Abstract
ABSTRACTThe acceptability of lifelong antiretroviral therapy (ART) among HIV-positive women in high-burden Nigeria, is not well-known. We explored readiness of users and providers of prevention of mother-to-child transmission of HIV (PMTCT) services to accept lifelong ART -before Option B plus was implemented in Nigeria. We conducted 142 key informant interviews among 100 PMTCT users (25 pregnant-newly-diagnosed, 26 pregnant-in-care, 28 lost-to-follow-up (LTFU) and 21 postpartum women living with HIV) and 42 PMTCT providers in rural North-Central Nigeria. Qualitative data were manually analyzed via Grounded Theory. PMTCT users had mixed views about lifelong ART, strongly influenced by motivation to prevent infant HIV and by presence or absence of maternal illness. Newly-diagnosed women were most enthusiastic about lifelong ART, however postpartum and LTFU women expressed conditionalities for acceptance and adherence, including minimal ART side effects and potentially serious maternal illness. Providers corroborated user findings, identifying the postpartum period as problematic for lifelong ART acceptability/adherence. Option B plus scale-up in Nigeria will require proactively addressing PMTCT user fears about ART side effects, and continuous education on long-term maternal and infant benefits. Structural barriers such as the availability of trained providers, long clinic wait times and patient access to ART should also be addressed.
Highlights
Nigeria is a key target in the global elimination of Mother-to-Child Transmission of HIV agenda
Given the lack of published studies on the acceptability of Option B+ in West Africa, this paper explores the perspectives of Prevention of Mother-toChild Transmission of HIV (PMTCT) users and providers on the readiness of HIV-positive women in rural Nigeria to accept and adhere to lifelong antiretroviral therapy (ART) under Option B+
Among the PMTCT users, 22% were lost to followup (LTFU), with a disproportionately higher percent of that sub-population representing women with three to four children (43%) or with secondary education (41%)
Summary
Nigeria is a key target in the global elimination of Mother-to-Child Transmission of HIV (eMTCT) agenda. 180,000 HIV-positive pregnant Nigerian women require PMTCT services every year (Nigeria National Agency for the Control of AIDS (NACA), 2016; UNICEF, 2018) only 32% of these women receive antiretroviral drugs (ARVs) for the Prevention of Mother-toChild Transmission of HIV (PMTCT) (UNAIDS, 2017). This low maternal ARV coverage contributes to an estimated 36,000 Nigerian children acquiring HIV infection annually (UNAIDS, 2018). Nigeria’s response to these PMTCT service gaps includes intensified PMTCT scale-up in rural communities, where services are largely provided by Primary Healthcare Centers (PHCs) (Federal Ministry of Health Nigeria, 2010b). PHC-based healthcare workers have been trained to provide
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