- 9m women get pregnant every year
- 267,000 children living with HIV
- Only 54, 000 on ART
Indications have emerged that the current 40 per cent of pregnant women who come for Antenatal Care (ANC) out of the estimated 9 million women who get pregnant in Nigeria every year based on the country’s fertility rate , is inadequate for her to achieve the goal of elimination of Mother-To -Child Transmission (MCTC) of HIV.
Current guidelines recommend inclusion of HIV testing in routine screening tests for all pregnant women. For this reason, ANC represents a vital component of efforts to Prevent Mother-To-Child Transmission (PMTCT) .
UNAIDS 2017 report shows that Nigeria is responsible for over 12.4 per cent of the global burden of HIV infected children with an estimated number of 267,000 children living with HIV in the country out of which, only 54 , 000 are on anti – retroviral treatment (ART)
“ Estimated pregnant women in Nigeria per year is 9 million out which 40 per cent come for ANC. Now, only 2.6 million of them are tested for HIV and 64,000 test positive to HIV. As a result of low uptake of ANC and the failure of HIV positive pregnant women to deliver at the health facility, children born to positive mothers about 8.4 per cent are coming down with infection
With 40 per cent ANC attendance and failure of positive pregnant women to deliver in health facilities, stakeholders say this remains a barrier in preventing mother-to-child transmission going by the above statistics.
The stakeholders, including the United Nations Children’s Fund , are of the view that one effective approach to achieving the goal of elimination of mother-to -child transmission is the increase in uptake of ANC and HIV testing, which they say will certainly increase opportunities for PMTCT programmes to reach HIV-positive pregnant women particularly those in rural settings.
According to them, there is also need to train, supervise and integrate unskilled attendants such as Traditional Birth Attendants into formal maternal and child health programmes as many of the pregnant women patronise them a lot.
Evidence shows that many pregnant women in the country find it difficulty patronising health facilities with skilled birth attendants where HIV screening is given a priority owing to affordability, accessibility and availability, coupled with health workers’ attitude.
The stakeholders believe that service integration has the potential to improve care and reduce missed opportunities for key interventions such as HIV testing, provision of Anti Retroviral Therapy, education in optimal breastfeeding and adherence support
They stressed that education of pregnant women and their communities is needed to increase HIV knowledge and reduce stigma.
Speaking at a media dialogue organised by UNICEF in Calabar recently, Assistant Director , PMTCT, at the National AIDS and STIs Control Programme , Dr. Ijaodola Olugbenga, said the need to increase ANC uptake needed not be overemphasised, describing the 40 per cent attendance as unacceptable.
Olugbenga said: “ Estimated pregnant women in Nigeria per year is 9 million out which 40 per cent come for ANC. Now, only 2.6 million of them are tested for HIV and 64,000 test positive to HIV. As a result of low uptake of ANC and the failure of HIV positive pregnant women to deliver at the health facility, children born to positive mothers about 8.4 per cent are coming down with infection. So, it is important for every pregnant woman that comes for ANC to be tested for HIV and screening should be done for hepatitis, syphilis and other sexually transmitted diseases also. Any pregnant woman who is found positive to HIV should be initiated on ART with referral to adult ART clinic after PMTCT.”
For HIV exposed infants, Olugbenga revealed that they will be place on treatment for life while calling for increased ANC uptake and improved facility based delivery to reduce risk of transmission to infants.
He, however, noted that Nigeria is committed to the goal of eliminating mother to child transmission by 2020 and has initiated a number of strategies as well as comprehensive package of PMTCT to achieve the goal.
To achieve the goal of elimination of MTCT, Olugbenga, said at least 90 per cent of HIV infected women must have access to comprehensive prevention of mother to child transmission of HIV services, including anti-retroviral drugs during pregnancy, labour, delivery and breastfeeding periods.
Giving insight into comprehensive package of PMTCT, he said : “We have HIV testing services (HTS); Provider-initiated testing and counselling (PITC); Infant feeding counselling; Family planning counselling and services ;ARV and Cotrimoxazole prophylaxis for mother-infant pairs; early infant diagnosis and linkage to treatment (EID/T). Others are screening of all pregnant women for hepatitis, syphilis and other sexually transmitted diseases; screening of the mother for cervical cancer; eligibility assessment of the mother for lifelong antiretroviral therapy .”
He listed strategic areas of focus to achieve MTCT to include, increase in ANC uptake and improving facility based delivery; increase HIV testing coverage among pregnant women ; provision of ARVs for the positive pregnant women during delivery and breastfeeding period ; increase EID coverage; improving the Peadiatric ART management ; coordination and harmonization of efforts and to improving data harvesting and management.
He urged religious leaders to join in raising awareness on the importance of ANC by encouraging their members who are pregnant to register and deliver in health facilities where there are skilled attendants.
Olugbenga, however, identified inadequate appropriation for HIV programme in national and states budget; dwindling support from partners, socio-economic challenges, poor Health seeking behaviour; culture, myths; misconceptions and stigmatization as factors limiting ongoing effort in PMCTC in Nigeria.
For UNICEF Specialist , Dr. Abiola Davies, Nigeria must think out of the box by looking at innovative ways of generating funds following the current decline in global funding for HIV in the country for her to meet the global target.
