Elimination of Mother to Child Transmission of HIV/AIDS

Advanced efforts have been made by several African countries to eliminate mother to child transmission of HIV with many southern African countries achieving over 80% coverage of antiretroviral (ARV) prophylaxis.  By contrast, West and Central Africa continue to lag behind at 23% (16%-44%) coverage. The gap of reaching the 80% coverage target for anti-retroviral prophylaxis is concentrated in only a few countries. Nigeria alone accounts for 32% of the gap with the Democratic Republic of Congo a far second at 7%.

Though there has been notable progress in the incidence of paediatric HIV in the country, Nigeria presently carries the highest burden of new pediatric HIV infections and was responsible for a quarter of all new HIV infections among children among the global priority countries in 2013 – nearly 51 000 [44 000–60 000] cases.

The Nigerian national goals are adapted from the WHO 4-pronged approach to primary prevention of MTCT, and center around achieving these three targets:

90%

  • 90% of all pregnant women have access to quality HIV counselling and testing;
  • 90% of all HIV-positive pregnant women and breastfeeding infant­mother pairs receive ARV prophylaxis;
  • 90% of all HIV exposed infants have access to early infant diagnosis services.

 

Our Goals

The national goals are ambitious but achievable through strong state leadership of elimination of mother-to-child transmission (eMTCT) programs and the use of innovative approaches. The goal of HSDF’s eMTCT team is therefore to strengthen state-led execution of eMTCT programs in order to support the states to achieve the national targets.  We support state-led execution by increasing the availability of quality eMTCT data and facilitating its utilization for decision making.

Our team provides technical assistance to 7 ‘high burden states’ to strengthen their efforts to scale up eMTCT interventions. These states are Akwa Ibom, Bayelsa, Cross River, Federal Capital Territory (FCT), Kano, Nasarawa and Rivers.

Our Approach

Diagnose

We conduct a diagnostic to establish a fact base, with a quantitative examination of patient need, service delivery, and the gaps between them;

Design

We support operational planning by supporting the development of simple, concrete, specific, state-led plans to scale eMTCT services focusing on the levers that need to be improved to achieve rapid scale;

Deliver

We support the state government to execute the scale up plan by tracking implementation progress against clear targets. Specifically, we support reporting and tracking of performance; trouble-shooting of emerging bottlenecks; and stakeholder alignment and collaboration.

Results

Scale up of eMTCT services:  

Responding to the baseline analyses identifying low coverage of eMTCT services in some areas state governments have activated more eMTCT sites and a supported increased eMTCT service provision across private healthcare facilities in the intervention states.  

Improved collaboration between key stakeholders:

Creation of a regular forum for partners and state officials during which progress made and challenges faced in the execution of eMTCT services are discussed.  Such fora have now been institutionalized in four states: Akwa-Ibom, Cross River, Rivers and Bayelsa.

Improved eMTCT data reporting:

HSDF has actively engaged private healthcare facilities to report eMTCT data on the national health reporting platforms and has also facilitated access to these platforms by key state officials.  These interventions have resulted in the increased listing of private healthcare facilities on the district health information system (DHIS) platform and improved eMTCT data reporting respectively, which in turns increases data available to monitor and evaluate progress, and inform decision making.

Please, permit me thank the whole HSDF team for your tremendous support to our state. Our health workers are beginning to appreciate the essence of the eMTCT program. Data elements are not just abstracts required by State Ministry of Health, but health workers are taking it now as indicators for assessing their contributions to the health of infants”. Dr John Markson (former State AIDS Program Coordinator, Akwa Ibom State, Nigeria)

Ongoing work

Implementing Data Quality Interventions in Three States:

HSDF currently conducts routine analyses of all eMTCT data reported by the 7 states we support. These analyses have highlighted the fragmentation of the reporting process across all levels of the reporting chain and indicate poor routine data reporting practices across health facilities. To address the root causes of this, HSDF will support 3 states to incorporate routine data quality audits (RDQA) into the Ministry of Health’s routine data collection process. This process will involve targeted investigations to identify the sources of data error, followed by state-specific corrective actions in response to challenges identified.

On-going implementation of Early Infant Diagnosis (EID) Operation Support Services:

HSDF is supporting this by first defining the EID burden on a state-by-state basis (diagnose), using information gathered to support the state in designing a state-specific response, and supporting each state to deliver tailored interventions. The goal of improving access to EID for HIV-exposed infants, making EID operations smarter by eliminating unnecessary steps, and ensuring early initiation on pediatric ART using state-level strategies. HSDF has supported 7 states to establish a baseline on access to Early Infant Diagnosis services.  We are currently providing targeted support to 4 states to improve access to Early Infant Diagnosis (EID) services.

Electronic Medical Records Pilot in one State for Improved Private Facility Reporting:

Unreliable reporting of service-utilization data in private facilities is a major impediment to successful programme execution. To address this, governments, have provided training and data-reporting tools to privately owned health facilities (PHFs).  Despite this, service-utilization data remains suboptimal, largely due to the burden of manual data entry and reporting on private health facilities with high client volumes.  HSDF is currently piloting an electronic medical records (EMR) tool in 20 high volume private facilities in Akwa Ibom State to demonstrate the feasibility of deploying a basic EMR tool in streamlining multiple manual reporting forms into a single electronically generated report.

Integration of HIV Counselling and Testing into Maternal, Neonatal and Child Health Week in Two States:

The Maternal Neonatal and Child Health Week (MNCHW) was inaugurated in 2010 as a state-level biannual (May and November) event that places focus on essential health services for mothers and children under the age of 5. These maternal and child health interventions such as immunization; nutritional supplementation (micronutrient powders and Vitamin A), growth monitoring, provision of zinc/lo-ORS and deworming medication for children under the age of five are delivered during that period. States face several challenges in implementing MNCHW optimally. HSDF is supporting 2 states to improve MNCHW programming in 3 key areas – early planning meetings, data reporting and supportive supervision, with a strong focus on the eMTCT integration.