Reaching the hard-to-reach: Integrating

HIV Counselling and Testing (HCT) in Maternal New-

born & Child Health (MNCH) Week – in Nigeria

By

Mr Araoye Segilola, Director, PDA

Dr Chukwuma Anyaike, CSG II/Head Prevention

National AIDS/STIs Control Programme (NASCP)

FEDERAL MINISTRY OF HEALTH, NIGERIA

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Outline of Presentation

• Background

• Objectives of the intervention

• Strategies and Structure

• Links to policy

• Service Delivery

• Successes and Challenges

• Sustainability and Replication

• Awards and Recognition

• Lessons Learned

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Background information

Located in West African region.

Estimated population 177 millions

Annual

Most populous country in Africa and

10th globally

# Annual pregnancy - 6 Millions

# Health facilities – 22, 726

Total Fertility rate - 5.7%

Comprised 36 states and Federal Capital Territory (Abuja)

# of Local Government Areas - 774

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Background 2

• Nigeria has the second highest burden of HIV in the world with a National

prevalence of 3.4% and approximately 3.3 million people living with HIV.

• The National mode of transmission study indicates that MTCT accounts for

22% of new infections.

• The number of pregnant women provided with antiretroviral drugs (ARVs)

for the purpose of PMTCT has increased from 13,000 in 2006 to 58,000 in

2013.

• Bottlenecks to eMTCT include inadequate access to HCT, poor uptake of

PMTCT services at the health facilities, barrier due to user fees, traditional

beliefs and practices, stigma and discrimination, missed opportunities due

to parallel programming and funding, lack of adequate infrastructure

including technical competence and man power.

• The MNCH week is an established platform in Nigeria implemented by the

Federal Ministry of Health where Antenatal services are provided to

pregnant women; immunization services to new born and infants; and family

planning to non-pregnant mothers. This provides ample opportunity to

access women of reproductive age including pregnant women with HCT

services.

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Objectives of the HCT/ MNCH

Integration

• To increase awareness of HIV and uptake

of HCT among women of reproductive

health but especially Pregnant women.

• To effectively link them to nearby health

facility for PMTC services.

• To replicate the findings and strategy to

other states of the federation.

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Strategies and Structure

• The first documented modeling of HCT in MNCH Week was in

Benue State conducted in June 2013 and generated the framework.

• Creation of enabling environment by the development of guidance

note/document.

• Leveraging on existing MNCH service delivery structures for HCT at

the grassroots.

• Active engagement of the communities, gate keepers, Civil Society(

ASWHAN) and implementing partners

• Several pre-programme meetings with multi-stakeholder planning

before implementation phase.

• Effective Coordination at all levels of health system

• The Programme was health facility based

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Links to Policy

• It encouraged the health facility delivery of

babies and improved health seeking

behaviour.

• Delivery by skilled health care workers

with the associated advantages

• The use of ARVs for the PMTCT

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Service Delivery

Coverage Preg. Women &

Tested ( 623 facilities in 5+1 States)

200,000

110,397 108,972

0

50,000

100,000

150,000

200,000

250,000

Target

Actual

# of HIV +preg. Wome- 1,434

(1.3%)

KADUNA STATE

Target - 53,021

Actual - 39,657 ( 74.8%)

C T & R - 38,429 (72.5% )

HIV+ - 207 ( 0.54%)

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Successes and Challenges

• Coverage of HIV testing among pregnant women during the week of

the HCT@MNCHWeek initiative was two-fold the coverage of HCT

during routine HCT at ANC in a 6-month period (January-June 2014)

prior to the campaign.

• It also provided opportunity for HCT for women of reproductive age;

takes care of prong 1 of the PMTCT elements.

• In some of the states it provided opportunity for men engagement .

• It provided opportunity for women at hard to reach areas and was

also cost effective.

• It provided a platform for effective linkages and referrals in the

system.

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Challenges

• The late arrival of HIV test kits in few

states delayed the HIV testing until the

third day of the campaign.

• Paucity of health care workers at the

health facilities.

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Sustainability and Replication

• Engagement of all stakeholders from the planning stage,

and capacity building at the lower level of care to

integrate HCT into MNCH Week.

• Particular attention was given to supply and procurement

of HIV test kits before the campaign.

• There has also been revision of current tools and data

base to measure and evaluate the HCT and MNCH

services.

• Daily supervision and real-time data collection are

potential success factors.

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Awards and Recognition

• The success of HCT/MNCH integration has been recognized by the

National Programme to increase uptake of PMTCT services in

Nigeria.

• This has lead to the review MNCH guidance note and integration of

the HCT protocols.

• The data collection tools have also been reviewed for appropriate

integration.

• The strategy has been adopted for replication in other states of the

federation.

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Lessons learned

• Government leadership and coordination of multi-level stakeholders was

critical to the success of this integration of HCT during the MNCH week

• Adequate and proper engagement of Communities, Gate keepers and civil

society organization was very critical to the achievements made.

• Regular stakeholders meeting was key for coordinated outcome.

• The use of Community Based Organizations enhanced appropriate linkages

and referrals and improved retention in care.

• The HCT/MNCH integration strategy improved health seeking

behaviour/demand creation.

• Innovative demand creation approaches of using clergymen, imams were

helpful in demand creation. Also conduct of additional rounds of demand

creation activities in the community so as to reach those away at work

during the day

• Motivation of staff was also a key factor

• Real-time daily data reporting using mobile phone helped in coordination

and review meetings to inform decision making.

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Conclusion

• The HCT in MNCH Week initiative is grounded on a valid

rationale of integration of services to increase utilization

of HIV testing and other MNCH services among women

of reproductive age and their under-five children, and

their male partner in Nigeria.

• Under Government leadership, and in partnership with

implementing partners, over 200,000 pregnant women

(3% of annual target) were reached in a week with

integrated HCT and MNCH services.

• Strong community endorsement of the activity was

evidenced through active participation of community

leaders and volunteers from CBO/PLHIV association.

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Acknowledgements

• UNICEF

• NPHCDA

• USG/PEPFAR

• NEPWHAN

• ASWHAN

• NACA

• SASCP

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Thank you for listening!