Experts have lamented the non availability of adequate data in effort to thoroughly implement the prevention of Mother-To-Child Transmission (PMTCT), thereby hindering treatment and prevention of mother to child infections of HIV and AIDS in Nigeria.
In 2016, 34% of adults living with HIV were aware of their status. Across the country testing rates are low as only 15.1% of people between the ages of 15-49 had tested in the last 12 months and knew their results.
Nigeria aims to reach the UNAIDS target, with 90% of people living with HIV knowing their status by 2021.
Surveys have also shown that only 60.4% of women and 70.8% of men knew where they could go to be tested for HIV.
There are a number of reasons why more people are not testing for HIV in Nigeria. These include supply problems with testing kits and logistic issues getting further supplies.
There is also a common belief that HIV Testing Centres(HTC) are where HIV-positive people go to access care, rather than them being testing centres for those who don’t know their status.
Although, a push on the number of sites providing HTC services has resulted in a huge increase, from around 1,000 in 2010 to more than 8,000 in 2014.
However, this number is woefully short of the estimated 23,600 sites needed to provide universal coverage.
Targets set in the most recent National Strategic Framework commit to 60% of the general population and 100% of key populations and children of mothers living with HIV to have access to HIV testing services.
The plan also hopes to integrate screening for other co-infections into HIV testing and counselling services.
Prevention of mother-to-child transmission (PMTCT) survey showed that just over a quarter (26.9%) of all cases of mother-to-child transmission (MTCT) of HIV in the world happen in Nigeria.
In 2016, only 32% of pregnant women living with HIV received antiretroviral treatment to prevent mother-to-child transmission as 7% were tested for HIV as part of their antenatal care.
This translated to the rate of mother-to-child transmission in the country has consistently remained quite high, compared to other countries.
In the United Nations Children Funds (UNICEF) with relevant agencies and government at all levels in Nigeria has dedicated resources particularly in a view to reducing the prevalence of mother to child transmission.
To achieve this, Nigeria was selected as one of UNAIDS’ 23 priority countries for PMTCT – being one of the nations with the highest HIV burden yet low levels of treatment coverage during pregnancy.
Sadly, in these 23 countries, Nigeria has the second-lowest level of ART coverage in pregnant women.
The number of pregnant women visiting health facilities remains low, as does the number of health facilities providing PMTCT services, with only 7,265 health facilities providing PMTCT in 2015.
However, Nigerian government has made a commitment to improve and create more PMTCT facilities in hospitals and general health clinics, it is doubtful that the target of 95% of health facilities providing PMTCT services by the end 2021 in Nigeria is achievable.
According to the Assistant Director, National Prevention of Mother To Child Transmission and Team Lead of the National AIDS and STI Control Programme of the Federal Ministry of Health, Dr Gbenga Ijaodola in an exclusive interview stated that there is need to increase data coverage to cover more facilities.
He further said that the facilities are doing a lot in providing services however effort should made to try as much as possible to increase the coverage and make sure government cover those facilities in terms of record keeping.
“It is estimated we have like 34,000 facilities providing ante natal care and majority of our data are coming from may be like 6,000 of them.
“That’s too low and it is not that those facilities have funds. The pregnant women are going there and that’s the more reason why we want to use this hub and the spoke method to see how we can reach out and the engagement with the local government to see how we can use the existing structures to emphasize more in all those facilities across the board and we believe that if we do hub and the spoke linking one facility to the other and we also use the local government people because they are closer to the grassroots I belive that we will be able to improve on the data, that will flow from the facility to the local government, state and then to the national across the board”.
“Both in public and private facilities and also the community structure and there is unit at the federal ministry of health that is responsible for that and that the unit has been looking at various way on how to increase the data coverage”.
Ijaodola also narrated the synergy between National Population Commission and the PMTCT in an effort to control the spread of HIVAIDS in Nigeria.
He said: “there is no focus on HIV number but they focused on general population which is where we look at people that of reproductive age and that we believe that people that are of reproductive age are the people that are prone to get infected because they are the one engaging in sexual activities as one of the ways which is of the major activities or in fact, the major avenue for transmitting HIV.
“I know Population Commission have their system and they are working on how to get the right figure for they have a statutory role. What they are getting is what we use as most of our denominator to calculate how far we have been able to go”.
“One of their responsibilities is the number of women of reproductive age. from there we will now know those that are HIV positive and then know how far we’ve gone”.
“Their work is very key and during the course of our HIV/AIDS survey, they are always very key organization in decision taking because they have the structure that can be used in all the states”.
They were there during the 2018 HIV/AIDS survey. They also contribute their efforts to that. We are working with them with some other organizations with NPHCDA that works on primary healthcare also the department of planning, research and statistics that responsible to the health reformation system across board.
“I think the main thing is always like that with a very large population. You try as much as how your structure can cover as much as possible”.
“All over the world, there is no perfect data, you will meet the target or work with target to know exactly where you are going to and then make efforts to reach there”.
“With the collaboration with our stakeholders, we already had a target for the year. The number of pregnant women that we expect will infected with HIV and it is a target and it is working. What we do now is to see how we can increase our efforts by getting everywhere that services are being provided”.
“The key thing is that target is not yet made where their services are being provided and we have not been able to ensure that we captured our data at all”.
“If we are able to capture our data from all and by the time we compare it with our target, we see that we have really gone far”.
“Effort so far revealed that we have been to cover 45 percent of what is expected but I know that if we put more effort, we can do more than that”.
In her presentation, the Medical Consultant of the University of Calabar Teaching Hospital at the Media Dialogue Supported by UNICEF, Dr Atana Ewa, from the University of Calabar, bemoaned the spread of HIV as it is a major cause of infant and childhood mortality and morbidity in Africa.
More than 1.9 million Nigerians are estimated to be living with HIV. In 2018 the incidence of HIV was estimated at 8per 10,000 persons.
Ewa emphasized that, in order to prevent mother to child transmission, a mother cannot breast feed the child more than 12 months and a breast feeding mother who is HIV positive must know her viral load and must be taking her anti retroviral drugs regularly.
She further said no matter how much she loves breast feeding and the baby, she must stop at 12 months, exclusive breast feeding for 6months and she continues but not beyond 12 months.
“The longer you breastfeed, the more you are increasing the chance of passing the virus. Even though she is on ART, let not do it too long, nobody knows the level of which infection can or can’t occur”.
“Even the pregnant women who attend ANC, over 63% of them don’t even have access to the much needed PMTCT”.
“In order to increase the number of pregnant women coming for ANC and PMTCT, it is imperative for the government to make ANC free and if possible give incentives to every pregnant woman that comes for ANC. When these women attend ANC, there will be proper documentation of these women and necessary tests would be carried out”.
‘Unfortunately, Nigeria contributes 22,000 new HIV infections in children globally and a mere 28 per cent HIV exposed infants had access to early infant diagnosis in 2020″.
Ewa however said for government to address data lapses in the country, there is need for the federal, state and local governments to create ante natal care and delivery services in every ward.
“It goes without saying that once a well equipped health facility is close enough and available, pregnant women will not have an excuse not to go for their ANC regularly”.
“Additionally, government must look into exorbitant health facilities fees, which has often discouraged most pregnant women in the country from attending ANC, hence the inability to collect and or gather good data”.
Prevention of mother-to-child transmission (PMTCT) programmes offer a range of services for women of reproductive age living with or at risk of HIV to maintain their health and stop their infants from acquiring HIV.
Prevention of Mother To Child Transmission, PMTCT, improves maternal and child health through preventing the spread of HIV infection.
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