Integrating HIV Counselling and Testing into
Maternal, Newborn and Child Health (MNCH) weeks,
Benue, Nigeria
Olusoji Akinleye, HIV Specialist UNICEF Nigeria
Background
• Nigeria accounts for 9% of the global population of people living with
HIV.
• She harbors 10% of new HIV infections and 30% of children living with
HIV.
• One of the reasons for this is low coverage of PMTCT service.
• One of the key reasons cited for low PMTCT coverage is limited access
to ANC.
• This approach integrated HCT into services offered to pregnant women
during MNCH weeks and linkage provided into PMTCT for those
positive.
• It also examined the acceptability of HIV testing during MNCH weeks in
Benue State, a State with the highest seroprevalence.
Methodology
• HTC was provided as part of the services
offered to during the MNCH week.
• 13 LGAs contributing 70% of MTCT burden
selected for intervention in 2014.
• All 23 LGAs were covered in 2015.
• Preparatory activities included
• generating estimates of expected
attendance
• resource requirements and
• development of follow up plan
• Intensive community mobilisation
• HCT services offered in accordance with
national protocols, in designated MNCHW
facilities – also PMTCT sites.
• PMM data was analysed using STRATA v. IC
11
• Positive pregnant women were registered
into PMTCT immediately.
• Appointment defaulters were tracked and
supported to attend clinics.
Key findings
HTC Coverage among Pregnant Women in 13 LGAs of
Benue State (Dec. 2014)
HTC Coverage among Pregnant Women in 13 LGAs of
Benue State (Dec. 2015)
70%
120%
60%
100%
50%
80%
40%
60%
30%
Routine HTC Coverage
MNCHW HTC Coverage
Routine HTC Coverage
MNCHW HTC Coverage
• Uptake of HTC increased significantly as a result of the integration into
MNCHW compared with uptake during routine ANC in a whole year
Total
Vandeikya
Ushongo
Tarka
Ukum
Otukpo
Okpokwu
Oju
Ohimini
Ogbadibo
Obi
Makurdi
Logo
Kwande
Konshisha
Katsina Ala
Gwer West
Guma
Gwer East
Gboko
0%
Buruku
0%
Apa
20%
Ado
10%
Agatu
40%
20%
Key findings
Yield of New Positives (Benue, 2014)
Yield of New Positives (Benue, 2015)
383
577
486
1280
Known Positives
Known Positives
New Positives
New Positives
• HTC as a result of the integration yielded between 54 and 77% pregnant
women who had never known their status and may have missed PMTCT
entirely
Key findings
HTC Coverage among Pregnant Women in 6 States
(Dec. 2015)
Previous HTC Exposure
80%
70%
60%
50%
37%
40%
30%
63%
20%
10%
0%
Yes
No
Lagos
Benue
Coverage of Routine HCT
Kaduna
FCT
Coverage of MNCHW HCT
Adamawa Anambra
Coverage of Total HCT
• Only about a third of women served has had previous HTC exposure
• In areas where uptake of HTC during routine ANC is low, integration into
MNCHW led to appreciable increase in uptake
• Integration complimented routine service delivery to increase service
uptake
Lessons learned
• Integration of HTC for pregnant women feasible as a strategy
to increase access to PMTCT
• MNCHW gives the best results where routine ANC service
uptake is low
• Targeting at least 70% of the estimated population of pregnant
women with HTC during every round of MNCHW has potential
to rapidly increase coverage
• 74 – 82% of positives successfully linked to PMTCT
Plans for country scale-up
• Integration now part of the national strategy for eMTCT
• Advocacy to States to replicate process
• National implementation guidance document disseminated
• Technical assistance to implementing States
• Sourcing and coordination of commodities
• Monitoring and quality assurance
• Coordination of reports
• Targeted testing for higher yield in focus
THANK YOU