COMPARATIVE EVALUATION OF PMTCT (PREVENTION OF MOTHER TO CHILD TRANSMISSION OF HIV) SERVICES IN MISSION AND GOVERNMENT OWNED SECONDARY HEALTH FACILITIES IN IDEMILI NORTH IGA, ANAMBRA

CHAPTER ONE

INTRODUCTION

1.1 Background of the study

The Anambra community have acknowledged the weight of mother-to-child transmission of HIV and sought to support countries’ serious attempts to scale up PMTCT programmes. As one of the first clinical HIV interventions to be broadly used in resource-constrained settings, PMTCT programmes supported to design the atmosphere for the later roll-out of antiretroviral treatment and to exhilarate political reinforcement for the widening of the global response to the HIV spreading. In whatever manner, the global scale-up of PMTCT failed to meet expectations in the previous years of implementation and very uneven between countries, falling far short of the previous five-year targets set in the affirmation of Commitment on HIV/AIDS of the United Nations General Assembly Special Session on HIV/AIDS. This programme have therefore channeled there energy on interventions to prevent transmission from women living with HIV to their infants in antenatal care and delivery settings which comprises, HIV testing and counseling, antiretroviral prophylaxis, safer delivery practices and counseling and reinforcement  on infant feeding. This is in partperhaps because of the lack of sound policy and operational guidance on how primary prevention of HIV among women of childbearing age and prevention of unintended pregnancies should be implemented in the ambient of PMTCT and within the basic structure of the overall national HIV prevention programmes.

In conformity to the newly released joint World Health Organization (WHO), Joint United Nations Programme on HIV/AIDS (UNAIDS) and United Nations Children’s Fund (UNICEF) Universal Access report, 33.4 million people are calculated to be living with HIV in all parts of the world; meanwhile, 15.7 million of these are women and 2 million are children younger than 15 years of age (UNAIDS, WHO, UNICEF 2009). HIV is the preceding reason for a number of deaths among women of reproductive age all over the world and is a significant contributor to maternal, infant and child morbidity and mortality. Without treatment, one third and more of children living with HIV die even before they reach one year of age. Also, over 50% die by their second year of life. In the year 2008, an evaluated sum of 1.4 million pregnant women living with HIV in low- and middle-income countries gave birth. The fact that 25-40% of infants born to HIV-positive mothers will become infected cannot be declined. With present interventions, this high risk level can be minimized to less than 5%. Thus, transmission of HIV from a pregnant woman to her infant can be averted. Productive provision of Prevention of Mother-to-Child Transmission of HIV (PMTCT) interventions enhances maternal health and infant HIV-free survival. PMTCT is a major factor of overall HIV prevention and aversion efforts and stands for a vital opportunity for an adverse tide of the HIV epidemic.

In other to be triumphant in minimizing mother-to-child transmission of HIV specifically in Anambra, the population-level attempts to prevent and put a stop to HIV infection among women of childbearing age must be realized. For the single woman, an all-embracing, well organized continuum of services must be made availablestarting with maximized access to counseling, testing, and primary prevention services, and also reproductive health choices giving either the prevention of unintended pregnancies or appropriate planning for intended future pregnancies for women living with HIV legal power. For HIV-positive women who are pregnant, they should be given access to follow through a productive interventions programme to prevent and terminate transmission to the infant and also, they should be provided with treatment for the women themselves and their children,  if infected must also be provided with Prong 1 Prevention of HIV infection among women of childbearing age, Prong 2 Prevention of unintended pregnancies among women living with HIV, Prong 3 Prevention of transmission of HIV from mothers living with HIV to their infants, Prong 4 Treatment, care and assistance for mothers living with HIV and their children and also their families to increase maternal health and infant HIV-free survival. This progression of services is most timessaid to be the PMTCT cascade and comprises: Antenatal care attendance, HIV counseling and testing with same day return of results to the woman, determination of eligibility for HIV treatment through CD4 count assessment (or less optimally, through clinical staging with fast return of results to the woman and her provider, Provision of antiretroviral treatment for women who needtreatment for their health and antiretroviral prophylaxis to prevent mother-to-child transmission to women who do not yet need treatment., ongoing, clinical, psychological and social care, reinforcement and supervision for the mother, infant and family For maximum results.These services rendered should be embedded within high-quality general maternal, newborn, infant and child health services and assisted by national and local government attachment and financing, community sensitization and marshaling, male partner and other family involvement, fortifying of health systems to advancebroad care and therapy, correct data collection, watching and evaluation, trusted supply of essential equipment and supplies and well-trained, patient-friendly health care workers. This study seeks to evaluation the prevention of mother to child transmission of HIV services in mission and government owned secondary health facilities in idemili north Lga, Anambra state.

1.2. Statement of the general problem

The high rate of mother to child transmission of HIV in Africa and especially in Nigeria has been a cause for a major concern. This high transmission of HIV from mother to child has led to the rise in the virus which does not say well about our health sector especially in the eyes of her western counterparts.

1.3. Aims and objectives of the study

The main aim of the study is to evaluate PMTCT dservices in secondary health centers in Nigeria. Other specific objectives of the study include the following;

1. To examine the challenges to effective PMTCT services in Nigeria.
2. To examine the level of HIV infection in Nigeria.
3. To know if PMTCT services have helped in reducing mother to child transmission of HIV.
4. To examine the role of health sector in the reduction of mother to child transmission of HIV in Nigeria.

1.4. Research Questions

1. What are the challenges to effective PMTCT services in Nigeria?
2. What is the level of HIV infection in Nigeria?
3. Have  PMTCT services have helped in reducing mother to child transmission of HIV?
4. What is the role of health sector in the reduction of mother to child transmission of HIV in Nigeria?

1.5. Research Hypothesis

H0: There are no challenges to the prevention of mother to child transmission of HIV in Nigeria.

H1: There are challenges to the prevention of mother to child transmission of HIV in Nigeria.

1.6. Significance of the study

The study would be of immense importance to nursing mothers and stakeholders in the health sector as it would reveal the challenges to an effective prevention of mother to child transmission of HIV in Nigeria. The study would also benefit researchers, students and scholars who are interested in developing further research on the subject matter.

1.7. Scope and limitation of the study

The study is restricted to the evaluation of the prevention of mother to child transmission of HIV services in both government and mission owned hospitals.

Limitation of the study

Financial constraint: Insufficient fund tends to impede the efficiency of the researcher in sourcing for the relevant materials, literature or information and in the process of data collection (internet, questionnaire and interview)

Time constraint: The researcher will simultaneously engage in this study with other academic work. This consequently will cut down on the time devoted for the research work.

REFERENCE

1. UNAIDS/WHO AIDS epidemic update: December 2006. Geneva, UNAIDS, 2006 (http://www.unaids.org/en/ HIV_data/epi2006/default.asp, accessed 13 June 2007).

2. De Cock KM et al. Prevention of mother-to-child HIV transmission in resource-poor countries: translating research into policy and practice. Journal of the American Medical Association, 2000, 283:1175–1182.

3. Dorenbaum A et al. Two-dose intra-partum/newborn nevirapine and standard antiretroviral therapy to reduce perinatal HIV transmission: a randomized trial. Journal of the American Medical Association, 2002, 288:189–198.