Risk factors for perinatal transmission of HIV among women attending prevention of mother-to-child transmission clinics in Northwest Nigeria

  • AIDS Care - Psychological and Socio-Medical Aspects of AIDS/HIV, Volume 31, No. 3, Year 2019

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Study Justification:
This study aimed to identify the risk factors for perinatal transmission of HIV among women attending prevention of mother-to-child transmission (PMTCT) clinics in Northwest Nigeria. Despite the effectiveness of antiretroviral therapy (ART) in preventing mother-to-child transmission of HIV, some HIV-infected women in PMTCT care still transmit the virus to their babies. Understanding the factors contributing to this transmission is crucial for developing targeted interventions to eliminate mother-to-child transmission of HIV in Nigeria.
Highlights:
– The study used a 1:1 unmatched case-control study design to assess the risk factors for perinatal transmission of HIV.
– Data were collected from medical records of HIV-infected and HIV-uninfected babies, as well as their mothers who accessed PMTCT services in three selected secondary health facilities.
– Factors such as sociodemographic characteristics, time of enrollment, type of maternal ART, receipt of infant antiretroviral prophylaxis, place of delivery, and feeding practice were analyzed to determine their association with HIV infection among exposed babies.
– The study found that rural residence, late enrollment, and non-receipt of infant antiretroviral prophylaxis were significantly associated with HIV infection among exposed babies.
– These findings highlight the importance of timely access to ART for mother-baby dyads in preventing perinatal transmission of HIV.
Recommendations:
Based on the study findings, the following recommendations can be made:
1. Improve access to ART: Interventions should focus on enhancing timely access to ART for HIV-infected pregnant women to reduce the risk of perinatal transmission.
2. Strengthen early enrollment: Efforts should be made to encourage early enrollment of pregnant women into PMTCT programs to maximize the benefits of ART.
3. Enhance infant antiretroviral prophylaxis: Strategies should be implemented to ensure that all exposed babies receive appropriate antiretroviral prophylaxis to further reduce the risk of HIV transmission.
4. Address rural residence challenges: Special attention should be given to women residing in rural areas, as they are at higher risk of perinatal transmission. Targeted interventions should be developed to overcome barriers to accessing PMTCT services in these areas.
Key Role Players:
1. Ministry of Health: Responsible for policy development, coordination, and implementation of interventions to prevent mother-to-child transmission of HIV.
2. Healthcare Providers: Including doctors, nurses, and counselors who provide PMTCT services and play a crucial role in ensuring timely access to ART and proper infant prophylaxis.
3. Community Health Workers: Involved in community outreach and education to raise awareness about PMTCT services and encourage early enrollment.
4. Non-Governmental Organizations (NGOs): Engaged in supporting PMTCT programs, providing resources, and implementing interventions to improve access and adherence to ART.
Cost Items for Planning Recommendations:
1. Training and Capacity Building: Budget for training healthcare providers and community health workers on PMTCT guidelines, counseling, and ART administration.
2. Medications and Supplies: Allocate funds for procuring antiretroviral drugs for pregnant women and infants, as well as other necessary medical supplies.
3. Infrastructure and Equipment: Consider the cost of establishing or upgrading PMTCT clinics, including equipment for HIV testing, laboratory facilities, and storage of medications.
4. Community Outreach and Education: Set aside funds for community engagement activities, including awareness campaigns, health education materials, and transportation for community health workers.
5. Monitoring and Evaluation: Include resources for data collection, analysis, and monitoring of program outcomes to ensure the effectiveness of interventions.
Please note that the cost items provided are general categories and may vary depending on the specific context and resources available.

The strength of evidence for this abstract is 7 out of 10.
The evidence in the abstract is moderately strong. The study design is a 1:1 unmatched case-control study, which allows for comparison between HIV-infected and HIV-uninfected babies. The data were obtained from medical records, which can provide reliable information. The study conducted both univariate and multivariate logistic regressions to identify risk factors associated with HIV transmission. However, the sample size is relatively small (94 cases and 94 controls) and the study was conducted in a specific region of Nigeria, which may limit the generalizability of the findings. To improve the strength of the evidence, a larger sample size and a more diverse population could be included in future studies. Additionally, conducting a prospective study design and collecting data directly from participants could provide more robust evidence.

Despite the effectiveness of antiretroviral therapy (ART) in the prevention of mother-to-child transmission of HIV (PMTCT), some HIV-infected women in PMTCT care are at risk of transmitting HIV to their babies. Using a 1:1 unmatched case–control study design, we assessed the risk factors for perinatal transmission among women who received ART for PMTCT in Sokoto State, Nigeria. Data were abstracted from medical records of cases (94 HIV-infected babies) and controls (94 HIV-uninfected babies) and their mothers who accessed PMTCT services in three purposefully selected secondary health facilities. We conducted univariate and multivariate logistic regressions to determine if sociodemographic characteristics, time of enrolment, type of maternal ART, receipt of infant antiretroviral (ARV) prophylaxis, place of delivery, or feeding practice were associated with HIV infection among HIV-exposed babies. Sixteen percent of the mothers of babies in the case group had early enrolment while 90% of those in the control group enrolled early. Infant prophylaxis was received in 54% of cases and 95% of controls. In both groups, 99% of the mothers practiced mixed feeding. In the univariate analysis, factors that were significantly associated with HIV infection were religion (islam), rural residence, late⁠ enrolment, and non-receipt of infant ARV prophylaxis. In the multivariate analysis, rural residence (Adjusted odds ratio (aOR) = 8.01, 95% CI = 1.79–35.78), late enrolment (aOR = 41.72, 95% CI = 15.16–114.79), and non-receipt of infant ARV prophylaxis (aOR = 4.1, 95% CI = 1.18–14.33) remained statistically significant. Findings from this study indicate that eliminating MTCT in Nigeria requires interventions that will enhance timely access of ART by mother-baby dyads.

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Innovation 1: Enhancing Timely Access to Antiretroviral Therapy (ART)
– Develop community-based awareness campaigns to promote early enrollment of pregnant women into PMTCT programs.
– Implement mobile clinics to bring healthcare services closer to pregnant women, particularly those in rural areas.
– Create targeted interventions to address barriers faced by women in rural areas, such as transportation or lack of healthcare facilities.

Innovation 2: Strengthening Prophylaxis for Infants
– Utilize mobile technology for reminders and follow-ups to ensure that all HIV-exposed infants receive the necessary antiretroviral (ARV) prophylaxis.
– Train healthcare providers on the importance of infant prophylaxis and provide ongoing education to ensure adherence.
– Implement systems to track and monitor the administration of prophylactic treatment to ensure all infants receive the appropriate care.

Innovation 3: Targeting Rural Communities
– Establish satellite clinics or mobile healthcare units that provide comprehensive PMTCT services in rural communities.
– Train and deploy community health workers to provide education, counseling, and support to pregnant women in remote areas.
– Develop strategies to overcome geographical barriers, such as providing transportation or organizing community-based transportation options for pregnant women in rural areas.

By implementing these innovative interventions, access to maternal health can be improved, and the risk of perinatal transmission of HIV can be reduced in Nigeria.
AI Innovations Description
Based on the research findings described in the publication “Risk factors for perinatal transmission of HIV among women attending prevention of mother-to-child transmission clinics in Northwest Nigeria,” the following recommendation can be developed into an innovation to improve access to maternal health:

1. Enhancing Timely Access to Antiretroviral Therapy (ART): The study found that late enrollment in PMTCT care was significantly associated with perinatal transmission of HIV. To improve access to maternal health, it is recommended to develop innovative strategies that promote early enrollment of pregnant women into PMTCT programs. This can be achieved through community-based awareness campaigns, mobile clinics, and targeted interventions to reach women in rural areas who may face barriers to accessing healthcare services.

2. Strengthening Prophylaxis for Infants: The research identified that non-receipt of infant antiretroviral (ARV) prophylaxis was a significant risk factor for perinatal transmission. To address this, innovative approaches should be developed to ensure that all HIV-exposed infants receive the necessary ARV prophylaxis. This can include the use of mobile technology for reminders and follow-ups, training healthcare providers on the importance of infant prophylaxis, and implementing systems to track and monitor the administration of prophylactic treatment.

3. Targeting Rural Communities: The study found that rural residence was associated with a higher risk of perinatal transmission. To improve access to maternal health in rural areas, innovative solutions should be developed to overcome geographical barriers. This can include establishing satellite clinics or mobile healthcare units that provide comprehensive PMTCT services in rural communities. Additionally, community health workers can be trained to provide education, counseling, and support to pregnant women in remote areas.

By implementing these recommendations as innovative interventions, it is possible to improve access to maternal health and reduce the risk of perinatal transmission of HIV in Nigeria.
AI Innovations Methodology
To simulate the impact of the main recommendations on improving access to maternal health, the following methodology can be used:

1. Data Collection: Collect data on the current status of access to maternal health services in the target area, including information on enrollment in PMTCT programs, receipt of antiretroviral therapy (ART) by pregnant women, and provision of infant antiretroviral (ARV) prophylaxis.

2. Baseline Analysis: Analyze the collected data to determine the current rates of late enrollment in PMTCT care, non-receipt of ART by pregnant women, and non-receipt of infant ARV prophylaxis. This will serve as the baseline for comparison.

3. Intervention Design: Develop innovative strategies based on the recommendations mentioned in the publication. This may include community-based awareness campaigns, mobile clinics, targeted interventions for rural areas, mobile technology for reminders and follow-ups, training healthcare providers, and implementing systems to track and monitor treatment administration.

4. Implementation: Implement the designed interventions in the target area. This may involve collaborating with local healthcare facilities, community organizations, and relevant stakeholders to ensure the successful implementation of the strategies.

5. Data Monitoring: Continuously monitor and collect data on the impact of the interventions. This includes tracking the number of pregnant women enrolling early in PMTCT care, the proportion of pregnant women receiving ART, and the percentage of HIV-exposed infants receiving ARV prophylaxis.

6. Analysis: Analyze the collected data to assess the impact of the interventions on improving access to maternal health. Compare the post-intervention rates of late enrollment, non-receipt of ART, and non-receipt of infant ARV prophylaxis with the baseline rates to determine the effectiveness of the interventions.

7. Evaluation: Evaluate the overall impact of the interventions on reducing perinatal transmission of HIV and improving access to maternal health. This can be done by comparing the rates of perinatal transmission before and after the implementation of the interventions.

By following this methodology, it will be possible to simulate the impact of the recommendations mentioned in the publication on improving access to maternal health in the target area. The data collected and analyzed will provide valuable insights into the effectiveness of the interventions and guide future efforts to further enhance access to maternal health services.

Statistics:
Citations: 2
Authors: 6
Identifiers:
DOI: 10.1080/09540121.2018.1524116
ISSN: 09540121
Research Areas:
Community Interventions, Health System and Policy, Infectious Diseases, Maternal and Child Health, Quality of Care
Study Countries:
Nigeria
Study Design:
Case-Control Study, randomised-control-trial
Participants Gender:
Female
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