Comparison of performance of prevention of mother-to-child transmission (PMTCT) of HIV/AIDS cascade between public and private health facilities in a community PMTCT implementation in north central Nigeria

Abstract

Initial national response to the HIV and AIDS epidemic had been mainly domiciled within the public health sector, with near exclusion or non-involvement of the private sector despite the significant proportion of the latter’s clientele. Over the years, it has become apparent that the public sector cannot meet the growing need and demand for HIV and AIDS related services. Therefore, the growing need for HIV and AIDS services coupled with the preferential needs of certain segments of the population for private health facility services indicated by the increasing majority of Nigerian population using private health service outlets for their various health needs and the diverse socio-economic profile of the epidemic make the involvement and engagement of the private sector health facilities imperative. With passing of time, there has been increasing involvement of the private sector in the health sector response to the disease through various avenues. Private health facilities have, on each one’s accord, provided HIV and AIDS services to their clients. The recognition of the potential role of the private sector health facilities in enhancing the needed response to the epidemic is what informed the engagement of some private health facilities in a PMTCT (Preventing maternal to child transmission) program in North Central Nigeria, the outcome of which formed the basis of this review. Data from a PMTCT service delivery program implemented through both public and private health facilities between October 2012 and September 2013 were reviewed and analyzed. Performances of the cascade within each of the two groups were reviewed and analyzed, and comparison made. Data reviewed included number of pregnant women reached with ante-natal care (ANC) services and provided HIV counseling and testing, number of HIV positive pregnant women identified and placed on antiretrovirals (ARVs) to prevent maternal to child transmission of HIV, number of infants born to HIV positive women, number of HIV exposed infants provided early infant diagnosis services and antiretroviral prophylaxis to avert pediatric infection, and the pediatric outcomes within the reporting period. Comparatively, uptake of services at the various levels of PMTCT cascade was higher among the private health facilities: more pregnant women provided ANC among the private health facilities (682 per private health facility) than among the public health facilities (477 per facility) in the reporting period with attendant greater number reached with HIV testing and counseling (652 per private health facility compared to 443 per public health facility) and equally greater number of identified HIV positive pregnant women (18 per private health facility compared to 11 per public health facility), the differences being statistically significantly different (pV = 0.05). Significantly higher performance was recorded in the provision of services to HIV exposed infants born to HIV positive mothers. At no level of service delivery per facility did the public health facilities record higher performance than the private health facilities. This review reveals the commendable performance of the private health facilities, indicating the great potential of the private health sector in the provision of PMTCT services when appropriately harnessed.

Keywords: Private Health Sector Engagement, public health sector engagement, PMTCT, HIV/AIDS