CRITICAL ANALYSIS OF PMTCT IN NIGERIA

HIV

OVERVIEW Describe Mother to child transmission of HIV (MTCT)

as a key public health issue

Describe the Prevention of mother to child transmission of HIV ‘PMTCT’ intervention

Demonstrate ability to integrate and interpret sources of evidence to provide rationale for PMTCT

Examine potential barriers & drivers to successful implementation of PMTCT

Examine the theoretical framework and communication channel.

Examine the evaluation of the PMTCT programme

MOTHER TO CHILD TRANSMISSION OF HIV (MTCT)

“Mother to child transmission of HIV (MTCT) or vertical transmission occur when HIV is

transmitted from an HIV infected mother to child during pregnancy, labour and delivery or while

breastfeeding”

(WHO, 2014)

CONTINUED....

Most children below 15 years living with HIV contract diseases through MTCT (FMoH, 2010)

Overall incidence of MTCT without intervention is 20%-45% distributed over

-Antenatal period

-Labour & Delivery

-Breastfeeding

Without intervention,o About 30% of infants of HIV infected mothers will be

infected during pregnancy and delivery An additional 5-20% will also be infected through

breastfeeding practices.

(FMoH, 2009)

ESTIMATED MAGNITUDE OF MTCT IN NIGERIA (2009)

Indicator Estimate

National Median HIV prevalence (ANC)

4.6%

Estimated Number of people living with HIV

Total: 2.98 million

Annual HIV positive births Total: 56,681

Annual AIDS deaths Total: 192,000 • Male 86,178 , Female 105,822

Number requiring anti-retroviral therapy

Total 857.455 • Adult 754,375 ,Children 103,080

New HIV infection Total: 336,379 • Male 149,095 Female 187,284

Number of children orphaned by AIDS

2,175,760

Source: FMOH (2008) ANC 2008 Report HIV estimates and projection

RISK FACTORS FOR MTCT High maternal viral load Vaginal delivery Sexually Transmitted Infections Low literacy level Preterm delivery Prolonged labour Prolonged breastfeeding Cultural beliefs Premature rupture of membrane Low birth weight Non utilisation of modern health care for antenatal

and delivery (Burr et al., 2007)

(Siame, 2009)

IMPLICATIONS

AIDS Anaemia (abnormality

in red blood cells) Nausea and vomiting Diarrhoea Headaches Pain and nerve

problems Rash Fatigue

(Aids.gov, 2009)

Anxiety Depression Death Suicide Homelessness Low self-esteem

(Seameo, 2002).)

Physiological Psychological

COST OF HIV

Estimates specifies that the cost directly attributed to the prevention of MTCT would cost $22billion - $24billion annually in 2015

Socio-economic cost -Loss of productivity

-Un employment

-Poverty

(UN, 2010)

THE INTERVENTION: PMTCT PROGRAMME Prevention of mother to

child transmission of HIV Programme in Niger state

Target group are women ,pregnant women and nursing mothers

Managed by the Niger state ministry of health

in collaboration with other stakeholders

Counsel for HIV test Voluntary HIV test, explain

result (optional) Perform CD4 test Dispense ARVs Safe obstetrics(Planned

caesarean at 38 weeks of pregnancy

Discuss infant feeding option Reinforce exclusive infant

feeding Perform HIV test at 12 months Explain results.

AIMS OF PMTCT PROGRAMME

Aim:• To reduce the risk of HIV infection for the infant

during pregnancy, childbirth, and breastfeeding by 90% in 2015.

• To increase antenatal clinic attendance• To ensure at least 90% of all HIV positive pregnant

women and breastfeeding infant - mother pairs receive ARV prophylaxis by 2015

• To increase the number of pregnant women tested for HIV

THE RATIONALE FOR PMTCT SERVICES

In Nigeria HIV accounts for 90% of children infection (NACA, 2010).

MTCT is the main route of children’s HIV infection

An estimate of 300,000 newborn contract HIV through breastfeeding (Msellati, 2009)

Children constitute of 6% of PLHIV

In Africa, over 1,000 newborns infected with HIV daily (Besser, 2010)

30–45% of MTCT are without intervention in Nigeria, (FMoH,2009)

POTENTIAL DRIVERS TO THE SUCCESSFUL IMPLEMENTATION OF THE INTERVENTION

Male partner involvement Engagement of community/opinion leaders Involvement of key people (grandmothers and

mother-in-laws) Involvement of gatekeepers Effective collaboration of stakeholders Trained health professionals Involvement of traditional birth attendants

(TBAs) Community health workers

POTENTIAL BARRIERS TO THE SUCCESSFUL IMPLEMENTATION OF THE INTERVENTION Lack of male partner involvement Fear or Stigma and discrimination Lack of knowledge of importance of PMTCT Fear amongst Health workers Loss of follow up Negative attitude of health care providers Poor utilisation on health care services Strong culture of breastfeeding with very low

rates of exclusive breast feeding before 6 months

(Ugba, 2012; FMoH, 2010; Maman, Mbwambo, Hogan, Kilonzo & Sweat, 2001s)

THEORIES AND CHANGE MODELS

Health belief models

- Perceived benefit

- Perceived barrier

- Cues to actions (posters, billboards, death) (Becker, 1974)

Implementation of PMTCT services was based on Diffusion theory of innovation which influences decision to adopt or reject an innovation

people, as part of a social system, adopt or perceive a new idea

(Rogers.

1995)

COMMUNICATION CHANNEL

Mass media Information, education

and communication materials (IEC) such as posters, billboard, prints, calendars

One on one

(FMoH, 2010)

EVALUATION

To assess the quality of PMTCT implementation in the antenatal clinic.

To measure the effectiveness of PMTCT Services and intervention outputs, outcomes and impact in ANC.

Elements such as number of ANC participants, uptake of mothers‘ infant feeding choice, utilisation of ARVs and number of infections averted in infants are measured.

Coverage and access analysis of PMTCT services

Effectiveness of ARV medication for PMTCT

Behaviour change impact of PMTCT program

CONCLUSION MTCT is a key public health issue in Nigeria

Interventions : PMTCT Programme

Rationale from epidemiological data

There are Potential drivers to the success of PMTCT Programme

There are potential barriers e.g. lack of family support

Evaluation of the PMTCT services.

THANK YOU FOR LISTENING

REFERENCE LIST

Aids.gov,. (2009). Side Effects. Retrieved 27 November 2014, from http://www.aids.gov/hiv-aids-basics/just-diagnosed-with-hiv-aids/treatment-options/side-effects/.

Burr, C., Lampe, M., Corle, S., Margolin, F., Abresh, C., & Clark, J. (2007). An End to Perinatal HIV: Success in the US Requires Ongoing and Innovative Efforts that Should Expand Globally. J Public Health Pol, 28(2), 249-260. doi:10.1057/palgrave.jphp.3200126

Becker, M. (1974). The health belief model and personal health behavior (1st ed.). Thorofare, N.J.: C.B. Slack

Federal Ministry of Health (2010). National HIV sero-prevalence sentinel survey among pregnant women attending antenatal clinics in Nigeria. Technical Report 2010. Abuja: FMOH

Federal Ministry of Health (2009) – Nigeria. National PMTCT and HIV & infant feeding guidelines Nigeria.

Maman, S., Mbwambo, J., Hogan, N., Kilonzo, G., & Sweat, M. (2001). Women's barriers to HIV-1 testing and disclosure: Challenges for HIV-1 voluntary counselling and testing. AIDS Care, 13(5), 595-603. doi:10.1080/09540120120063223

Siame, G. (2009). 140 Risk factors associated with a high chance of mother to child transmission (MTCT) of HIV: a retrospective study of HIV-exposed infants/children in Kitwe, Zambia. JAIDS Journal Of Acquired Immune Deficiency Syndromes, 51, 1. doi:10.1097/01.qai.0000351097.32772.7d

Seameo.org,. (2002). virtual library form. Retrieved 27 November 2014, from http://www.seameo.org/vl/hiv-aids/20h-re32.htm

United Nation. (2010). UN News Service Section - UN study finds overall drop in funding for AIDS response in 2010. Retrieved 27 November 2014, from http://www.un.org/apps/news/story.asp?NewsID=39305#.VHbb8mcqfk8

Ugba, E.A.(2012) Increasing PMTCT uptake in a rural hospital using community-based volunteers and male involvement campaigns: experience from northern Nigeria. In: Nineteenth International AIDS Conference, Washington DC. 60-87. 2012.

WHO. (2014). WHO | Mother-to-child transmission of HIV. Retrieved 8 December 2014, from http://www.who.int/hiv/topics/mtct/en/