HIV/AIDS 2014. The GAP report; children and pregnant women living with HIV, https://www.unaids.org/sites/default/files/media_asset/09_ChildrenandpregnantwomenlivingwithHIV.pdf (accessed May 2022).

3. WHO. Global HIV and Programme; Mother to child transmission of HIV, https://www.who.int/teams/global-hiv-hepatitis-and-stis-programmes/hiv/prevention/mother-to-child-transmission-of-hiv (accessed May 2022).

4. Trends and effects of antiretroviral therapy coverage during pregnancy on mother-to-child transmission of HIV in Sub-Saharan Africa. Evidence from panel data analysis

5. UNICEF 2019. Children, HIV and AIDS, regional snapshot, Sub-Saharan Africa, https://www.childrenandaids.org/sites/default/files/2020-08/SSA%20Regional%20snapshot-%20v5-%206%20Nov%20%281%29.pdf (accessed May 2022).

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