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Improving PMTCT Coverage and Access in Communities with Unmet Needs in Jos, Nigeria by Adopting Task Shifting and Task Sharing Strategies

Received: 28 April 2021     Accepted: 14 May 2021     Published: 26 May 2021
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Abstract

Towards achieving an AIDS-free generation, UNAIDS set the 90-90-90 target aiming at 90% of HIV positive persons knowing their status, 90% of positives receive sustained antiretroviral drugs and 90% of those receiving ARVs attain virologic suppression by 2020. The attainment are dependent on continual access, quality care and treatment retention, so efforts must address context specific barriers to accessing services. The ethnoreligious conflicts in Jos created barriers to accessing HIV/PMTCT services, even when treatment sites existed around the metropolis. Fifteen communities lacked comprehensive HIV services and residents could not access treatment facilities because of security challenges. A specialized strategy using community oriented resource persons (CORPs) and task shifting task sharing (TSTS) principles conceptualized by stakeholders was utilized to bridge personnel gaps and scale-up PMTCT. The HIV Lead Implementing Partner supported a faith based community organization to identify and scale-up PMTCT into 28 hospitals in 15 communities. Training and task devolution to Community Health workers (CHWs), expert patients and Traditional Birth Attendants (TBAs) was utilized. The facilities were networked for service delivery, referrals, supervision and commodity logistics. HIV testing was provided to pregnant women during ANC, labour and postnatal, and their children and spouses. All 28 facilities offered HCT and provided ARVs to those testing positive in labour, women testing positive during ANC were managed/referred to 8 PMTCT sites for evaluation and ARV commencement according to Nigerian HIV Guidelines. Infants received Nevirapine, early infant diagnosis and Cotrimoxazole. HIV positive children and non-pregnant adults were referred to three ART sites for evaluation and treatment. The twenty-eight facilities were activated for HCT/PMTCT/ART using MNCH structures and CHEWs, TBAs and PLHIV expert patients provided care, support and tracking. After the six-month pilot, of 3,293 women receiving ANC, 3,094 (93.9%) accepted HCT and received same-day results. Thirty-four tested positive, but 15 previously knew their status and on ARVs, but had challenges accessing care, while 17 of 19 newly diagnosed women commenced ARVs while 2 defaulters are being tracked. Five HIV exposed babies delivered received Nevirapine and cotrimoxazole, four were tested HIV-negative. Also 7193 adults and 23 children received HCT and results, 69 positive adults and 2 positive children enrolled care, among who 33 adults and 2 children commenced ARVs. PMTCT diagnostics must identify specific barriers communities experience and implement multipronged context specific scale-up efforts to improve access/uptake to eliminate Paediatric HIV infections. CORPs and TSTS strategies are critical to improve service-delivery and retention in care.

Published in European Journal of Preventive Medicine (Volume 9, Issue 3)
DOI 10.11648/j.ejpm.20210903.13
Page(s) 83-93
Creative Commons

This is an Open Access article, distributed under the terms of the Creative Commons Attribution 4.0 International License (http://creativecommons.org/licenses/by/4.0/), which permits unrestricted use, distribution and reproduction in any medium or format, provided the original work is properly cited.

Copyright

Copyright © The Author(s), 2021. Published by Science Publishing Group

Keywords

Task Shifting Task Sharing, Devolve, Community Resources, PMTCT, Scale-up

References
[1] UNAIDS (2013). “90-90-90 An ambitious treatment target to help end the AIDS Epidemic,” available at http://www.unaids.org/en/sites/default/files/media_asset/90-90-90_en0.pdf. accessed on 11/04/2021.
[2] UNAIDS (2013). Progress Report on the global plan towards the elimination of new HIV infections among children by 2015 and keeping their mothers alive. 2013. Available at: http://www.unaids.org/en/media/unaids/contentassets/documents/unaidspublication/2013/20130625_progress_global_plan_en.pdf accessed on 3/04/2021.
[3] UNAIDS (2010). HIV and conflict: Connections and the need for universal access. A Forced Migration Review special supplement. Available at https://www.unaids.org/en/resources/presscentre/featurestories/2010/october/20101027fssecurityandconflict Accessed 22/02/2021.
[4] Plateau State at a Glance. Available at https://www.plateaustate.gov.ng/plateau/at-a-glance accessed on 23/02/2021.
[5] National Population Commission of Nigeria (2020) https://www.citypopulation.de/php/nigeria-admin.php?adm1id=NGA032.
[6] UNICEF (2015). Interagency Task Team HIV in Humanitarian Emergencies PMTCT in Humanitarian Settings https://www.childrenandaids.org/sites/default/files/2017-04/IATT_Part-2-PMTCT-in-Humanitarian-Settings_2015_0.pdf.
[7] WHO (2010). Global Atlas of the Health Workforce, August 2010.
[8] Federal Ministry of Health, Nigeria (2012). Nigeria Health Workforce Profile as of December 2012. Available at https://Nigeriandocuments.blogspot.com assessed on 20/04/2021.
[9] Federal Ministry of Health, Nigeria (2014). Task-Shifting and Task-sharing Policy for Essential Health Care Services in Nigeria. Available at https://www.health.gov.ng/doc/TSTS.pdf assessed on 01/03/2021.
[10] Federal Ministry of Health (2009). The National Strategic Health Development Plan Framework (2009-2015). Available at https://www.uhc2030.org assessed 17/04/2021.
[11] Jos, Nigeria Metro Area Population 1950-2021. Available at https://www.macrotrends.net>cities Assessed 19/03/2021.
[12] Federal Ministry of Health, Nigeria (2010). National Guidelines for Prevention of mother-to-child transmission (PMTCT) of HIV 2010.
[13] Marcos Y, Phelps BR, Bachman G (2012). Community strategies that improve care and retention along the prevention of mother-to-child transmission of HIV cascade: a review. J Int AIDS Soc. 2012 Jul 11; 15 Suppl 2 (Suppl 2): 17394. doi: 10.7448/IAS.15.4.17394. PMID: 22789647; PMCID: PMC3499877. Available at https://pubmed.ncbi.nlm.nih.gov/22789647/Assessed 19/03/2021.
[14] World Health Organization (2008): Task Shifting-Global Recommendations and Guidelines. 2008. Available at: http://www.who.int/healthsystems/TTR-TaskShifting.pdf Assessed on 22/01/2021.
[15] World Health Organization (2008): Working together for health: the World Health Report. 2006. Geneva, Switzerland: World Health Organization, 2006. Available at: http://www.who.int/whr/2006/whr06_en.pdf. Assessed on 22/01/2021.
[16] Samb B, Celletti F, Holloway J, Van Damme W, Lawson L, De Cock K, Dybul M. (2007). Task shifting: An emergency response to the health workforce crisis in the era of HIV. Lessons from the past, current practice and thinking. N Engl Med 357; 24.
[17] Federal Ministry of Health (2008). National Guidelines for the integration of Reproductive health and HIV programs in Nigeria 2008.
[18] Perez, F, Mukotekwa, T, Miller, A, Orne-Gliemann, J, Glenshaw, M, Chitsike, I and Dabis, F. (2004) Implementing a rural programme of prevention of mother-to-child transmission of HIV in Zimbabwe: first 18 months of experience. PMID: 15228487. DOI: 10.1111/j.1365-3156.2004.01264.x Assessed on 20 /01/2021.
[19] Harvey, K. M, Figueroa, J. P, Tomlinson, J, Gebre, Y, Forbes, S, Toyloy, T, Thompson, T, Thompson, K. An assessment of mother-to-child HIV transmission prevention in 16 pilot antenatal clinics in Jamaica. PMID: 15675493.
[20] Center for Health Market Innovations. Community Prevention of Mother to Child HIV transmission Project. Available at https://healthmarketinnovations.org/program/community-prevention-mother-child-hiv-transmission-project Accessed 16/02/2021.
[21] Measure Evaluation. Community Based Indicators for HIV Programs. Prevention of Mother to Child Transmission of HIV. Available At https://www.measureevaluation.org/community-based-indicators/PMTCT/pmtct assessed 22/02/2021.
Cite This Article
  • APA Style

    Tinuade Abimbola Oyebode, Zuwaira Hassan, Tolulope Afolaranmi, Muazu Auwal, Mohammed Shehu, et al. (2021). Improving PMTCT Coverage and Access in Communities with Unmet Needs in Jos, Nigeria by Adopting Task Shifting and Task Sharing Strategies. European Journal of Preventive Medicine, 9(3), 83-93. https://doi.org/10.11648/j.ejpm.20210903.13

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    Tinuade Abimbola Oyebode; Zuwaira Hassan; Tolulope Afolaranmi; Muazu Auwal; Mohammed Shehu, et al. Improving PMTCT Coverage and Access in Communities with Unmet Needs in Jos, Nigeria by Adopting Task Shifting and Task Sharing Strategies. Eur. J. Prev. Med. 2021, 9(3), 83-93. doi: 10.11648/j.ejpm.20210903.13

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    AMA Style

    Tinuade Abimbola Oyebode, Zuwaira Hassan, Tolulope Afolaranmi, Muazu Auwal, Mohammed Shehu, et al. Improving PMTCT Coverage and Access in Communities with Unmet Needs in Jos, Nigeria by Adopting Task Shifting and Task Sharing Strategies. Eur J Prev Med. 2021;9(3):83-93. doi: 10.11648/j.ejpm.20210903.13

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  • @article{10.11648/j.ejpm.20210903.13,
      author = {Tinuade Abimbola Oyebode and Zuwaira Hassan and Tolulope Afolaranmi and Muazu Auwal and Mohammed Shehu and Ngwoke Kelechi and Agbaji Oche and Solomon Sagay and Jerry Gwamna and Prosper Okonkwo and Phyllis Kanki},
      title = {Improving PMTCT Coverage and Access in Communities with Unmet Needs in Jos, Nigeria by Adopting Task Shifting and Task Sharing Strategies},
      journal = {European Journal of Preventive Medicine},
      volume = {9},
      number = {3},
      pages = {83-93},
      doi = {10.11648/j.ejpm.20210903.13},
      url = {https://doi.org/10.11648/j.ejpm.20210903.13},
      eprint = {https://article.sciencepublishinggroup.com/pdf/10.11648.j.ejpm.20210903.13},
      abstract = {Towards achieving an AIDS-free generation, UNAIDS set the 90-90-90 target aiming at 90% of HIV positive persons knowing their status, 90% of positives receive sustained antiretroviral drugs and 90% of those receiving ARVs attain virologic suppression by 2020. The attainment are dependent on continual access, quality care and treatment retention, so efforts must address context specific barriers to accessing services. The ethnoreligious conflicts in Jos created barriers to accessing HIV/PMTCT services, even when treatment sites existed around the metropolis. Fifteen communities lacked comprehensive HIV services and residents could not access treatment facilities because of security challenges. A specialized strategy using community oriented resource persons (CORPs) and task shifting task sharing (TSTS) principles conceptualized by stakeholders was utilized to bridge personnel gaps and scale-up PMTCT. The HIV Lead Implementing Partner supported a faith based community organization to identify and scale-up PMTCT into 28 hospitals in 15 communities. Training and task devolution to Community Health workers (CHWs), expert patients and Traditional Birth Attendants (TBAs) was utilized. The facilities were networked for service delivery, referrals, supervision and commodity logistics. HIV testing was provided to pregnant women during ANC, labour and postnatal, and their children and spouses. All 28 facilities offered HCT and provided ARVs to those testing positive in labour, women testing positive during ANC were managed/referred to 8 PMTCT sites for evaluation and ARV commencement according to Nigerian HIV Guidelines. Infants received Nevirapine, early infant diagnosis and Cotrimoxazole. HIV positive children and non-pregnant adults were referred to three ART sites for evaluation and treatment. The twenty-eight facilities were activated for HCT/PMTCT/ART using MNCH structures and CHEWs, TBAs and PLHIV expert patients provided care, support and tracking. After the six-month pilot, of 3,293 women receiving ANC, 3,094 (93.9%) accepted HCT and received same-day results. Thirty-four tested positive, but 15 previously knew their status and on ARVs, but had challenges accessing care, while 17 of 19 newly diagnosed women commenced ARVs while 2 defaulters are being tracked. Five HIV exposed babies delivered received Nevirapine and cotrimoxazole, four were tested HIV-negative. Also 7193 adults and 23 children received HCT and results, 69 positive adults and 2 positive children enrolled care, among who 33 adults and 2 children commenced ARVs. PMTCT diagnostics must identify specific barriers communities experience and implement multipronged context specific scale-up efforts to improve access/uptake to eliminate Paediatric HIV infections. CORPs and TSTS strategies are critical to improve service-delivery and retention in care.},
     year = {2021}
    }
    

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    T1  - Improving PMTCT Coverage and Access in Communities with Unmet Needs in Jos, Nigeria by Adopting Task Shifting and Task Sharing Strategies
    AU  - Tinuade Abimbola Oyebode
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    AU  - Tolulope Afolaranmi
    AU  - Muazu Auwal
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    AU  - Ngwoke Kelechi
    AU  - Agbaji Oche
    AU  - Solomon Sagay
    AU  - Jerry Gwamna
    AU  - Prosper Okonkwo
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    T2  - European Journal of Preventive Medicine
    JF  - European Journal of Preventive Medicine
    JO  - European Journal of Preventive Medicine
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    PB  - Science Publishing Group
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    AB  - Towards achieving an AIDS-free generation, UNAIDS set the 90-90-90 target aiming at 90% of HIV positive persons knowing their status, 90% of positives receive sustained antiretroviral drugs and 90% of those receiving ARVs attain virologic suppression by 2020. The attainment are dependent on continual access, quality care and treatment retention, so efforts must address context specific barriers to accessing services. The ethnoreligious conflicts in Jos created barriers to accessing HIV/PMTCT services, even when treatment sites existed around the metropolis. Fifteen communities lacked comprehensive HIV services and residents could not access treatment facilities because of security challenges. A specialized strategy using community oriented resource persons (CORPs) and task shifting task sharing (TSTS) principles conceptualized by stakeholders was utilized to bridge personnel gaps and scale-up PMTCT. The HIV Lead Implementing Partner supported a faith based community organization to identify and scale-up PMTCT into 28 hospitals in 15 communities. Training and task devolution to Community Health workers (CHWs), expert patients and Traditional Birth Attendants (TBAs) was utilized. The facilities were networked for service delivery, referrals, supervision and commodity logistics. HIV testing was provided to pregnant women during ANC, labour and postnatal, and their children and spouses. All 28 facilities offered HCT and provided ARVs to those testing positive in labour, women testing positive during ANC were managed/referred to 8 PMTCT sites for evaluation and ARV commencement according to Nigerian HIV Guidelines. Infants received Nevirapine, early infant diagnosis and Cotrimoxazole. HIV positive children and non-pregnant adults were referred to three ART sites for evaluation and treatment. The twenty-eight facilities were activated for HCT/PMTCT/ART using MNCH structures and CHEWs, TBAs and PLHIV expert patients provided care, support and tracking. After the six-month pilot, of 3,293 women receiving ANC, 3,094 (93.9%) accepted HCT and received same-day results. Thirty-four tested positive, but 15 previously knew their status and on ARVs, but had challenges accessing care, while 17 of 19 newly diagnosed women commenced ARVs while 2 defaulters are being tracked. Five HIV exposed babies delivered received Nevirapine and cotrimoxazole, four were tested HIV-negative. Also 7193 adults and 23 children received HCT and results, 69 positive adults and 2 positive children enrolled care, among who 33 adults and 2 children commenced ARVs. PMTCT diagnostics must identify specific barriers communities experience and implement multipronged context specific scale-up efforts to improve access/uptake to eliminate Paediatric HIV infections. CORPs and TSTS strategies are critical to improve service-delivery and retention in care.
    VL  - 9
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Author Information
  • Faculty of Medical Sciences, University of Jos, Jos, Nigeria

  • Faculty of Medical Sciences, University of Jos, Jos, Nigeria

  • Faculty of Medical Sciences, University of Jos, Jos, Nigeria

  • Department of Chemical Pathology, Jos University Teaching Hospital, Jos, Nigeria

  • Department of Strategic Information (Data), Jos University Teaching Hospital, Jos, Nigeria

  • AIDS Prevention Initiative in Nigeria (APIN), Abuja, Nigeria

  • Faculty of Medical Sciences, University of Jos, Jos, Nigeria

  • Faculty of Medical Sciences, University of Jos, Jos, Nigeria

  • Center for Disease Control and Prevention (CDC), Abuja, Nigeria

  • AIDS Prevention Initiative in Nigeria (APIN), Abuja, Nigeria

  • Infectious Diseases & Immunology, Harvard School of Public Health, Boston, MA, USA

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