Abstract
Towards achieving an AIDS-free generation, UNAIDS set the 90-90-90 target aiming at 90% of HIV positive persons knowing their status, 90% of positives receive sustained antiretroviral drugs and 90% of those receiving ARVs attain virologic suppression by 2020. The attainment are dependent on continual access, quality care and treatment retention, so efforts must address context specific barriers to accessing services. The ethnoreligious conflicts in Jos created barriers to accessing HIV/PMTCT services, even when treatment sites existed around the metropolis. Fifteen communities lacked comprehensive HIV services and residents could not access treatment facilities because of security challenges. A specialized strategy using community oriented resource persons (CORPs) and task shifting task sharing (TSTS) principles conceptualized by stakeholders was utilized to bridge personnel gaps and scale-up PMTCT. The HIV Lead Implementing Partner supported a faith based community organization to identify and scale-up PMTCT into 28 hospitals in 15 communities. Training and task devolution to Community Health workers (CHWs), expert patients and Traditional Birth Attendants (TBAs) was utilized. The facilities were networked for service delivery, referrals, supervision and commodity logistics. HIV testing was provided to pregnant women during ANC, labour and postnatal, and their children and spouses. All 28 facilities offered HCT and provided ARVs to those testing positive in labour, women testing positive during ANC were managed/referred to 8 PMTCT sites for evaluation and ARV commencement according to Nigerian HIV Guidelines. Infants received Nevirapine, early infant diagnosis and Cotrimoxazole. HIV positive children and non-pregnant adults were referred to three ART sites for evaluation and treatment. The twenty-eight facilities were activated for HCT/PMTCT/ART using MNCH structures and CHEWs, TBAs and PLHIV expert patients provided care, support and tracking. After the six-month pilot, of 3,293 women receiving ANC, 3,094 (93.9%) accepted HCT and received same-day results. Thirty-four tested positive, but 15 previously knew their status and on ARVs, but had challenges accessing care, while 17 of 19 newly diagnosed women commenced ARVs while 2 defaulters are being tracked. Five HIV exposed babies delivered received Nevirapine and cotrimoxazole, four were tested HIV-negative. Also 7193 adults and 23 children received HCT and results, 69 positive adults and 2 positive children enrolled care, among who 33 adults and 2 children commenced ARVs. PMTCT diagnostics must identify specific barriers communities experience and implement multipronged context specific scale-up efforts to improve access/uptake to eliminate Paediatric HIV infections. CORPs and TSTS strategies are critical to improve service-delivery and retention in care.
Highlights
A Prevention of Mother to Child Transmission of HIV (PMTCT/HIV) intervention pilot project targeting fifteen communities of Jos, Plateau State capital lacking access to parts of town because of security risks arising from ethnoreligious conflict and the subsequent partitioning
They identified, upgraded, activated and trained staff of twenty eight private community facilities to implement programs of HIV testing, Prevention of Mother to Child transmission and Antiretroviral treatment. They engaged, trained and worked with other community oriented resource persons (CORPs)- Persons living with HIV (PLHIVs), Traditional Birth attendants (TBAs) and Muslim women using task shifting and task sharing principles to address the shortage of human resources for health (HRH) in the communities
A review of unpublished results of rapid statewide facility assessment conducted as part of Plateau PMTCT diagnostics in 2013, revealed that many health facilities were destroyed, healthcare workers (HCW) were displaced and killed in some communities, while ARV/commodity logistics were disrupted in several parts of the state
Summary
A Prevention of Mother to Child Transmission of HIV (PMTCT/HIV) intervention pilot project targeting fifteen communities of Jos, Plateau State capital lacking access to parts of town because of security risks arising from ethnoreligious conflict and the subsequent partitioning. There were seven major Comprehensive HIV treatment facilities, but located in majorly Christian dominated parts of Jos, and three of them were Church based hospitals These densely populated communities that lacked comprehensive HIV treatment centers included Ali Kazaure, Angwan Rogo, Angwan Rimi, Bauchi Road, Bukuru, Congo Russia, Corner Shagari, Dogon Dutse, Fillin Ball, Gangare, Naraguta Village, Masalacin Jumaa, Masalacin Idi, Nasarawa Gwom, Rikkos and Yan Shanu. A team of Competent HIV care providers of same faith and ethnicity were engaged to pioneer an intervention through a faith based community organization to scale up HIV/PMTCT using MNCH platform They identified, upgraded, activated and trained staff of twenty eight private community facilities to implement programs of HIV testing, Prevention of Mother to Child transmission and Antiretroviral treatment. The observations led to stakeholders’ deliberations, facility mappings, HIV/PMTCT diagnostics and identification of communities lacking PMTCT/HIV treatment centers, who found it difficult to access other parts of Jos metropolis
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