Optimizing Integrated PMTCT Services in Rural North-Central Nigeria

In resource-limited settings progress in scaling up services for prevention of mother-to-child transmission of HIV (PMTCT) continues to lag behind the rest of the world. Nigeria has one of the highest burdens of mother-to-child transmission of HIV in the world. The elimination of mother-to-child transmission of HIV in Nigeria will require innovative methods of PMTCT service delivery at the lowest level of the health care system, consistent with appropriate, feasible and effective care.

The study will implement and evaluate the impact of a family-focused integrated PMTCT package comprising task shifting, point-of-care CD4 testing, and a prominent role for influential family members (particularly male partners) in rural health centers in Niger state of Nigeria.

The study aims to:

  1. Evaluate whether implementation of the integrated PMTCT package in primary level antenatal clinics increases the proportion of eligible pregnant women who initiate antiretroviral medications for the purposes of PMTCT;
  2. Determine whether implementation of the PMTCT package improves postpartum retention of mother-infant pairs at 6 weeks; and
  3. Conduct a cost-effectiveness analysis of the impact of this novel PMTCT intervention compared to the existing standard-of-care referral model.

This innovative approach to scaling up PMTCT service provision, if proven feasible and effective, will be adopted in PEPFAR programs to accelerate progress toward eliminating mother-to-child transmission of HIV and helping women with HIV infection live long, healthy lives.

Muktar Aliyu, M.D., M.P.H., Dr.P.H., assistant professor of Preventive Medicine, will work as the principal investigator of the grant along with Carolyn Audet, Ph.D., research assistant professor of Preventive Medicine; Mary Lou Lindegren, M.D., M.P.H., associate professor of Medicine; VIGH director Sten Vermund, M.D., Ph.D.; C. William Wester, M.D., M.P.H., assistant professor of Medicine; Bryan Shepherd, Ph.D., associate professor of Biostatistics and Usman Gebi, M.B.B.S, FGH Chief of Party and adjunct assistant professor of Preventive Medicine.

Aliyu is program director for Friends in Global Health Nigeria (FGH), a wholly owned subsidiary of Vanderbilt Health Services, which will help coordinate the prevention services. FGH provides HIV/AIDS services in 32 rural health centers across North-Central Nigeria. Since October 2011, more than 22, 900 pregnant women received HIV services from FGH sites through support from the United States President’s Emergency Plan for AIDS Relief (PEPFAR).

NIH grant: 1R01HD075075