Enhancing Prevention Of Mother-To-Child Transmission (Pmtct) Of Hiv Implementation Through Community Engagement: Evidence From North Central Nigeria

Abstract

Despite the enormous resources so far expended in the country’s HIV mitigation, Nigeria continues to post poor PMTCT performance. The characteristic poor uptake of maternal, newborn and child health services creates a block to the attainment of desired universal accessibility of pregnant women to needed PMTCT services. Community-level factors such as stigma, adverse gender dynamics, low support for HIV testing and antenatal care, inadequate skilled birth attendance and poor linkages between communities and their facilities have similarly hindered the uptake of PMTCT services. Demand-side factors as inadequate knowledge and mis-conceptions about HIV and PMTCT; gender inequities and other harmful gender norms; HIV-related stigma; and financial constraints, including transport are other factors with similar negative effect. Various promising practices of community engagement with evidences of their positive impact on PMTCT service uptake have been documented. The recognition of community engagement as a strategy for enhancing PMTCT uptake and a successful PMTCT outcome is what informed the implementation of the community PMTCT program in North-Central Nigeria, for which the outcome forms the basis of this review. Ward Development Committees were established for the 104 health facilities and their adjoining communities which constitute the implementation settings in this model of community PMTCT in North- Central Nigeria to engage their respective communities and create awareness and demand for PMTCT and related services. Their activities included participation in health facilities’ community service provision which included community mobilization for service uptake, monthly meeting to address community health issues and service implementation and advocate to government and other stakeholders for support to facilities and communities in their health activities. Protocols and standard operation procedures as guidelines, as well as reporting formats and templates for documentation of their activities were provided. Effectiveness was determined by increase in the number of new ANC clients booked, increase in number of ANC clients counseled, tested and received results, increase in number of facility-based delivery among ANC and PMTCT clients, and increase of partners of HIV positive clients who got counseled and tested within the reporting period. The number of pregnant women who took up ANC at the facilities rose by 50%, while the number who accepted HIV counseling and testing increased by 48% above the pre-community engagement period. Similarly, facility-based deliveries among the ANC clients rose by 61%. Among the HIV positive pregnant women, facility-based delivery increased by 25%. Acceptance of HIV counseling and testing among partners of HIV positive pregnant women rose by 75%. The outcome of this review indicates that community engagement can improve PMTCT uptake, and where rigorously implemented within the PHC system, can improve PMTCT coverage and uptake. The increases in number and proportions as found in the review buttress this.

 Key words: Community Engagement, PMTCT, Ante natal care, North East Nigeria