Accelerate PMTCT uptake in 12 plus 1 high burden states

Nigeria’s HIV response has made some progress towards universal access to HIV services including the PMTCT services for pregnant women and their children. The 2010 National Sero-Sentinel Survey by the Federal Ministry of Health estimates HIV prevalence of 4.1% among pregnant women attending antenatal clinics while the 2012 National AIDS and Reproductive Health Survey (NARHS) Plus revealed 3.4% prevalence for the general population with marked differences in prevalence for various states and communities. The comprehensive approach to PMTCT include HIV primary prevention, counseling and testing of pregnant women during the antenatal period, provision of antiretroviral drugs as prophylaxis, safe delivery practices, counseling and support for infant feeding, provision of early infant diagnosis including the treatment and care and support for HIV positive children. However, Nigeria still accounts for more than 20% of the world’s children newly infected with HIV each year and with only a 2% decline in number of new infections in children since 2009.

There is a strong commitment from the global community to achieving the elimination of MTCT (eMTCT) of HIV by 2015, at least in 22 priority countries that contribute to over 80% of the global unmet PMTCT needs.  Nigeria has been identified as one of the priority countries for achieving the elimination of MTCT by 2015. However, the President launched a new eMTCT initiative and target aiming to achieve this new target by 2030[1]

There has been progress in increasing the coverage of PMTCT with availability of services from primary to tertiary levels of health care. Several challenges are responsible for the low coverage of PMTCT services.  Geographical coverage and utilization of ANC services, facility delivery and Skilled Birth Attendants remain very low.  Also, while over 14,000 health facilities offer ANC services, only a small fraction of these facilities, less than 5 % offer PMTCT services.  At the end of 2011 only 17% of pregnant women received an HIV test, the entry point to PMTCT services.

Integration of services provided at the PHC facilities is limited.  The focus on primary HIV prevention, and Sexual Reproductive Health (SRH) of women and their partners especially Family Planning (FP) information, services and commodities is inadequate. The Procurement Supply Management (PSM) system for HIV is complex with challenges throughout the PSM cycle resulting into incessant stock-outs of HIV diagnostics, ARVs and other related commodities.  Weak data management systems and use of generated data at state and LGA levels is also a major challenge.

It is against this back drop that NACA developed the strategic approach of rapid scale-up of PMTCT in the 12 plus 1 high burden states, aiming to saturate them with PMTCT services, as they attribute for 70% of the HIV/AIDS burden in Nigeria.  In furtherance of this strategic approach, NACA committed MDG resources to further strengthen access to Prevention of Mother To Child Transmission (PMTCT) services through community mobilization.

Objectives of the PMTCT scale-up intervention

  1. To advocate increased access to HIV counselling and testing services by pregnant women and girls in the 12 plus 1 states.
  2. To identify and train community volunteers on HIV issues and need to refer clients for HCT services.
  3. To mobilize and support pregnant women and sexually active girls to access RH services, ANC and HCT
  4. To monitor and follow-up on HIV positive cases and establish linkages to PMTCT services and other care and treatment.
  5. To strengthen capacities at the community level for project coordination

Methodology

Planning meeting

On the 4th of December 2014, NACA/MDG team held a two-day Project Inception meeting with the 9 CBOs/FBOs supported under the NACA –MDG project, and the representatives of the PMTCT-focused NGOs were all in attendance. In his special remarks, the Director General of NACA, Prof John Idoko (represented by Dr P Ibekwe, Acting Director, Programme Co-ordination), celebrated the success of the previous years implementation and tasked the organizations to produce results over the remaining period of the MGDs. She emphasised the need for the NGOs to dedicate time and effort, ensure proper documentation in appropriate format to demonstrate output/outcome and timely reporting. Issues raised by the NGO representatives were clarified following which each organisation signed a grant agreement with NACA.

Community mobilization

Advocacy at State and LGA Levels

Each of the NGOs conducted advocacy visits to relevant Government institutions at State and LGA levels during which they introduced the project and enlisted their support and commitment to the project. This was necessary because of their strategic role in providing leadership and coordination of HIV/AIDS activities in the state.  The government institutions expressed their pleasure with the oncoming project, which they said was timely as the State is still, faced significant challenges of HIV/AIDS epidemic.

Advocacy at the community level

The NGOs took the advocacy messages further to the communities where their projects were located, where they interacted with traditional rulers, religious leaders, women and youth leaders, opinion leaders and community members. During these meetings, they secured the consents and support of these leaders for the successful implementation of the project in their domains.

The traditional leaders and all concerned were very appreciative that NACA through the NGOs was bringing the projects to their various communities and registered their commitment and willingness to urge their subjects to participate fully. They further requested for immediate commencement of the project and demanded that the Chiefs should be counselled and tested first before other community members. Sensitization sessions were also held for specific target population groups such as women and young people.

Linkage to Care

NACA shared the list of donor-supported facilities where HIV/AIDS services are provided at no cost across the 36 states and FCT. The NGOs established formal relationship with their catchment facilities and worked with a focal person within the facility to facilitate easy referrals. Services clients accessed at the facilities included HCT, SRH, ANC, PMTCT and family planning. The NGOs were encourage to partner with other organizations to offer a HIV test at first contact to pregnant women if they did not have the capacity within their organization to conduct the test.

Interim results

250 women mobilized in 6 states, 66 HIV positive women have been referred for PMTCT services in Anambra, Edo, Ebonyi, FCT, Lagos and Rivers state.