FHI 360 facilitates major scale-up for the prevention of mother-to-child transmission of HIV in Nigeria
Through the Strengthening Integrated Delivery of HIV/AIDS Services (SIDHAS) project, funded by the U.S. Agency for International Development, FHI 360 is leading a consortium of partners to support the Government of Nigeria’s goal to eliminate mother-to-child transmission of HIV by 2015 in the country’s 12 states, plus the Federal Capital Territory, that contribute 70 percent of Nigeria’s HIV burden, known as the “12+1.”
As the lead implementing partner in eight of the 12 states and Federal Capital Territory, FHI 360 builds the capacity of state and local government stakeholders to deliver quality services for the prevention of mother-to-child transmission of HIV (PMTCT) through a combination of facility and community initiatives.
Unfortunately, coverage of critical PMTCT services, such as HIV counseling and testing for pregnant women and uptake of antiretroviral drugs, has remained low, despite the efforts of the Government of Nigeria, donors and implementing partners. As of 2012, national PMTCT coverage was less than 20 percent, with variations across the six geographic zones (see figure).
Since February 2013, FHI 360 has supported the scale-up of PMTCT services, beginning with technical assistance for statewide rapid health facility assessments in all of the health facilities across eight of the 12+1 priority states that SIDHAS supports. Those facilities were providing antenatal care but not PMTCT services. The assessments, led by state governments with support from local governments, were designed to determine whether facilities had the staff, infrastructure and service optimization to deliver PMTCT services.
The assessments revealed that about 90 percent of the health facilities were not prepared to provide PMTCT services. In response, FHI 360, in collaboration with various stakeholders, conducted workshops in the eight states to set state-specific targets for eliminating mother-to-child transmission and to discuss strategies for achieving these targets. From this workshop, operational plans and costs were developed for each state. State-level stakeholders, including national and international development partners, helped to develop these plans and will contribute to the scale-up by providing human and material resources.
Rapid expansion of PMTCT services to new health facilities
FHI 360 has also helped to conduct trainings and site start-up activities in selected facilities for the provision of PMTCT services and early infant diagnosis. Over nine months, a phased expansion approach led to massive site activations of PMTCT and early infant diagnosis services across the eight states. This expansion has rapidly increased facility-based coverage of PMTCT services. As the table shows, up to 98 percent of health facilities that provide antenatal care in SIDHAS-supported local government areas have started PMTCT service provision. And, as of April 2014, 2,044 new sites have been activated for PMTCT service provision across the eight states, excluding sites where PMTCT services already existed.
FHI 360 partnered with the Joint United Nations Programme on HIV/AIDS (UNAIDS) and the United Nations Children’s Fund (UNICEF) to conduct an impact estimation of the state operational plans to eliminate mother-to-child transmission. The impact estimation revealed that when the operational plans are fully implemented in all eight states, they will help avert:
- 66,698 HIV infections among women of reproductive age
- 119,340 pregnancies among HIV-positive women of reproductive age
- 127,870 HIV infections among HIV-exposed infants
- 37,293 deaths among HIV-exposed infants
- 955 maternal deaths among HIV-positive women
Figure: Status of PMTCT coverage in Nigeria as of 2012 (Source: President's Comprehensive Response Plan)
Homepage photo: Mrs. Rabi Ibrahim holds her 4-month-old son Muktar Tanko, as nurse Karimatu Abdulmalik prepares for their maternal-child health session at the rural health clinic in Maikunkele village, Bosso, LGA, Niger State, Nigeria.
© 2013 Adrian Brooks, Courtesy of Photoshare