‘Making the most of our situation’: a qualitative study reporting health providers’ perspectives on the challenges of implementing the prevention of mother-to-child transmission of HIV services in Lagos, Nigeria

ObjectivesTo investigate the challenges of, and opportunities for, effective delivery of prevention of mother-to-child transmission (PMTCT) services from the perspectives of primary healthcare providers in Lagos, Nigeria.DesignThis qualitative study consisted of nine focus groups with 59 health providers, analysed thematically.SettingThirty-eight primary health facilities in central and western districts of Lagos, Nigeria.ParticipantsParticipants included nurses, nursing assistants, community health workers, laboratory workers, pharmacists, pharmacy technicians, monitoring and evaluation staff and medical records personnel.ResultsHealth providers’ challenges included frustration with the healthcare system where unmet training needs, lack of basic amenities for effective and safe treatment practices, low wages and inefficient workflow were discussed. Providers discussed patient-level challenges, which included the practice of giving fake contact information for fear of HIV-related stigmatisation, and refusal to accept HIV-positive results and to enrol in care. Providers’ suggestions for addressing PMTCT service delivery challenges included the provision of adequate supplies and training of healthcare workers. To mitigate stigmatisation, participants suggested home-based care, working with traditional birth attendants and religious institutions and designating a HIV health educator for each neighbourhood.ConclusionsFindings illustrate the complex nature of PMTCT service delivery and illuminate issues at the patient and health system levels. These results may be used to inform strategies for addressing identified barriers and to improve the provision of PMTCT services, thus ensuring better outcomes for women and families.

A multilevel analysis of determinants of PMTCT service utilisation among women during the antepartum, intrapartum and postpartum period in Ethiopia

Background Mother-to-child transmission (MTCT) is the largest source of HIV infection in children below the age of 15 years, and more than 90% of pediatric HIV are infected through mother to child transmission. Without treatment, one-half of those infected children will die before the age of 2 years. Despite this, there is limited evidence on PMTCT and its determinants. Therefore, this study aimed to determine the factors affecting the PMTCT service utilisation in Ethiopia. Methods A two-stage stratified sampling technique was used to identify 4081 women from 2016 Ethiopian Demographic and Health Survey (EDHS). A multilevel mixed-effect binary logistic regression analysis was used to identify the individual and community level factors associated with PMTCT services utilisation. In the final model, a p-value of < 0.05 and Adjusted Odds Ratio (AOR) with 95% confidence interval (CI) were used to declare statistically significant factors with the utilisation. Results Overall, 21.9% (95% CI, 20.6–23.2) of the women were utilized PMTCT services. Educational status; primary (AOR: 1.65, 95% CI: 1.27–2.13), secondary (AOR: 1.52, 95% CI: 1.03–2.24) and higher school (AOR: 2.48, 95% CI: 1.45–4.22), poorer (AOR: 1.62, 95% CI: 1.12–2.37), middle (AOR: 1.82, 95% CI: 1.10–3.02), richer (AOR: 2.44, 95% CI: 1.42–4.21) and richest (AOR: 4.45, 95% CI: 2.43–8.14) wealth status and orthodox religion follower (AOR: 1.62, 95% CI: 1.22–2.16) were the individual level factors. Moreover, having basic (AOR: 1.66, 95% CI: 1.34–2.06) and comprehensive (AOR: 1.73, 95% CI: 1.38–2.18) knowledge on HIV prevention methods, having knowledge on MTCT of HIV (AOR: 2.69, 95% CI: 2.16–3.36) were also factors at individual level. Whereas, rural residence (AOR: 0.52, 95% CI: 0.32–0.85) was the community level factors that affects the utilization. Conclusions Less than one-fourth of the mothers had utilised the PMTCT services in Ethiopia. To increase the utilisation of the services, the health care providers should give emphases on counselling, awareness creation, and strengthen the existing frontline integrated health care services in the country.

Maternal Educational Level Determine Mother-to-child Transmission of HIV Among HIV-exposed Infants in Governmental Health Facility of Bahir Dar City, Northwest Ethiopia.

Background: Globally at the end of 2011, 3.2 million children under the age of 15 were living with HIV, among these children 91% found in Africa. In Ethiopia, one of every three children born to these women is infected with HIV. This study was done to determine mother-to-child transmission of HIV infection and its factors among HIV-exposed infants on PMTCT service. Method: An institutional-based cross-sectional study was conducted among randomly selected 423 HIV exposed infants on PMTCT service in Bahir Dar city public health facility. Data were collected through chart review by using a pre-tested and structured checklist. Data was entered into Epi-data version 3.1 and exported to SPSS version 20 for analysis. The dependent variable association with explanatory variables was determined using logistic regression. Statistical significance was considered at p-value <0.05 with 95% CI. Result: The proportion of mother-to-child transmission of HIV infection among HIV-exposed infants on PMTCT services was 9.9%. Maternal educational status (AOR=3.196; 95% CI: 1.161-8.797), ANC follow-up (AOR=5.414; 95% CI: 1.860-15.761), age of infant at HIV infection confirmed (AOR=0.088; 95% CI: 0.033-0.238), and maternal CD4 count (AOR=3.162; 95% CI: 1.295-7.720) were factors significantly associated with mother-to-child transmission of HIV.Conclusion: The overall proportion of mother-to-child transmission of HIV infection among HIV exposed infants on PMTCT service were significantly high. This was due to low maternal educational status, absence of ANC follow-up, age of the infant at HIV infection confirmed, and low maternal CD4 count. Therefore, promoting women’s education, antenatal care, age of the infant at HIV test, and maintaining maternal CD4 count should be a great concern for health policymakers and health service providers.

A Review to Identify the Gaps in Prevention of Mother to Child Transmission of HIV Services in Nigeria

Background: Nigeria has the second largest burden of maternal to child transmission of HIV (MTCT) in the world at a rate of 30% and has the largest burden of paediatric HIV infection globally at the rate of 10%. Effective prevention of mother to child transmission of HIV (PMTCT) can drastically reduce the paediatric HIV infection to 2%. However, recent evidence reveals yawning gaps in the PMTCT services in Nigeria, where out of estimated 9.2 million pregnancies, only about 3 million received HIV counselling and testing (HCT). This review is to unravel the unmet needs for PMTCT of HIV services in Nigeria. Methods: Keywords from objectives of review are MTCT and PMTCT which were used to search for related literatures through online libraries of national and international journals; Medline and PubMed including google. 62 related literatures/studies were initially generated and then narrowed down to 19 literatures were selected which met the inclusion criteria- less than 10 year and related to objective of review. Findings: There are unmet needs for PMTCT of HIV services in Nigeria due to challenges like low HCT/PMTCT service uptake (35.5%), low HCT/PMTCT service delivery facilities (27%), low ANC (58%) and low (35%) delivery in formal health setting. Conclusion: PMTCT target in Nigeria has not been met. Regular training of existing health workforce including the TBAs and the adoption of the recommendations for an HIV-free generation will bridge the HCT / PMTCT of HIV services gap identified in this review.

PMTCT Service Uptake among Pregnant Women in 3 Internally Displace Persons Camps in Borno State Northeast Nigeria

Background: Humanitarian emergencies upset and wreck existing healthcare services and systems. Pregnant women and infant are incredibly defenseless, as these infants are exposed to the risk of preventable childhood disease which includes HIV that is transmitted from their HIV positive mother. In the absence of any intervention, the risk of HIV transmission increases to about 40% among infant born to HIV positive mothers. Objectives: To examine the prevalence and uptake of HIV services among pregnant women and to assess the level of Early Infant Diagnosis (EID) by PCR uptake for children under 2 months born to HIV positive mothers. Methods: A sentinel case study approach conducted in 3 internally displaced people (IDP) camps in 3 LGAs (Banki, Dikwa and Ngala) of Borno state Nigeria, from January 2018 to May 2019. Data collected using standard tools and DHIS 2.0 used for data extraction and MS Excel used for analysis. Results: Prevalence of HIV among pregnant women (1st ANC Visits) in the 3 IDP camps were 1.22% (Ngala), 0.44% (Banki) and 0.16% (Dikwa) with an average of 0.61% compared to the 2018 National zonal average for the North East of1.1%. Uptake of HIV testing service among pregnant women in the 3 IDP camps were 90.65% (Ngala), 100% (Banki) and 100% (Dikwa), with an average uptake of 96.9%; while EID uptake for HIV exposed children within 2 months of age were: 50.0% (Dikwa), 12.5% (Banki) and 0% (Ngala). Conclusions: The study also shows that none of the 3 IDP camps were able to optimize Early Infant Diagnosis at 2 months of birth. It is hereby recommended that Care-giver Focused Approach should be prioritized in preventing mother-to-child transmission (PMTCT) service delivery.

Level of Quality of Option B+PMTCT Service Provision in Public Health Facilities in Mekelle Zone, Northern Ethiopia: Cross-sectional study

Background: Substantial improvements have been observed in the coverage and access to maternal health services in Ethiopia. However, quality of care has been lagging behind. Therefore, the aim of this study was to assess quality of Option B+ PMTCT service provision. Methods: Facility based cross sectional study was conducted from February to April 2016 in Northern Ethiopia. The quality of service delivery was assessed in 12 health facilities based on Donabedian input-process-output quality components. It employed mixed method approach involving both quantitative and qualitative data. Facilities were categorized rendering good input service quality if scored 100 % as per national guideline; whilst, 90 % and more for process and output quality components respectively. The emerged themes of factors for good and bad service quality from content analysis were then thematically fitted to donabedian themes. Results: Overall 2 of 12 (16.7%) facilities fulfilled all the three quality components according to predetermined judgment criteria. The input quality was better than their counterpart; in which it was judged as good in 33.3% of facilities. Besides, one fourth of them were realized process and output quality. We identified multiple barriers and facilitators for good and bad service quality in respective quality components influencing quality of care. Conclusion: Only 16.7% of facilities declared the overall quality in all three dimensions according to service delivery guideline. The desired level of quality will be realized if and only if the three quality components would be kept on eye side by side in line with identified facilitators and barriers for good and bad service quality.

Level of Quality of Option B+PMTCT Service Provision in Public Health Facilities in Mekelle Zone, Northern Ethiopia: Cross-sectional study

Back ground: Substantial improvements have been observed in the coverage and access to maternal health services in Ethiopia. However, quality of care has been lagging behind. Therefore, the aim of this study was to assess quality of Option B + PMTCT service provision. Methods : Facility based cross-sectional study was conducted in 12 public health facilities from February to April 2016. It employed both quantitative and qualitative method. Donabedian input-process-output quality assessment model was used to evaluate the service. Data collection techniques carried out were facility inventory, non-participatory observation, record and chart review to assess input, process and output service quality. Concurrently, patients and service providers were subjected to exit and in-depth interview autonomously to explore barriers for good and bad service quality. Quantitative data were analyzed using SPSS version 21. Use of manual thematic approach was used for qualitative data analysis. R esults: The level of overall quality of Option B+ PMTCT service provision has rendered as good in two out of 12(16.7%) studied health facilities. The input quality was better than its counterpart; which was judged as good in 33.3% of health facilities. Only, one fourth of studied health facilities were rated as good for the process and output service quality respectively. Conclusion : The overall level of quality was achieved optimal in insignificant number of facilities. The desired level of quality will be realized if and only if the three quality components would be kept on eye side by side during service mentoring. Likewise, persistent effort in view of Donabedian theoretical framework will improve the overall service quality. Key words: Quality, Option B+PMTCT, HIV Positive Women, Tigray, Northern Ethiopia

AIDS-related stigmatisation in the healthcare setting: a study of primary healthcare centres that provide services for prevention of mother-to-child transmission of HIV in Lagos, Nigeria

ObjectiveTo assess AIDS stigmatising attitudes and behaviours by prevention of mother-to-child transmission (PMTCT) service providers in primary healthcare centres in Lagos, Nigeria.DesignCross-sectional survey.SettingThirty-eight primary healthcare centres in Lagos, Nigeria.ParticipantsOne hundred and sixty-one PMTCT service providers.Outcome measuresPMTCT service providers’ discriminatory behaviours, opinions and stigmatising attitudes towards persons living with HIV/AIDS (PLWHAs), and nature of the work environment (HIV/AIDS-related policies and infection-control guidelines/supplies).ResultsReported AIDS-related stigmatisation was low: few respondents (4%) reported hearing coworkers talk badly about PLWHAs or observed provision of poor-quality care to PLWHAs (15%). Health workers were not worried about secondary AIDS stigmatisation due to their occupation (86%). Opinions about PLWHAs were generally supportive; providers strongly agreed that women living with HIV should be allowed to have babies if they wished (94%). PMTCT service providers knew that consent was needed prior to HIV testing (86%) and noted that they would get in trouble at work if they discriminated against PLWHAs (83%). A minority reported discriminatory attitudes and behaviours; 39% reported wearing double gloves and 41% used other special infection-control measures when providing services to PLWHAs. Discriminatory behaviours were correlated with negative opinions about PLWHAs (r=0.21, p<0.01), fear of HIV infection (r=0.16, p<0.05) and professional resistance (r=0.32, p<0.001). Those who underwent HIV training had less fear of contagion.ConclusionsThis study documented generally low levels of reported AIDS-related stigmatisation by PMTCT service providers in primary healthcare centres in Lagos. Policies that reduce stigmatisation against PLWHA in the healthcare setting should be supported by the provision of basic resources for infection control. This may reassure healthcare workers of their safety, thus reducing their fear of contagion and professional resistance to care for individuals who are perceived to be at high risk of HIV.