| Peer-Reviewed

Implementation of Context Specific Diagnostics, Strategies and Resources for PMTCT Scale-up Programming in Conflict Affected Communities in Jos, Nigeria

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

The 2013 WHO HIV guidelines provided effective antiretroviral regimens to reduce perinatal transmission to below 2%. The option-B approach of providing antiretroviral drugs was adopted by Nigeria, which contributed 32% of global gaps in Preventing Mother to child transmission (PMTCT). In Plateau State, which had 7.7% HIV prevalence, incessant ethnoreligious conflict created challenges impacting on HIV service delivery and access to treatment centers. PMTCT diagnostics conducted by the lead HIV implementing Partner (IP), revealed that several communities in Jos, Plateau State, lacked HIV treatment centers, but were also unable to access existing centers because of conflict related partitioning of Jos, calling for specialized strategies and collaboration to scale-up to affected communities. To bridge existing challenges related to distrust amongst communities, the intervention strategy identified six community oriented resource persons (CORPs), of same ethnoreligious dispensation as people in affected communities, who also possessed HIV programing competencies, to lead the intervention. The project methodology included engagement of community gatekeepers and Plateau HIV stakeholders, who generated context specific strategies to enter these communities and scale-up HIV/PMTCT. The lead CORPs included a female public health/HIV physician, another clinician who owned a community hospital, a HIV laboratory personnel, a HIV trained Data officer, a religious cleric/youth leader and a female expert patient cum member of Federation of Muslim women association of Nigeria (FOMWAN). Collaborating with various stakeholders, they birthed a community faith based organization they called Muslim Health Initiative of Nigeria (MUHIN). This served as platform for community engagement to scale-up HIV/PMTCT services. The Lead HIV Partner supported, engaged and funded MUHIN to provide context specific scale-up to address existing gaps. MUHIN identified, assessed, upgraded and activated twenty-eight community clinics for HIV/PMTCT service deliver, building on existing Maternal, child and New-born health (MNCH) structures. They provided HIV trainings, MNCH materials, national data-capture tools and capacity building to the identified facilities, staff and CORPs. They stratified according to facility capacity, and linked them using the Hub-and-spoke model, to provide HIV testing, PMTCT and Antiretroviral therapy (ART) services. In order to bridge existing human resource for health gaps existing at the clinics, community health workers and HIV positive women who had successfully completed PMTCT programs were engaged and trained according to task shifting and task sharing (TSTS) guidelines, in preparation for HIV/PMTCT activation using HCT as entry. We conclude that detailed diagnostics, planning and utilization of context-specific strategies including TSTS are critical for successful project outcomes.

Published in International Journal of HIV/AIDS Prevention, Education and Behavioural Science (Volume 7, Issue 1)
DOI 10.11648/j.ijhpebs.20210701.13
Page(s) 15-26
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), 2024. Published by Science Publishing Group

Keywords

Prevention of Mother to Child Transmission, Human Immunodeficiency Virus, Plateau State, Community Oriented Resource Persons, Ethnoreligious, Conflict and Scale-up

References
[1] Avert. HIV and AIDS in Nigeria. Global Information and Education on HIV and AIDS. https://www.avert.org/professionals/hiv-around-world/sub-saharan-africa/nigeria.
[2] National Agency for the Control of AIDS (NACA). Key HIV Statistics in Nigeria. Fact Sheet: HIV Prevention Program. https://naca.gov.ng/fact-sheet-hiv-prevention-program/.
[3] UNAIDS 2016. Prevention Gap Report. https://www.unaids.org/sites/default/files/media_asset/2016-prevention-gap-report_en.pdf.
[4] World Economic Forum (2017). The Global Gender Gap Report 2017. http://www3.weforum.org/docs/WEF_GGGR_2017.pdf.
[5] PEPFAR (2016) ‘Nigeria Gender Assessment’ [pdf].
[6] Makama, G. A. (2013) Patriarchy and gender inequality in Nigeria: the way forward. European Scientific Journal June 2013 edition vol. 9, No. 17. Available at https://doi.org/10.19044/esj.2013.v9n17p%25p.
[7] UNAIDS (2018) ‘Start free, Stay free, AIDS free: 2017 progress report’ [pdf].
[8] National Bureau of Statistics (NBS) and United Nations Children’s Fund (UNICEF) (2017) Multiple Indicator Cluster Survey 2016-17, Survey Findings Report [pdf].
[9] National Agency for the Control of AIDS (NACA) 2012. Federal Republic of Nigeria Global AIDS Response. Country Progress Report, Nigeria, GARPR 2012. Abuja; 2012. Available at http://www.unaids.org/en/dataanalysis/knowyourresponse/countryprogressreports/2012countries/ Nigeria 2012 GARPR Report Revised.pdf UNAIDS 2012. Accessed 14/03/2021.
[10] United Nations. The millennium development goals progress report. http://www.un.org/millennium/pdf/MDG Report 2012.pdf. Accessed 15/03/2021.
[11] NACA (2017) ‘National Strategic Framework on HIV and AIDS: 2017 -2021’ [pdf].
[12] Jos, Nigeria Metro Area Population 1950-2021. Available at https://www.macrotrends.net>cities Assessed 19/03/2021.
[13] Nyam, A. D., Ayuba, L. T. (2016). The Growth of Urban Slums and Conflicts in Nigeria: A Case Study of Jos and Environs 1980-2010. International Journal of Social Science and Humanity 6 (5): 364-369. May 2016. DOI: 10.7763/IJSSH.2016.V6.673.Available at https://www.researchgate.net/publication/279232886_The_Growth_of_Urban_Slums_and_Conflicts_in_Nigeria_A_Case_Study_of_Jos_and_Environs_1980-2010/references Assessed 23/01/2021.
[14] Nyam, A. D. and Ajiji D. Y. (2016). The growth of Urban Slums and Conflicts in Nigeria: A Case Study of Jos and Environs 1980-2010. International Journal of Social Science and Humanity 6 (5): 364-369. DOI: 10.7763/IJSSH.2016.V6.673. Available at https://www.researchgate.net/publication/279232886_The_Growth_of_Urban_Slums_and_Conflicts_in_Nigeria_A_Case_Study_of_Jos_and_Environs_1980-2010/citations accessed 23/03/2021.
[15] Nyam, A. D. (2011). Colonialism and Intergroup Relations in the Central Nigeria Highlands: The Afizere Story, Aboki Publishers, Abuja, p. 205, 2011.
[16] UNAIDS (2010). HIV and conflict: Connections and the need for universal access. A Forced Migration Review special supplement https://www.unaids.org/en/resources/presscentre/featurestories/2010/october/20101027fssecurityandconflict.
[17] Federal Ministry of Health (FMOH) National STI/AIDS Control Program, Abuja (2014). Integrated National Guidelines for HIV treatment and Care Technical report on National HIV prevention, treatment and care.
[18] Krause, J. (2010). A Deadly Cycle: Ethno-Religious Conflict in Jos, Plateau State, Nigeria. Geneva Declaration. A working Paper. https://reliefweb.int/report/nigeria/deadly-cycle-ethno-religious-conflict-jos-plateau-state-nigeria Assessed 19/01/2021.
[19] Best, S. G. (2007) Conflict and Peace Building in Plateau State, Nigeria, Ibadan: Spectrum Books Ltd.
[20] International Crises Group. (2012). Curbing Violence in Nigeria (I): The Jos Crisis Report 196 / Africa 17 December 2012. Available at https://www.crisisgroup.org/africa/west-africa/nigeria/curbing-violence-nigeria-i-jos-crisis Assessed 19/01/2021.
[21] Ogbuleke, L. E. (2019). Democracy and Ethno-Religious Conflicts in Jos, Plateau State, Nigeria (2007-2012). Irish Interdisciplinary Journal of Science & Research (IIJSR) (Quarterly International Journal) Volume 3, Issue 2, Pages 29-44, April-June 2019, Available at SSRN: https://ssrn.com/abstract=3418857.
[22] Suleiman, T. (2011) “Saving the Killing Field Stakeholders Agitate Over the Reluctance of the Authorities to Implement the Recommendations of Different Panels On How to Restore Peace to Jos”. Tell, March 21, Pp. 50-54. Thisday (2010) “Again Plateau Burns, 22nd, January.
[23] Human Rights Watch (HWR) (2005). Revenge in the Name of Religion: The Cycle of Violence in Plateau and Kano States. Vol. 17, No. 8 (A). May. New York: HRW. https://www.hrw.org/reports/2005/nigeria0505/ Assessed 19/01/2021.
[24] The New Humanitarian (2005). ‘Nigeria: Plateau State IDPs Face Daunting Obstacles to Return to “Home of Peace and Tourism.”’ Available at https://www.thenewhumanitarian.org/report/53098/nigeria-plateau-state-idps-face-daunting-obstacles-return-home-peace-and-tourism Assessed 19/01/2021.
[25] The New Humanitarian (2010). ‘Our Lives Will Never Be the Same Again.’ Available at https://www.thenewhumanitarian.org/news/2010/01/22/our-lives-will-never-be-same-again Assessed 19/01/2021.
[26] National Population Commission (2019). Nigeria Demographic and Health Survey. The DHS Program ICF, Rockville, Maryland, USA.
[27] Oyebode, T. A. (2020). Knowledge product tool Kit for managing and improving access to Sexual and Reproductive Health and Rights Services in Fragile and Humanitarian settings during COVID-19 pandemic and future epidemics. Share-Net International on LinkedIn: FINAL EDITED SRHR TOOLKIT. pdf Available At https://share-netinternational.org/category/resources/access-to-quality-srhr-services-for-people-affected-by-conflict-fragility-and-crisis/.
[28] Jamestown Foundation, Northern Cameroon Under Threat from Boko Haram and Séléka Militants, 9 January 2014, Terrorism Monitor Volume: 12 Issue: 1, available at: https://www.refworld.org/docid/52e0e6d84.html accessed 27 July 2020.
[29] Padian NS, McCoy SI, Karim SS, Hasen N, Kim J, Bartos M, Katabira E, Bertozzi SM, Schwartländer B, Cohen MS. HIV prevention transformed: the new prevention research agenda. Lancet. 2011 Jul 16; 378 (9787): 269-78.
[30] Busza, J., Walker, D., Hairston, A., Gable, A., Pitter, C., Lee, S., Katirayi, L., Simiyu, R., & Mpofu, D. (2012). Community-based approaches for prevention of mother to child transmission in resource-poor settings: a social ecological review. Journal of the International AIDS Society, 15 Suppl 2 (Suppl 2), 17373. https://doi.org/10.7448/IAS.15.4.17373 Assessed 19/01/2021.
[31] International Planned Parenthood Federation. IPPF Comprehensive HIV Services Package. Available at https://www.ippf.org/sites/default/files/202007/IPPF%20%20Comprehensive%20HIV%20Services%20Package.pdf Assessed 12/01/2021.
[32] Coutsoudis A, Kwaan L, Thomson M. Prevention of vertical transmission of HIV-1 in resource-limited settings. Expert Rev Anti Infect Ther. 2010; 8 (10): 1163–75.
[33] Msellati P. Improving mothers’ access to PMTCT programs in West Africa: a public health perspective. Soc Sci Med. 2009; 69 (6): 807–12.
[34] Coordination in hierarchical pickup and delivery problems using delegate multi-agent systems. Available at https://www.researchgate.net/publication/228902224_Coordination_in_hierarchical_pickup_and_delivery_problems_using_delegate_multi-agent_systems/figures?lo=1 assessed on 01/04/2021.
[35] 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.
[36] World Health Organization (WHO). Consensus statement. Delivering antiretroviral drugs in emergencies: neglected but feasible. 2006.
[37] UNAIDS, GAP Report, 2014.
[38] Abimbola, S., Okoli, U., Olubajo, O., Abdullahi, M. J., Pate, M. A. (2012) The Midwives Service Scheme in Nigeria. PLoS Med 9 (5): e1001211. Available at https://doi.org/10.1371/journal.pmed.1001211 Assessed 01/03/2021.
[39] Overseas Development Institute (2010) Millennium Development Goals (MDG) report card: measuring progress across countries. Overseas Development Institute2010 Millennium Development Goals (MDG) report card: measuring progress across countries. Available: http://www.odi.org.uk/resources/download/5027.pdf. (Assessed 03/03/2021).
[40] Acosta, M. (2016) ‘India’s Janani Suraksha Yojana: Global Health Transformations of a National Program and Dissipating the Right to Health’. Unpublished. Available at: https://www.academia.edu/29182185/Indias_Janani_Suraksha_Yojana_Global_Healths_Transformations_of_a_National_Program_and_Dissipating_the_Right_to_Health (Accessed: 15 March 2021).
[41] Health Partners international (2015) Health systems that work for women and girls- Project Report. Available at http://resources.healthpartners-int.co.uk/wp-content/uploads/2016/09/Health-systems-that-work-for-women-girls_Web-May2016.pdf Assessed 29/03/2021.
[42] World Health Organization (2015a) Trends in maternal mortality: 1990 to 2015: estimates by WHO, UNICEF, UNFPA, World Bank Group and the United Nations Population Division. Tools for improving data collection.
[43] Federal Ministry of Health Nigeria (2016). National Health Policy. Promoting the Health of Nigerians to Accelerate Socio-economic Development.
[44] Avert. Global Information and Education on HIV and AIDS 2015. HIV positive mothers thrive on peer support. Available at https://www.avert.org/news/hiv-positive-mothers-thrive-peer-support assessed 29/03/2021.
[45] 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, Musa Tanko Umar, Francis Magaji, et al. (2021). Implementation of Context Specific Diagnostics, Strategies and Resources for PMTCT Scale-up Programming in Conflict Affected Communities in Jos, Nigeria. International Journal of HIV/AIDS Prevention, Education and Behavioural Science, 7(1), 15-26. https://doi.org/10.11648/j.ijhpebs.20210701.13

    Copy | Download

    ACS Style

    Tinuade Abimbola Oyebode; Zuwaira Hassan; Tolulope Afolaranmi; Musa Tanko Umar; Francis Magaji, et al. Implementation of Context Specific Diagnostics, Strategies and Resources for PMTCT Scale-up Programming in Conflict Affected Communities in Jos, Nigeria. Int. J. HIV/AIDS Prev. Educ. Behav. Sci. 2021, 7(1), 15-26. doi: 10.11648/j.ijhpebs.20210701.13

    Copy | Download

    AMA Style

    Tinuade Abimbola Oyebode, Zuwaira Hassan, Tolulope Afolaranmi, Musa Tanko Umar, Francis Magaji, et al. Implementation of Context Specific Diagnostics, Strategies and Resources for PMTCT Scale-up Programming in Conflict Affected Communities in Jos, Nigeria. Int J HIV/AIDS Prev Educ Behav Sci. 2021;7(1):15-26. doi: 10.11648/j.ijhpebs.20210701.13

    Copy | Download

  • @article{10.11648/j.ijhpebs.20210701.13,
      author = {Tinuade Abimbola Oyebode and Zuwaira Hassan and Tolulope Afolaranmi and Musa Tanko Umar and Francis Magaji and Maria Pawa and Patrick Akande and Solomon Sagay and Jerry Gwamna and Prosper Okonkwo and Phyllis Kanki},
      title = {Implementation of Context Specific Diagnostics, Strategies and Resources for PMTCT Scale-up Programming in Conflict Affected Communities in Jos, Nigeria},
      journal = {International Journal of HIV/AIDS Prevention, Education and Behavioural Science},
      volume = {7},
      number = {1},
      pages = {15-26},
      doi = {10.11648/j.ijhpebs.20210701.13},
      url = {https://doi.org/10.11648/j.ijhpebs.20210701.13},
      eprint = {https://article.sciencepublishinggroup.com/pdf/10.11648.j.ijhpebs.20210701.13},
      abstract = {The 2013 WHO HIV guidelines provided effective antiretroviral regimens to reduce perinatal transmission to below 2%. The option-B approach of providing antiretroviral drugs was adopted by Nigeria, which contributed 32% of global gaps in Preventing Mother to child transmission (PMTCT). In Plateau State, which had 7.7% HIV prevalence, incessant ethnoreligious conflict created challenges impacting on HIV service delivery and access to treatment centers. PMTCT diagnostics conducted by the lead HIV implementing Partner (IP), revealed that several communities in Jos, Plateau State, lacked HIV treatment centers, but were also unable to access existing centers because of conflict related partitioning of Jos, calling for specialized strategies and collaboration to scale-up to affected communities. To bridge existing challenges related to distrust amongst communities, the intervention strategy identified six community oriented resource persons (CORPs), of same ethnoreligious dispensation as people in affected communities, who also possessed HIV programing competencies, to lead the intervention. The project methodology included engagement of community gatekeepers and Plateau HIV stakeholders, who generated context specific strategies to enter these communities and scale-up HIV/PMTCT. The lead CORPs included a female public health/HIV physician, another clinician who owned a community hospital, a HIV laboratory personnel, a HIV trained Data officer, a religious cleric/youth leader and a female expert patient cum member of Federation of Muslim women association of Nigeria (FOMWAN). Collaborating with various stakeholders, they birthed a community faith based organization they called Muslim Health Initiative of Nigeria (MUHIN). This served as platform for community engagement to scale-up HIV/PMTCT services. The Lead HIV Partner supported, engaged and funded MUHIN to provide context specific scale-up to address existing gaps. MUHIN identified, assessed, upgraded and activated twenty-eight community clinics for HIV/PMTCT service deliver, building on existing Maternal, child and New-born health (MNCH) structures. They provided HIV trainings, MNCH materials, national data-capture tools and capacity building to the identified facilities, staff and CORPs. They stratified according to facility capacity, and linked them using the Hub-and-spoke model, to provide HIV testing, PMTCT and Antiretroviral therapy (ART) services. In order to bridge existing human resource for health gaps existing at the clinics, community health workers and HIV positive women who had successfully completed PMTCT programs were engaged and trained according to task shifting and task sharing (TSTS) guidelines, in preparation for HIV/PMTCT activation using HCT as entry. We conclude that detailed diagnostics, planning and utilization of context-specific strategies including TSTS are critical for successful project outcomes.},
     year = {2021}
    }
    

    Copy | Download

  • TY  - JOUR
    T1  - Implementation of Context Specific Diagnostics, Strategies and Resources for PMTCT Scale-up Programming in Conflict Affected Communities in Jos, Nigeria
    AU  - Tinuade Abimbola Oyebode
    AU  - Zuwaira Hassan
    AU  - Tolulope Afolaranmi
    AU  - Musa Tanko Umar
    AU  - Francis Magaji
    AU  - Maria Pawa
    AU  - Patrick Akande
    AU  - Solomon Sagay
    AU  - Jerry Gwamna
    AU  - Prosper Okonkwo
    AU  - Phyllis Kanki
    Y1  - 2021/05/26
    PY  - 2021
    N1  - https://doi.org/10.11648/j.ijhpebs.20210701.13
    DO  - 10.11648/j.ijhpebs.20210701.13
    T2  - International Journal of HIV/AIDS Prevention, Education and Behavioural Science
    JF  - International Journal of HIV/AIDS Prevention, Education and Behavioural Science
    JO  - International Journal of HIV/AIDS Prevention, Education and Behavioural Science
    SP  - 15
    EP  - 26
    PB  - Science Publishing Group
    SN  - 2575-5765
    UR  - https://doi.org/10.11648/j.ijhpebs.20210701.13
    AB  - The 2013 WHO HIV guidelines provided effective antiretroviral regimens to reduce perinatal transmission to below 2%. The option-B approach of providing antiretroviral drugs was adopted by Nigeria, which contributed 32% of global gaps in Preventing Mother to child transmission (PMTCT). In Plateau State, which had 7.7% HIV prevalence, incessant ethnoreligious conflict created challenges impacting on HIV service delivery and access to treatment centers. PMTCT diagnostics conducted by the lead HIV implementing Partner (IP), revealed that several communities in Jos, Plateau State, lacked HIV treatment centers, but were also unable to access existing centers because of conflict related partitioning of Jos, calling for specialized strategies and collaboration to scale-up to affected communities. To bridge existing challenges related to distrust amongst communities, the intervention strategy identified six community oriented resource persons (CORPs), of same ethnoreligious dispensation as people in affected communities, who also possessed HIV programing competencies, to lead the intervention. The project methodology included engagement of community gatekeepers and Plateau HIV stakeholders, who generated context specific strategies to enter these communities and scale-up HIV/PMTCT. The lead CORPs included a female public health/HIV physician, another clinician who owned a community hospital, a HIV laboratory personnel, a HIV trained Data officer, a religious cleric/youth leader and a female expert patient cum member of Federation of Muslim women association of Nigeria (FOMWAN). Collaborating with various stakeholders, they birthed a community faith based organization they called Muslim Health Initiative of Nigeria (MUHIN). This served as platform for community engagement to scale-up HIV/PMTCT services. The Lead HIV Partner supported, engaged and funded MUHIN to provide context specific scale-up to address existing gaps. MUHIN identified, assessed, upgraded and activated twenty-eight community clinics for HIV/PMTCT service deliver, building on existing Maternal, child and New-born health (MNCH) structures. They provided HIV trainings, MNCH materials, national data-capture tools and capacity building to the identified facilities, staff and CORPs. They stratified according to facility capacity, and linked them using the Hub-and-spoke model, to provide HIV testing, PMTCT and Antiretroviral therapy (ART) services. In order to bridge existing human resource for health gaps existing at the clinics, community health workers and HIV positive women who had successfully completed PMTCT programs were engaged and trained according to task shifting and task sharing (TSTS) guidelines, in preparation for HIV/PMTCT activation using HCT as entry. We conclude that detailed diagnostics, planning and utilization of context-specific strategies including TSTS are critical for successful project outcomes.
    VL  - 7
    IS  - 1
    ER  - 

    Copy | Download

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

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

  • Plateau AIDS Control Agency (PLACA), Jos, Nigeria

  • State AIDS/STI Control Program (SASCP), Plateau State Ministry of Health, Jos, Nigeria

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

  • Sections