Closing the prevention of mother-to-child transmission gap in Nigeria: an evaluation of service improvement intervention in Nigeria

Objectives: The objective was to assess improvement, or lack thereof, in the uptake of prevention of mother-to-child transmission (MTCT) services at selected sites supported sites by the Global HIV/AIDS Initiative Nigeria (GHAIN). Design: The study used aggregated monthly service statistics to evaluate service improvement efforts that were conducted before and after these were undertaken between July 2007-June 2008. Settings and subjects: The service improvement efforts took place in 60 public healthcare facilities. Outcome measures: The study measured changes in the number of pregnant women who attended antenatal clinics for the first time, the number of pregnant women tested for human immunodeficiency virus (HIV), the number of HIV-positive women receiving antiretroviral (ARV) prophylaxis, and the service ratio, an indicator of the relative uptake of ARV prophylaxis. An estimate of MTCT events that were averted through ARV prophylaxis taken by the pregnant women was also calculated. Results: One hundred and twenty thousand, five hundred and thirty-seven women attended an antenatal clinic (ANC) for the first time. There was an average of 167.4 monthly attendances per facility. ANC attendance increased per facility by 11.1 women monthly post-intervention (p-value < 0.01). The uptake of HIV testing was 87%, with a monthly average increase of 17.8 women tested per facility (p-value < 0.01). ARV prophylaxis uptake rose from 3.3-5.4 women per facility per month (p-value < 0.01). The service ratio per facility improved from 5.3 women receiving ARVs to 6.5 for every 10 women who tested positive for HIV (p-value < 0.01). Applying risk reduction estimates of different ARV regimens, it was estimated that between 88-169 MTCT events were averted pre-intervention, and 143-276 events, post-intervention. Conclusion: Service improvement intervention improved the utilisation of PMTCT services. It should be a key intervention that is used to close the PMTCT gap in Nigeria.Keywords: HIV, PMTCT, evaluation, Nigeria, service improvement, effectiveness