Strategies for increasing the uptake of services to prevent mother-to-child transmission (PMTCT) of HIV: the FHI360/Nigeria experience R.Abdul-Hadi, W.O Adebimpe, E.A.Oladele, H.Khamofu, S.Odafe, S.Cartier, E. Egwa, B. Aiyenigba, K.Torpey, O.Chabikuli ICASA 2011, Addis-Ababa

Issues Nigeria million population, 3.3 million living with HIV, 1.7 million HIV+ve women (age 15+) †, 4.1% HIV prevalence among ANC attendees # Nigeria contributes 30% to the global PMTCT gap ‡ Low coverage of PMTCT services in Nigeria - 13% for Counseling & Testing, 11% for ARVs* ANC attendance in Nigeria is just 58% and only 35% of Nigerian women deliver their babies in hospitals** † UNICEF # FMOH National HIV Sentinel Survey ‡ WHO Universal Access Report *FMOH National Scale-up Plan **NPC NDHS

Objective This study examined the role of a community-based intervention in complementing facility-based uptake of PMTCT services in FHI-supported public health facilities in Nigeria

Description: Intervention Commenced February of 185 FHI360-supported health facilities (hubs) were identified to have low ANC uptake compared to expected threshold as per fertility rate and population figures Cause and effect analysis showed that women used smaller PHCs and TBAs within the communities 3 main intervention steps conducted within defined clusters: – Advocacy & community sensitization – Outreaches – Referral to hub for ANC/enrolment into care

Community Description: Advocacy and community sensitization Hub Gatekeepers Targeted at - – Community leaders – Key opinion leaders – Staff of faith-based maternity homes (FBMH) – Primary health care centers (PHCs) – Traditional birth attendants (TBAs) Outcomes – Buy-in from key persons – Sensitized communities – Negotiated dates, venues and modalities for regular outreaches FBMH TBA Intervention cluster PHC

Description: Outreaches Community Hub Gatekeepers FBMH PHC Capacity development – Training for health workers from hubs, volunteer lay counselors and testers, mobile counseling and testing teams – SOPs, documentation & referral tools – Recognition of high-risk pregnancies for referral – Close mentoring and supportive supervision Outreach planning – Sound commodity management – Clear communication with community leaders, TBAs and other staff – Dates TBA Intervention cluster

Community Description: Two-way referral system Hub Gatekeepers FBMH PHC TBA Activities during outreaches – Routine HIV testing and counseling with opt-out option – Partner testing – Referral to hub for ANC and enrolment into care Two-way referral – Referral hub was in close proximity to community – Education of clients on free-nature of services to be received at hub – Comprehensive referral directory – Feedback to referral source – Adequate documentation and tracking Intervention cluster

Description: Methodology Retrospective review of service data was conducted in all 57 health facilities Uptake of PMTCT services before the intervention (Oct Jan 2010) was compared with uptake after the intervention (March – June 2010) February 2010 was allowed as lead time to allow all sites fully take-up the intervention Differences in selected indicators of PMTCT services were analyzed using the t-test and chi-square (5% significance level)

Lessons learned

Lessons learned II Community-based approaches: – can effectively complement facility-based service provision – have the potential to increase the overall uptake of PMTCT services There is a strong need to intensify efforts at partner testing

Next steps Community-based interventions with active community involvement and participation should be scaled up including partner testing Geographic areas with low uptake of ANC should adopt community-based strategies as a strong component of PMTCT

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