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Ganguly S, Chakraborty D, Debnath F, Biswas S, Majumdar A, Saha MK, Dutta S. Epidemiological drivers of mother to child HIV transmission in West Bengal, India: A retrospective cohort study. Int J STD AIDS 2022; 33:472-478. [PMID: 35306925 DOI: 10.1177/09564624221076618] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
BACKGROUND HIV transmission through vertical route can be reduced to a large extent with combination of medical interventions. Apart from maternal HIV status several other epidemiological attributes determine this transmission dynamics.Objective: The objective of this study was to identify various associated factors that determine and modify the risk of HIV transmission from a mother living with HIV to her child.Materials and method: A retrospective cohort-study was conducted with 518 HIV-positive pregnant women with delivering live babies between April 2016 - September 2018. The HIV status of the children was ascertained with polymerase chain reaction. A number of socio-demographic and medical attributes were compared between HIV-positive (41) and HIV-negative babies (477) using bivariate and multivariate methods to identify disease modifying factors. RESULTS Maternal HIV detection during the postnatal period (AOR = 11.2; 5.2 - 23.8), low birth weight (AOR = 2.7; 1.2 - 5.9), and vaginal delivery (AOR = 2.8; 1.01 - 7.7) were significantly associated with vertical transmission of HIV. Lower duration of maternal antiretroviral treatment and higher maternal age (>25 years) were also associated in bivariate analysis. CONCLUSION The battery of PPTCT (Prevention of Parent to Child Transmission) interventions should be tailored in such a way to address all the epidemiological attributes influencing vertical transmission.
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Affiliation(s)
- Suman Ganguly
- West Bengal State AIDS Prevention & Control Society Kolkata, RinggoldID:245567National AIDS Control Organisation, Kolkata, West Bengal, India
| | - Debjit Chakraborty
- Division of Epidemiology, RinggoldID:30170ICMR- National Institute of Cholera and Enteric Disease, Kolkata, West Bengal, India
| | - Falguni Debnath
- Division of Epidemiology, RinggoldID:30170ICMR- National Institute of Cholera and Enteric Disease, Kolkata, West Bengal, India
| | - Subrata Biswas
- Division of Virology, RinggoldID:30170ICMR- National Institute of Cholera and Enteric Disease, Kolkata, West Bengal, India
| | - Agniva Majumdar
- Division of Bacteriology & VRDL, RinggoldID:30170ICMR- National Institute of Cholera and Enteric Disease, Kolkata, West Bengal, India
| | - Malay Kumar Saha
- Division of Virology, RinggoldID:30170ICMR- National Institute of Cholera and Enteric Disease, Kolkata, West Bengal, India
| | - Shanta Dutta
- Division of Bacteriology, RinggoldID:30170ICMR- National Institute of Cholera and Enteric Disease, Kolkata, West Bengal, India
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Helova A, Onono M, Abuogi LL, Hampanda K, Owuor K, Odwar T, Krishna S, Odhiambo G, Odeny T, Turan JM. Experiences, perceptions and potential impact of community-based mentor mothers supporting pregnant and postpartum women with HIV in Kenya: a mixed-methods study. J Int AIDS Soc 2021; 24:e25843. [PMID: 34797955 PMCID: PMC8604379 DOI: 10.1002/jia2.25843] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/21/2021] [Accepted: 10/21/2021] [Indexed: 12/03/2022] Open
Abstract
Introduction Community‐based mentor mothers (cMMs) are women living with HIV who provide peer support to pregnant/postpartum women living with HIV (PWLWH) to enhance antiretroviral therapy (ART) adherence, retention in care and prevent perinatal transmission of HIV. The goal of this study was to explore the experiences, perceptions, mechanisms and health impact of cMMs on PWLWH in Kenya from the perspective of cMMs. Methods We conducted a prospective mixed‐methods study in southwestern Kenya in 2015–2018. In the qualitative phase, we completed in‐depth interviews with cMMs to explore their perceptions and experiences in supporting PWLWH. Transcripts were broad‐coded according to identified themes, then fine‐coded using an inductive approach. In the quantitative phase, we analysed medical record data from PWLWH who were randomized in the cMM intervention to examine the impact of cMM visits on optimal prevention of mother‐to‐child transmission (PMTCT). We used cluster‐adjusted generalized estimating equation models to examine relationships with a composite outcome (facility delivery, infant HIV testing, ART adherence and undetectable viral load at 6 weeks postpartum). Finally, qualitative and quantitative results were integrated. Results Convergence of findings from cMM interviews (n = 24) and PWLWH medical data (n = 589) revealed: (1) The cMM intervention was utilized and perceived as acceptable. PWLWH received, on average, 6.2 of 8 intended home visits through 6 weeks postpartum. (2) The cMMs reported serving as role models and confidantes, supporting PWLWH's acceptance of their HIV status, providing assurances about PMTCT and assisting with male partner disclosure and communication. cMMs also described benefits for themselves, including empowerment and increased income. (3) The cMM visits supported PWLWH's completion of PMTCT steps. Having ≥4 cMM home visits up to 6 weeks postpartum, as compared to <4 visits, was associated with higher likelihood of an optimal PMTCT composite outcome (adjusted relative risk 1.42, p = 0.044). Conclusions We found that peer support from cMMs during pregnancy through 6 weeks postpartum was associated with improved uptake of critical PMTCT services and health behaviours and was perceived as beneficial for cMMs themselves. CMM support of PWLWH may be valuable for other low‐resource settings to improve engagement with lifelong ART and HIV services among PWLWH.
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Affiliation(s)
- Anna Helova
- Department of Health Care Organization and Policy and Sparkman Center for Global Health, School of Public Health, The University of Alabama at Birmingham, Birmingham, Alabama, USA
| | - Maricianah Onono
- Centre for Microbiology Research, Kenya Medical Research Institute, Nairobi, Kenya
| | - Lisa L Abuogi
- Department of Pediatrics, School of Medicine, University of Colorado Denver, Aurora, Colorado, USA
| | - Karen Hampanda
- Department of Obstetrics and Gynecology, University of Colorado Denver, Anschutz Medical Campus, Aurora, Colorado, USA
| | - Kevin Owuor
- Centre for Microbiology Research, Kenya Medical Research Institute, Nairobi, Kenya.,Department of Biostatistics, School of Public Health, The University of Alabama at Birmingham, Birmingham, Alabama, USA
| | - Tobias Odwar
- Centre for Microbiology Research, Kenya Medical Research Institute, Nairobi, Kenya
| | - Sandhya Krishna
- Department of Health Care Organization and Policy and Sparkman Center for Global Health, School of Public Health, The University of Alabama at Birmingham, Birmingham, Alabama, USA
| | - Gladys Odhiambo
- Centre for Microbiology Research, Kenya Medical Research Institute, Nairobi, Kenya
| | - Thomas Odeny
- Centre for Microbiology Research, Kenya Medical Research Institute, Nairobi, Kenya.,Department of Medicine, University of Missouri, Kansas City, Missouri, USA
| | - Janet M Turan
- Department of Health Care Organization and Policy and Sparkman Center for Global Health, School of Public Health, The University of Alabama at Birmingham, Birmingham, Alabama, USA
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Kasede AN, Tylleskär T, Mukunya D, Tumuhamye J, Ndeezi G, Arach AAO, Waako P, Tumwine JK. Incidence of home delivery among women living with HIV in Lira, Northern Uganda: a prospective cohort study. BMC Pregnancy Childbirth 2021; 21:763. [PMID: 34758766 PMCID: PMC8579617 DOI: 10.1186/s12884-021-04222-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/04/2021] [Accepted: 10/13/2021] [Indexed: 11/11/2022] Open
Abstract
Background Home delivery has been associated with mother-to-child transmission of HIV and remains high among HIV-infected women. Predictors for home delivery in the context of HIV have not been fully studied and understood in Northern Uganda. We therefore aimed to find out the incidence and risk factors for home delivery among women living with HIV in Lira, Northern Uganda. Methods This prospective cohort study was conducted between August 2018 and January 2020 in Lira district, Northern Uganda. A total of 505 HIV infected women receiving antenatal care at Lira regional referral hospital were enrolled consecutively and followed up at delivery. We used a structured questionnaire to obtain data on exposures which included: socio-demographic, reproductive-related and HIV-related characteristics. Data was analysed using Stata version 14.0 (StataCorp, College Station, Texas, U.S.A.). We estimated adjusted risk ratios using Poisson regression models to ascertain risk factors for the outcome of interest which was home delivery (which is delivering an infant outside a health facility setting under the supervision of a non-health worker). Results The incidence of home delivery among women living with HIV was 6.9% (95%CI: 4.9–9.5%). Single women were more likely to deliver at home (adjusted risk ratio = 4.27, 95%CI: 1.66–11). Women whose labour started in the night (night time onset of labour ARR = 0.39, 95%CI: 0.18–0.86) and those that were adherent to their ART (ARR = 0.33, 95%CI: 0.13–0.86) were less likely to deliver at home. Conclusion Home delivery remains high among women living with HIV especially those that do not have a partner. We recommend intensified counselling on birth planning and preparedness in the context of HIV and PMTCT especially for women who are: separated, divorced, widowed or never married and those that are not adherent to their ART. Supplementary Information The online version contains supplementary material available at 10.1186/s12884-021-04222-5.
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Affiliation(s)
- Agnes Napyo Kasede
- Busitema University Faculty of Health Sciences, Department of Public Health, P.O. Box 236, Tororo, Uganda. .,College of Health Sciences, Department of Paediatrics and Child Health, Makerere University, P.O. Box 7072, Kampala, Uganda. .,Centre for International Health, Department of Global Public Health and Primary Care, University of Bergen, P.O. Box 7800, 5020, Bergen, Norway.
| | - Thorkild Tylleskär
- Centre for International Health, Department of Global Public Health and Primary Care, University of Bergen, P.O. Box 7800, 5020, Bergen, Norway
| | - David Mukunya
- Centre for International Health, Department of Global Public Health and Primary Care, University of Bergen, P.O. Box 7800, 5020, Bergen, Norway
| | - Josephine Tumuhamye
- Centre for International Health, Department of Global Public Health and Primary Care, University of Bergen, P.O. Box 7800, 5020, Bergen, Norway
| | - Grace Ndeezi
- College of Health Sciences, Department of Paediatrics and Child Health, Makerere University, P.O. Box 7072, Kampala, Uganda
| | - Anna Agnes Ojok Arach
- College of Health Sciences, Department of Paediatrics and Child Health, Makerere University, P.O. Box 7072, Kampala, Uganda.,Department of Nursing and Midwifery, Lira University, P. O. Box 1035, Lira, Uganda
| | - Paul Waako
- Busitema University Faculty of Health Sciences, Department of Public Health, P.O. Box 236, Tororo, Uganda
| | - James K Tumwine
- College of Health Sciences, Department of Paediatrics and Child Health, Makerere University, P.O. Box 7072, Kampala, Uganda
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Abraham SA, Clow SE. Staying, leaving and returning: Trends of prevention of mother-to-child transmission retention among newly diagnosed HIV-positive pregnant and postpartum women. Int J STD AIDS 2021; 33:81-87. [PMID: 34632873 DOI: 10.1177/09564624211046995] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Uptake of services and retention throughout the Prevention of Mother-to-Child Transmission continuum are necessary to achieve the goal of reducing Mother-to-Child Transmission of Human Immunodeficiency Virus (HIV). Adopting a retrospective cohort design, we tracked the uptake of services in a district hospital in Ghana from antenatal booking through to six weeks postnatal when early infant diagnosis was conducted. Of the 1252 pregnant women booked antenatally, 94.1% (n = 1178) received pre-test counselling, 96.3% (1134) opted for HIV testing and 3.8% (n = 43) women tested positive for HIV throughout the continuum. The retention rate at six weeks postpartum was 67.4%. Missed opportunities occurred throughout the programme and the highest disengagement, 58.9% (23/39) occurred antenatally. Instances of re-engagement were also recorded. Establishing measures to promote retention throughout the programme is critical to ensuring HIV-infected mothers maintain their health and their exposed newborns are HIV-free. This phase of the study provided a comprehensive view of retention in the absence of any baseline.
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Affiliation(s)
- Susanna A Abraham
- Adult Health Department, School of Nursing and Midwifery, College of Health and Allied Sciences, 63726University of Cape Coast, Cape Coast, Ghana.,Division of Nursing and Midwifery, Faculty of Health Sciences, 63726University of Cape Town, Cape Town, South Africa
| | - Sheila E Clow
- Adult Health Department, School of Nursing and Midwifery, College of Health and Allied Sciences, 63726University of Cape Coast, Cape Coast, Ghana
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Mixed Infant Feeding Practice and Associated Factors among HIV-Positive Women under Care in Gondar City's Public Health Facilities within Two Years Postpartum: A Cross-Sectional Study. Int J Pediatr 2020; 2020:4597962. [PMID: 32695187 PMCID: PMC7350176 DOI: 10.1155/2020/4597962] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/19/2019] [Revised: 05/14/2020] [Accepted: 06/02/2020] [Indexed: 11/18/2022] Open
Abstract
Background Mixed infant feeding practice remains a major setback for effective prevention of mother to child transmission of HIV program and updated evidences on this issue is essential for better interventions. Therefore, this study was aimed at assessing the proportion and associated factors of mixed infant feeding practice among HIV-positive women under care in public health institutions in Gondar city within two years postpartum, Ethiopia, 2017. Methods A cross-sectional study was conducted on 485 HIV-positive women under care in Gondar City's health facilities from May 1 to June 30/2017. Data were collected via interviewer administered questionnaire supplemented with chart review, entered into Epinfo version 7.0 and then exported to SPSS version 20.0. Both bivariable and multivariable analyses were done, and the statistical significance of each variable was claimed based on the adjusted odds ratio (AOR) with 95% confidence interval (CI) and its P value ≤0.05. Result The proportion of HIV-positive women practicing mixed infant feeding was 21.6%. Whereas, about 73.8% and 4.5% of the mothers demonstrated exclusive breastfeeding and exclusive replacement feeding, respectively. Mixed infant feeding practice was independently predicted by lack of antenatal care (AOR = 6.9; 95% CI: 3.4, 14.1) and home delivery (AOR = 2.8; 95% CI: 1.4, 5.4). Conclusion The magnitude of mixed infant feeding practice was higher than the reports of many other studies, and its predictors were connected to poor adherence to maternal health care service utilization. Hence, stakeholders need to work more on ANC and facility delivery service coverage.
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Odiachi A, Sam-Agudu NA, Erekaha S, Isah C, Ramadhani HO, Swomen HE, Charurat M, Cornelius LJ. A mixed-methods assessment of disclosure of HIV status among expert mothers living with HIV in rural Nigeria. PLoS One 2020; 15:e0232423. [PMID: 32353036 PMCID: PMC7192376 DOI: 10.1371/journal.pone.0232423] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/04/2020] [Accepted: 04/14/2020] [Indexed: 11/22/2022] Open
Abstract
Background Peer support provided by experienced and/or trained “expert” women living with HIV has been adopted by prevention of mother-to-child transmission of HIV (PMTCT) programs across sub-Saharan Africa. While there is ample data on HIV status disclosure among non-expert women, there is little data on disclosure among such expert women, who support other women living with HIV. Objective This study compared HIV disclosure rates between expert and non-expert mothers living with HIV, and contextualized quantitative findings with qualitative data from expert women. Methods We compared survey data on HIV disclosure to male partners and family/friends from 37 expert and 100 non-expert mothers living with HIV in rural North-Central Nigeria. Four focus group discussions with expert mothers provided further context on disclosure to male partners, extended family and peers. Chi square and Fisher’s exact tests were applied to quantitative data. Qualitative data were manually analyzed using a Grounded Theory approach. Results Two-thirds of the 137 participants were 21–30 years old; 89.8% were married, and 52.3% had secondary-level education. Disclosure to male partners was higher among expert (100.0%) versus non-expert mothers (85.0%), p = 0.035. Disclosure to anyone (93.1% vs 80.8%, p = 0.156), and knowledge of male partners’ HIV status were similar (75.7% versus 66.7%, p = 0.324) between expert and non-expert mothers, respectively. With respect to male partners, HIV serodiscordance rates were also similar (46.4% vs 55.6%, p = 0.433). Group discussions indicated that expert mothers did not consistently disclose to their mentored clients, with community-level stigma and discrimination stated as major reasons for this non-disclosure. Conclusions Expert mothers experience similar disclosure barriers as their non-expert peers, especially regarding disclosure outside of intimate relationships. Thus, attention to expert mothers’ coping skills and disclosure status, particularly to mentored clients is important to maximize the impact of peer support in PMTCT. Clinical trials registration Clinicaltrials.gov registration number NCT 01936753 (retrospective), September 3, 2013.
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Affiliation(s)
| | - Nadia A. Sam-Agudu
- International Research Center of Excellence, Institute of Human Virology Nigeria, Abuja, Nigeria
- Division of Epidemiology and Prevention, Institute of Human Virology, University of Maryland School of Medicine, Baltimore, Maryland, United States of America
- * E-mail:
| | - Salome Erekaha
- International Research Center of Excellence, Institute of Human Virology Nigeria, Abuja, Nigeria
| | - Christopher Isah
- International Research Center of Excellence, Institute of Human Virology Nigeria, Abuja, Nigeria
| | - Habib O. Ramadhani
- Division of Epidemiology and Prevention, Institute of Human Virology, University of Maryland School of Medicine, Baltimore, Maryland, United States of America
| | - Homsuk E. Swomen
- Sexual, Reproductive Health and Gender Unit, United Nations Population Fund, Abuja, Nigeria
| | - Manhattan Charurat
- Division of Epidemiology and Prevention, Institute of Human Virology, University of Maryland School of Medicine, Baltimore, Maryland, United States of America
| | - Llewellyn J. Cornelius
- School of Social Work and College of Public Health, University of Georgia Athens, Athens, Georgia, United States of America
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Dirisu O, Eluwa G, Adams E, Torpey K, Shittu O, Adebajo S. "I think this is the only challenge… the stigma" Stakeholder perceptions about barriers to Antenatal care (ANC) and Prevention of mother-to-child transmission (PMTCT) uptake in Kano state, Nigeria. PLoS One 2020; 15:e0232028. [PMID: 32339180 PMCID: PMC7185580 DOI: 10.1371/journal.pone.0232028] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/21/2019] [Accepted: 04/06/2020] [Indexed: 11/19/2022] Open
Abstract
Background Despite the progress made so far in reducing mother-to-child transmission (MTCT), Nigeria still contributes significantly to the global burden of new pediatric HIV infections. The elimination target for MTCT has not been reached and the decline in new infections among all Global Plan countries from 2009 to 2015 was lowest in Nigeria. This qualitative study explores the barriers to uptake of prevention of mother-to-child transmission (PMTCT) intervention in Kano, the second most populous state in Nigeria. Methods Key informant interviews (KIIs) were conducted among twelve stakeholders who were purposively selected based on their knowledge and involvement in PMTCT program activities in the state. The KII guide explored the status and challenges of PMTCT uptake in Kano state. Qualitative data analysis was managed using NVIVO 11 software and themes were analyzed using thematic analysis. Results We found that the key barriers to uptake of PMTCT identified by stakeholders cut across the domains of the socio-ecological model. These include—fear of stigma associated with being seen accessing HIV related services, low male partner involvement, socio-cultural beliefs about the dangers of hospital-based delivery, poor attitude of health workers, distance/cost to facilities, issues with availability of HIV test kits and poor organization of health services. Conclusion The implementation of effective PMTCT programs would require innovative strategies that leverage improvement of Antenatal care (ANC) uptake as an entry point for PMTCT. In addition, sustaining engagement in care requires creating a supportive stigma-free environment in the community as well as spousal support to ensure women can navigate the socio-cultural barriers that limit access to health services.
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Affiliation(s)
- Osasuyi Dirisu
- HIV and AIDS Program, Population Council, Abuja, Nigeria
- * E-mail:
| | - George Eluwa
- HIV and AIDS Program, Population Council, Abuja, Nigeria
| | | | - Kwasi Torpey
- College of Health Sciences, University of Ghana, Accra, Ghana
| | - Oladapo Shittu
- Department of Obstetrics & Gynaecology, Ahmadu Bello University Teaching Hospital, Zaria, Kaduna, Nigeria
| | - Sylvia Adebajo
- HIV and AIDS Program, Population Council, Abuja, Nigeria
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Olakunde BO, Adeyinka DA, Olawepo JO, Pharr JR, Ozigbu CE, Wakdok S, Oladele T, Ezeanolue EE. Towards the elimination of mother-to-child transmission of HIV in Nigeria: a health system perspective of the achievements and challenges. Int Health 2019; 11:240-249. [PMID: 31028402 DOI: 10.1093/inthealth/ihz018] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/04/2018] [Revised: 02/28/2019] [Accepted: 03/09/2019] [Indexed: 11/14/2022] Open
Abstract
Despite its scaled-up response for prevention of mother-to-child transmission of HIV (PMTCT), Nigeria still contributes the greatest number of infants infected with HIV worldwide. Drawing on our knowledge, and review of policy documents and research papers, we explored the achievements and challenges in the elimination of mother-to-child transmission of HIV in Nigeria using the WHO's health systems framework. We found that Nigeria has increased the number of PMTCT sites, decentralized and integrated PMTCT care for expanded service delivery, adopted task-shifting to address the shortage of skilled healthcare providers, explored alternative sources of domestic funding to bridge the funding gap and harmonized the health management information system to improve data quality. Some of the challenges we identified included: difficulty in identifying HIV-infected pregnant women because of low uptake of antenatal care; interrupted supplies of medical commodities; knowledge gaps among healthcare workers; and lack of a national unique identifying system to enhance data quality. While there have been some achievements in the PMTCT program, gaps still exist in the different blocks of the health system. Elimination of mother-to-child transmission of HIV in Nigeria will require the implementation of feasible, culturally acceptable and sustainable interventions to address the health system-related challenges.
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Affiliation(s)
- Babayemi O Olakunde
- Department of Occupational and Environmental Health, School of Public Health, University of Nevada, Las Vegas, 4505 S Maryland Pkwy, Las Vegas, NV, USA.,National Agency for the Control of AIDS, Plot 823, Ralph Shodeinde Street, Central Business District, Abuja, Nigeria
| | - Daniel A Adeyinka
- Department of Community Health and Epidemiology, University of Saskatchewan, 104 Clinic Place, Saskatoon, SK, Canada.,National AIDS & STIs Control Programme, Federal Ministry of Health, Plot 75, Ralph Sodeinde Street, Central Area, Abuja, Nigeria
| | - John O Olawepo
- Department of Occupational and Environmental Health, School of Public Health, University of Nevada, Las Vegas, 4505 S Maryland Pkwy, Las Vegas, NV, USA
| | - Jennifer R Pharr
- Department of Occupational and Environmental Health, School of Public Health, University of Nevada, Las Vegas, 4505 S Maryland Pkwy, Las Vegas, NV, USA
| | - Chamberline E Ozigbu
- National AIDS & STIs Control Programme, Federal Ministry of Health, Plot 75, Ralph Sodeinde Street, Central Area, Abuja, Nigeria.,Department of Health Services Policy and Management, Arnold School of Public Health, University of South Carolina, 915 Greene Street, Columbia, SC, USA
| | - Sabastine Wakdok
- National Agency for the Control of AIDS, Plot 823, Ralph Shodeinde Street, Central Business District, Abuja, Nigeria
| | - Tolu Oladele
- National Agency for the Control of AIDS, Plot 823, Ralph Shodeinde Street, Central Business District, Abuja, Nigeria
| | - Echezona E Ezeanolue
- Department of Pediatrics and Child Health, College of Medicine, University of Nigeria, 1, Old UNTH Road, Nsukka, Enugu, Nigeria.,HealthySunrise Foundation, 308 South Jones Blvd, Las Vegas, NV, USA
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Anaba UC, Sam-Agudu NA, Ramadhani HO, Torbunde N, Abimiku A, Dakum P, Aliyu SH, Charurat M. Missed opportunities for early infant diagnosis of HIV in rural North-Central Nigeria: A cascade analysis from the INSPIRE MoMent study. PLoS One 2019; 14:e0220616. [PMID: 31365571 PMCID: PMC6668908 DOI: 10.1371/journal.pone.0220616] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/27/2018] [Accepted: 07/20/2019] [Indexed: 11/18/2022] Open
Abstract
Background Early identification of HIV-infected infants for treatment is critical for survival. Efficient uptake of early infant diagnosis (EID) requires timely presentation of HIV-exposed infants, same-day sample collection, and prompt release of results. The MoMent (Mother Mentor) Nigeria study investigated the impact of structured peer support on EID presentation and maternal retention. This cascade analysis highlights missed opportunities for EID and infant treatment initiation during the study. Methods HIV-infected pregnant women and their infants were recruited at 20 rural Primary Healthcare Centers. Routine infant HIV DNA PCR testing was performed at centralized laboratories using dried blood spot (DBS) samples ideally collected by age two months. EID outcomes data were abstracted from study case report forms and facility registers. Descriptive statistics summarized gaps and missed opportunities in the EID cascade. Results Out of 497 women enrolled, delivery data was available for 445 (90.8%), to whom 415 of 455 (91.2%) infants were live-born. Out of 408 live-born infants with available data, 341 (83.6%) presented for DBS sampling at least once. Only 75.4% (257/341) were sampled, with 81.7% (210/257) sampled at first presentation. Only 199/257 (77.4%) sampled infants had results available up to 28 months post-collection. Two (1.0%) of the 199 infants tested HIV-positive; one infant died before treatment initiation and the other was lost to follow-up. Conclusions While nearly 85% of infants presented for sampling, there were multiple missed opportunities, largely due to health system and not necessarily patient-level failures. These included infants presenting without being sampled, presenting multiple times before samples were collected, and getting sampled but results not forthcoming. Finally, neither of the two HIV-positive infants were linked to treatment within the follow-up period, which may have led to the death of one. To facilitate patient compliance and HIV-free infant survival, quality improvement approaches should be optimized for EID commodity availability, consistent DBS sample collection, efficient processing/result release, and prompt infant treatment initiation.
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Affiliation(s)
- Udochisom C. Anaba
- International Research Center of Excellence, Institute of Human Virology Nigeria, Abuja, Federal Capital Territory, Nigeria
| | - Nadia A. Sam-Agudu
- International Research Center of Excellence, Institute of Human Virology Nigeria, Abuja, Federal Capital Territory, Nigeria
- Division of Epidemiology and Prevention, Institute of Human Virology, University of Maryland School of Medicine, Baltimore, Maryland, United States of America
- Prevention, Care and Treatment Unit, Institute of Human Virology Nigeria, Abuja, Federal Capital Territory, Nigeria
- * E-mail:
| | - Habib O. Ramadhani
- Division of Epidemiology and Prevention, Institute of Human Virology, University of Maryland School of Medicine, Baltimore, Maryland, United States of America
| | - Nguavese Torbunde
- Prevention, Care and Treatment Unit, Institute of Human Virology Nigeria, Abuja, Federal Capital Territory, Nigeria
| | - Alash’le Abimiku
- International Research Center of Excellence, Institute of Human Virology Nigeria, Abuja, Federal Capital Territory, Nigeria
- Division of Epidemiology and Prevention, Institute of Human Virology, University of Maryland School of Medicine, Baltimore, Maryland, United States of America
| | - Patrick Dakum
- Division of Epidemiology and Prevention, Institute of Human Virology, University of Maryland School of Medicine, Baltimore, Maryland, United States of America
- Prevention, Care and Treatment Unit, Institute of Human Virology Nigeria, Abuja, Federal Capital Territory, Nigeria
| | - Sani H. Aliyu
- Office of the Director-General, National Agency for the Control of AIDS, Abuja, Nigeria
| | - Manhattan Charurat
- Division of Epidemiology and Prevention, Institute of Human Virology, University of Maryland School of Medicine, Baltimore, Maryland, United States of America
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Olakunde BO, Adeyinka DA, Olakunde OA, Ozigbu CE, Ndukwe CD, Oladele T, Wakdok S, Udemezue S, Ezeanolue EE. Correlates of antiretroviral coverage for prevention of mother-to-child transmission of HIV in sub-Saharan Africa. AIDS Care 2019; 31:1255-1260. [PMID: 30829049 DOI: 10.1080/09540121.2019.1587364] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
Abstract
Antiretroviral (ARV) drugs are effective in the prevention of mother-to-child transmission of HIV (PMTCT), however many sub-Saharan African countries are yet to achieve universal ARV coverage among pregnant women living with HIV. This study examined factors associated with ARV coverage for PMTCT in 41 sub-Saharan Africa countries. Country-level aggregated data were obtained from the Joint United Nations Programme on HIV/AIDS, World Health Organization, and United Nations Children's Fund. Using Spearman's rho and point-biserial correlation, we conducted bivariate analyses between ARV coverage for PMTCT and the following variables: stigma, antenatal care (ANC) uptake, institutional delivery, community delivery of ARV drugs, number of HIV testing and counselling (HTC) facilities, and density of skilled health workers. We also performed a multivariate median regression with the significant correlates. P < .05 was considered statistically significant for all the tests. The median ARV coverage for PMTCT was 76% (IQR: 55-85%). ARV coverage for PMTCT was significantly associated with HTC facilities (r = 0.46, p = .004), institutional delivery (r = 0.48, p = .002), ANC uptake: at least one visit (r = 0.54, p = .001), and stigma (r=-0.52, p = .003). In the multivariate analysis, only stigma remained statistically significant (β = -0.6, 95% CI = -1.13, -0.07, p = .03). To eliminate perinatal transmission of HIV in sub-Saharan Africa, interventions that will address stigma-related barriers to uptake of PMTCT services are needed. More research on country-specific population-level correlates of ARV coverage for PMTCT is recommended.
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Affiliation(s)
| | - Daniel A Adeyinka
- b National AIDS & STIs Control Programme, Federal Ministry of Health , Abuja , Nigeria.,c Department of Community Health and Epidemiology, University of Saskatchewan , Saskatoon , Canada
| | | | - Chamberline E Ozigbu
- b National AIDS & STIs Control Programme, Federal Ministry of Health , Abuja , Nigeria.,e Department of Health Services Policy and Management, University of South Carolina , Columbia , SC , USA
| | | | - Tolu Oladele
- a National Agency for the Control of AIDS , Abuja , Nigeria
| | | | | | - Echezona E Ezeanolue
- f Department of Pediatrics and Child Health, College of Medicine, University of Nigeria , Nsukka , Enugu , Nigeria.,g Healthy Sunrise Foundation , Las Vegas , NV , USA
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Schmitz K, Basera TJ, Egbujie B, Mistri P, Naidoo N, Mapanga W, Goudge J, Mbule M, Burtt F, Scheepers E, Igumbor J. Impact of lay health worker programmes on the health outcomes of mother-child pairs of HIV exposed children in Africa: A scoping review. PLoS One 2019; 14:e0211439. [PMID: 30703152 PMCID: PMC6355001 DOI: 10.1371/journal.pone.0211439] [Citation(s) in RCA: 23] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/29/2018] [Accepted: 01/14/2019] [Indexed: 02/06/2023] Open
Abstract
Background Increased demand for healthcare services in countries experiencing high HIV disease burden and often coupled with a shortage of health workers, has necessitated task shifting from professional health workers to Lay Health Workers (LHWs) in order to improve healthcare delivery. Maternal and Child Health (MCH) services particularly benefit from task-shifting to LHWs or similar cadres. However, evidence on the roles and usefulness of LHWs in MCH service delivery in Sub-Saharan Africa (SSA) is not fully known. Objectives To examine evidence of the roles and impact of lay health worker programmes focusing on Women Living with HIV (WLH) and their HIV-exposed infants (HEIs). Methods A scoping review approach based on Arksey and O’Malley’s guiding principles was used to retrieve, review and analyse existing literature. We searched for articles published between January 2008 and July 2018 in seven (7) databases, including: MEDLINE, Embase, PsycINFO, Joanna Briggs, The Cochrane Library, EBM reviews and Web of Science. The critical constructs used for the literature search were “lay health worker”, “community health worker”, “peer mentor”, “mentor mother,” “Maternal and Child health worker”, “HIV positive mothers”, “HIV exposed infants” and PMTCT. Results Thirty-three (33) full-text articles meeting the eligibility criteria were identified and included in the final analysis. Most (n = 13, 39.4%) of the included studies were conducted in South Africa and used a cluster RCT design (n = 13, 39.4%). The most commonly performed roles of LHWs in HIV specific MCH programmes included: community engagement and sensitisation, psychosocial support, linkage to care, encouraging women to bring their infants back for HIV testing and supporting default tracing. Community awareness on Mother to Child Transmission of HIV (MTCT), proper and consistent use of condoms, clinic attendance and timely HIV testing of HEIs, as well as retention in care for infected persons, have all improved because of LHW programmes. Conclusion LHWs play significant roles in the management of WLH and their HEIs, improving MCH outcomes in the process. LHW interventions are beneficial in increasing access to PMTCT services and reducing MTCT of HIV, though their impact on improving adherence to ART remains scanty. Further research is needed to evaluate ART adherence in LHW interventions targeted at WLH. LHW programmes can be enhanced by increasing supportive supervision and remuneration of LHWs.
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Affiliation(s)
| | - Tariro Jayson Basera
- School of Public Health, University of the Witwatersrand, Johannesburg, South Africa
- * E-mail:
| | - Bonaventure Egbujie
- School of Public Health, University of Western Cape, Cape Town, South Africa
| | - Preethi Mistri
- School of Public Health, University of the Witwatersrand, Johannesburg, South Africa
| | - Nireshni Naidoo
- School of Public Health, University of the Witwatersrand, Johannesburg, South Africa
| | - Witness Mapanga
- Center for Health Policy, School of Public Health, University of the Witwatersrand, Johannesburg, South Africa
| | - Jane Goudge
- Center for Health Policy, School of Public Health, University of the Witwatersrand, Johannesburg, South Africa
| | | | | | | | - Jude Igumbor
- School of Public Health, University of the Witwatersrand, Johannesburg, South Africa
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12
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Chinaeke EE, Fan-Osuala C, Bathnna M, Ozigbu CE, Olakunde B, Ramadhani HO, Ezeanolue EE, Sam-Agudu NA. Correlates of reported modern contraceptive use among postpartum HIV-positive women in rural Nigeria: an analysis from the MoMent prospective cohort study. Reprod Health 2019; 16:2. [PMID: 30621714 PMCID: PMC6323844 DOI: 10.1186/s12978-018-0663-8] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/15/2018] [Accepted: 12/20/2018] [Indexed: 11/16/2022] Open
Abstract
Background Nigeria has an annual population of ~ 200,000 women who are both pregnant and HIV-positive. High unmet need for family planning in this population could lead to unintended pregnancies, along with the increased risk of mother-to-child transmission of HIV (MTCT). To identify modifiable barriers and facilitators in effective family planning, we examined correlates of modern contraceptive use among HIV-positive women enrolled in the MoMent prevention of MTCT (PMTCT) implementation research study in rural North-Central Nigeria. Methods In this prospective cohort study, HIV-positive pregnant women were enrolled at 20 Primary Healthcare Centers and followed up to 12 months postpartum. Baseline socio-demographic, clinical and obstetric data were collected at enrollment. Participants were to receive routine family planning counselling from healthcare workers during postnatal visits. Analysis utilized baseline data linked to available family planning information collected from each woman at the first postpartum visit. Multivariate logistic regression was performed to determine factors associated with modern contraceptive use. Results Out of 497 women enrolled, family planning data was available for 399 (80.3%) women, of whom 349 (87.5%) received family planning counselling, and 321 (80.5%) were 30 years old or less. Two-thirds (268, 67.2%) of the cohort analyzed had 1–2 children at baseline; 24.8% (n = 99) had 3–4 children, and 8.0% (n = 32) had > 4 children. Approximately half (199, 49.9%) of the women reported no modern contraceptive use in the postpartum period. Male condoms (116, 29.1%) were the most reported method of contraception; other methods reported included oral hormones (71, 17.8%) and intrauterine devices (13, 3.2%). Only disclosure of HIV status to male partner or relative (aOR = 2.0, 95% CI: 1.2–3.3; p = 0.01) and receipt of family planning counselling (aOR = 2.3, 95% CI: 1.1–4.8; p = 0.03) were positively associated with reported modern contraceptive use. Age, marital or educational status, religious affiliation, employment status, gravidity and parity were non-correlates. Conclusions Family planning counselling and disclosure of HIV status are modifiable positive predictors of contraceptive use among our cohort of postpartum HIV-positive women in rural Nigeria. Rates of unintended pregnancy and concomitant risk of MTCT could be significantly reduced through strategies that facilitate these correlates. Clinical trials registration Clinicaltrials.gov registration number: NCT 01936753; registered September 3, 2013.
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Affiliation(s)
- Eric E Chinaeke
- Department of Clinical Pharmacy and Outcome Sciences, University of South Carolina College of Pharmacy, Columbia, USA
| | - Chinenye Fan-Osuala
- International Research Center of Excellence, Institute of Human Virology Nigeria, Abuja, Nigeria
| | - Miriam Bathnna
- International Research Center of Excellence, Institute of Human Virology Nigeria, Abuja, Nigeria
| | - Chamberline E Ozigbu
- Department of Health Services Policy and Management, Arnold School of Public Health, University of South Carolina, Columbia, USA
| | - Babayemi Olakunde
- School of Community Health Sciences, University of Nevada Las Vegas, Las Vegas, NV, USA.,National Agency for the Control of AIDS, Abuja, Nigeria
| | - Habib O Ramadhani
- Division of Epidemiology and Prevention, Institute of Human Virology, University of Maryland School of Medicine, Baltimore, USA
| | - Echezona E Ezeanolue
- Healthy Sunrise Foundation, Las Vegas, USA.,Department of Paediatrics and Child Health, University of Nigeria, Enugu, Nigeria
| | - Nadia A Sam-Agudu
- International Research Center of Excellence, Institute of Human Virology Nigeria, Abuja, Nigeria. .,Division of Epidemiology and Prevention, Institute of Human Virology, University of Maryland School of Medicine, Baltimore, USA.
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Sam-Agudu NA, Aliyu MH, Adeyemi OA, Oronsaye F, Oyeledun B, Ogidi AG, Ezeanolue EE. Generating evidence for health policy in challenging settings: lessons learned from four prevention of mother-to-child transmission of HIV implementation research studies in Nigeria. Health Res Policy Syst 2018; 16:32. [PMID: 29665809 PMCID: PMC5905153 DOI: 10.1186/s12961-018-0309-x] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/22/2017] [Accepted: 04/02/2018] [Indexed: 11/29/2022] Open
Abstract
BACKGROUND Implementation research (IR) facilitates health systems strengthening and optimal patient outcomes by generating evidence for scale-up of efficacious strategies in context. Thus, difficulties in generating IR evidence, particularly in limited-resource settings with wide disease prevention and treatment gaps, need to be anticipated and addressed. Nigeria is a priority country for the prevention of mother-to-child transmission of HIV (PMTCT). This paper analyses the experiences of four PMTCT IR studies in Nigeria, and proffers solutions to major challenges encountered during implementation. STUDIES INCLUDED AND FINDINGS Multicentre PMTCT IR studies conducted in Nigeria during the Global Plan's assessment period (2011 to 2015) were included. Four studies were identified, namely The Baby Shower Trial, Optimizing PMTCT, MoMent and Lafiyan Jikin Mata. Major common challenges encountered were categorised as 'External' (beyond the control of study teams) and 'Internal' (amenable to rectification by study teams). External challenges included healthcare worker strikes and turnover, acts and threats of ethnic and political violence and terrorism, and multiplicity of required local ethical reviews. Internal challenges included limited research capacity among study staff, research staff turnover and travel restrictions hindering study site visits. Deliberate research capacity-building was provided to study staff through multiple opportunities before and during study implementation. Post-study employment opportunities and pathways for further research career-building are suggested as incentives for study staff retention. Engagement of study community-resident personnel minimised research staff turnover in violence-prone areas. CONCLUSIONS The IR environment in Nigeria is extremely diverse and challenging, yet, with local experience and anticipatory planning, innovative solutions can be implemented to modulate internal challenges. Issues still remain with healthcare worker strikes and often unpredictable insecurity. There is a dire need for cooperation between institutional review boards across Nigeria in order to minimise the multiplicity of reviews for multicentre studies. External challenges need to be addressed by high-level stakeholders, given Nigeria's crucial regional and global position in the fight against the HIV epidemic.
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Affiliation(s)
- Nadia A. Sam-Agudu
- International Research Center of Excellence, Institute of Human Virology Nigeria, Abuja, Nigeria
- Division of Epidemiology and Prevention, Institute of Human Virology, University of Maryland School of Medicine, Baltimore, MD United States of America
| | - Muktar H. Aliyu
- Department of Health Policy, Vanderbilt University Medical Center, Nashville, TN United States of America
- Vanderbilt Institute for Global Health, Nashville, TN United States of America
| | - Olusegun A. Adeyemi
- International Research Center of Excellence, Institute of Human Virology Nigeria, Abuja, Nigeria
- Department of Epidemiology and Public Health, University of Maryland School of Medicine, Baltimore, MD United States of America
| | - Frank Oronsaye
- Center for Integrated Health Programs, Abuja, Federal Capital Territory Nigeria
| | - Bolanle Oyeledun
- Center for Integrated Health Programs, Abuja, Federal Capital Territory Nigeria
| | - Amaka G. Ogidi
- Research Resource Centre, University of Nigeria Nsukka, Enugu, Nigeria
| | - Echezona E. Ezeanolue
- HealthySunrise Foundation, Las Vegas, NV United States of America
- Department of Paediatrics and Child Health, University of Nigeria Nsukka, Enugu, Nigeria
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