Improving the coverage of prevention of mother-to-child transmission of HIV services in Nigeria: should traditional birth attendants be engaged?

Traditional birth attendants (TBAs) play an important role in the provision of care to pregnant women in rural parts of Nigeria, but they are barely engaged by the formal healthcare system in expanding the low coverage of prevention of mother-to-child transmission of HIV (PMTCT) services. Using a systematic approach, we engaged TBAs in Abia and Taraba States to scale-up PMTCT services under the National Agency for Control of AIDS Comprehensive AIDS Program with States. We conducted mapping of the TBAs, built their capacities, obtained their buy-in on mobilization of their clients and other pregnant women for HIV testing service outreaches, and established referral and linkage systems. A total of 720 TBAs were mapped (Abia 407; Taraba 313). Three hundred and ninety-nine TBAs who participated in the capacity-building meeting were linked to 115 primary healthcare centers (PHCs) in Abia State, while 245 TBAs were linked to 27 PHCs in Taraba State. From July 2016 to March 2017, the outreaches contributed 20% to the overall total number of pregnant women counseled, tested and received results, and 12% to the total number of HIV-infected women identified. There was a considerable yield of HIV-infected pregnant women among those tested in the TBA outreaches in comparison with the supported antenatal facilities (2% versus 3%, respectively). Engaging TBAs has the potential to improve the coverage of PMTCT services in Nigeria.

The plug domain of a neisserial TonB-dependent transporter retains structural integrity in the absence of its transmembrane beta-barrel

Transferrin binding protein A (TbpA) is a TonB-dependent outer membrane protein expressed by pathogenic bacteria for iron acquisition from human transferrin. The N-terminal 160 residues (plug domain) of TbpA were overexpressed in both the periplasm and cytoplasm of Escherichia coli. We found this domain to be soluble and monodisperse in solution, exhibiting secondary structure elements found in plug domains of structurally characterized TonB-dependent transporters. Although the TbpA plug domain is apparently correctly folded, we were not able to observe an interaction with human transferrin by isothermal titration calorimetry or nitrocellulose binding assays. These experiments suggest that the plug domain may fold independently of the beta-barrel, but extracellular loops of the beta-barrel are required for ligand binding.