PREVENTION OF MOTHER TO CHILD TRANSMISSION OF HIV/AIDS (PMTCT)
Nigeria has an estimated 3.4 million people living with HIV (NARHS, 2012), Nigeria ranks second to South Africa, presenting a substantive disease burden. 58% of those living with HIV in Nigeria are pregnant women and women of child bearing age of 15-49 years old, who are also nearly twice likely to get newly infected and to live with HIV. 30% of 244,000 HIV-infected women who were estimated to have been pregnant in 2014 were reached leaving an unmet gap of 70% in the PMTCT National response. Also there is a geographical disparity in PMTCT coverage with North Central having the lowest coverage of 23%.
FCT and Nasarawa states after series of interventions were carried out by government and development partners recorded the highest number of PMTCT lost to follow up between 2010 and 2014 of 15% (DASH 2015). The report also showed that there is high incidence of unwanted pregnancy, unsafe abortion, HIV and STIs among women of child bearing in the two states. According to NDHS (2015) report for FCT and Nasarawa state, 20% of women of reproductive age had an unwanted pregnancy, 43% of women who sought an abortion did so because they were not married, were too young or were still in school, an estimated one in three pregnancies were unplanned.
Previous interventions in these two states did not make a direct link between prevention of unwanted pregnancy, PMTCT and other HIV prevention programs but rather a parallel non-integrated intervention.
CHEERS with support from NACA MDG is currently implementing a comprehensive PMTCT/SRH project in FCT and Nasarawa States. Implementation of the project adopted a three prong approach of primary HIV prevention among women of reproductive age, prevention of unintended pregnancies among HIV positive women through sexual reproductive health services (SRH) and improve the follow-up system to ensure that lost to follow-up is eliminated while service uptake is optimized.
In using the above approaches, strategies including training of identified community women change actors to provide sexual reproductive health education to women of child bearing age in the two states are employed. The project also identifies the men as being responsible for high teenage, and unwanted pregnancy, unsafe abortions and high PMTCT prevalence, therefore advocacy activities have been focused on traditional institutions and male dominated groups in these states to create awareness and sensitize them on the need for their female partners to uptake PMTCT and reproductive health services provided by the project.
Through this project, the community’s knowledge and awareness of SRH, PMTCT and overall wellbeing has been increased. Specific impact are being made on strategies for ensuring continuous elimination of lost to follow up even after the project ends. It is also hoped that male involvement in ANC/PMTCT activities which the project facilitated will result to a positive impact in the communities capacity to respond to PMTCT. The community volunteers that have been trained during the project life span acts as the community’s resource base for continuing PMTCT response which will also bring about leveraging and indicative continuum of care for pregnant mothers and their babies. The project has also empowered communities to develop community action plans towards resource mobilization and leveraging for PMTCT related activities when the funding is no longer available to support these activities.
Midterm report from the project indicate a behavioural change towards positive pregnant mothers and their households. Many stigmatized households where positive pregnant mothers come from are no longer be stigmatized, health care workers have been equipped and are now providing appropriate information and counselling during ANC days to all pregnant women within the communities. The traditional institutions in the targeted communities have received adequate information and capacity to develop community oriented strategies for ensuring that every pregnant woman within their community received HIV/AIDS Counselling and Testing either from the health facility, in the TBA home or at her own residence.