Abstract
Background
Perinatal transmission of human immunodeficiency virus (HIV) continues in Nigeria because of the poor use of prevention of mother-to-child transmission of HIV (PMTCT) services. This study reports on the barriers preventing mothers of vertically infected HIV-seropositive infants to use the PMTCT services at the Federal Medical Centre, Makurdi, Nigeria.
Methods
This is a descriptive study conducted between January and April, 2014. A quantitative survey was applied to detect barriers along the PMTCT services cascade among 52 mothers of vertically infected HIV-seropositive infants. This includes 22 women who attended antenatal care at the Federal Medical Centre (designated as Group A mothers) and 30 women who did not receive any form of PMTCT service (Group B mothers). The study was supplemented with a focused group discussion involving 12 discussants from the two groups.
Results
In the quantitative assessment: among the Group A mothers, falling asleep was the most common reason (n=22, 100%) for missing therapeutic/prophylactic antiretroviral medicine; financial constraint (n=22, 100%) was the most common reason for antenatal care visit defaults; and a lot of the mothers (n=11, 50.0%) did not give nevirapine to their newborns because they delivered at home. Among Group B mothers, unawareness of HIV-seropositive status was the most common reason (n=28, 93.3%) given for not accessing PMTCT services. In the qualitative study: noninvolvement of male partners, stigma and discrimination experienced by HIV-seropositive mothers, financial constraints in couples, involvement of traditional birth attendants in antenatal care and delivery of HIV-infected women, unawareness of HIV-seropositive status by pregnant women, poor health system, and the lack of funding for PMTCT services at private and rural health facilities were the major barriers preventing the use of PMTCT services.
Conclusion
In order to reduce the missed opportunities for PMTCT interventions in Makurdi and by extension the Benue State it represents in Nigeria, strong political and financial commitments are needed to overcome the identified barriers.
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Acknowledgments
This work was funded in part by the US Department of Health and Human Services, Health Resources and Services Administration (U51HA02522), and the Centers for Disease Control and Prevention through APIN (PS001058). We also acknowledge Dr J Abah, the Principal Investigator of the program and Drs E Oko, JA Onoja, and KB Ahmed who served as research assistants during the FGD. We also appreciate all the women who participated in this study.
Author contributions
From May 2006 until March 2014, EAA was the pediatric coordinator of the AIDS Prevention Initiative in Nigeria (APIN)/Harvard PEPFAR (The USA President’s Emergency Plan for AIDS Relief) program at the FMC, Makurdi. During this period, he was also a member of the Technical Committee of the program. He ensured that quality services are provided at the pediatric unit of the program. BRA was also the PMTCT coordinator during this period. Together, the duo supervised the robust linkages between the two units. All authors contributed toward data analysis, drafting and critically revising the paper and agree to be accountable for all aspects of the work.
Disclosure
The authors report no conflicts of interest in this work.