Correlates of facility delivery for rural HIV-positive pregnant women enrolled in the MoMent Nigeria prospective cohort study

Sam-Agudu, Nadia A.; Isah, Christopher; Fan-Osuala, Chinenye; Erekaha, Salome; Ramadhani, Habib O.; Anaba, Udochisom; Adeyemi, Olusegun A.; Manji-Obadiah, Grace; Lee, Daniel; Cornelius, Llewellyn J.; Charurat, Manhattan

doi:10.1186/s12884-017-1417-2

Cited by 16 publications

(21 citation statements)

References 29 publications

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“…The available data is mixed on this issue: while Sarko et al [13] reported that male partner disclosure was positively associated with facility-based delivery (important for PMTCT) among WLHIV in North-Central Nigeria, they did not find any significant associations between disclosure and education. Our study team's findings from a different cohort of women in the same setting showed that disclosure status did not correlate with facility delivery [29]. In Uganda, Ngonzi et al reported that primary education was associated with a 3.5-fold increase in the odds of disclosure compared to those with post-primary education among pregnant WLHIV [30].…”

Section: Discussionmentioning

confidence: 61%

A mixed-methods assessment of disclosure of HIV status among expert mothers living with HIV in rural Nigeria

Odiachi¹,

Sam-Agudu

Erekaha

et al. 2020

PLoS ONE

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Background Peer support provided by experienced and/or trained "expert" women living with HIV has been adopted by prevention of mother-to-child transmission of HIV (PMTCT) programs across sub-Saharan Africa. While there is ample data on HIV status disclosure among nonexpert women, there is little data on disclosure among such expert women, who support other women living with HIV. Objective This study compared HIV disclosure rates between expert and non-expert mothers living with HIV, and contextualized quantitative findings with qualitative data from expert women. Methods We compared survey data on HIV disclosure to male partners and family/friends from 37 expert and 100 non-expert mothers living with HIV in rural North-Central Nigeria. Four focus group discussions with expert mothers provided further context on disclosure to male partners, extended family and peers. Chi square and Fisher's exact tests were applied to quantitative data. Qualitative data were manually analyzed using a Grounded Theory approach. Results Two-thirds of the 137 participants were 21-30 years old; 89.8% were married, and 52.3% had secondary-level education. Disclosure to male partners was higher among expert (100.0%) versus non-expert mothers (85.0%), p = 0.035. Disclosure to anyone (93.1% vs 80.8%, p = 0.156), and knowledge of male partners' HIV status were similar (75.7% versus 66.7%, p = 0.324) between expert and non-expert mothers, respectively. With respect to male partners, HIV serodiscordance rates were also similar (46.4% vs 55.6%, p = 0.433).

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Section: Discussionmentioning

confidence: 61%

A mixed-methods assessment of disclosure of HIV status among expert mothers living with HIV in rural Nigeria

Odiachi¹,

Sam-Agudu

Erekaha

et al. 2020

PLoS ONE

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“…Additionally, the Baby Shower Trial enrolled 2498 male partners. Primary and key secondary outcome results from all four studies have been published, with largely positive findings regarding impact of the interventions tested [ 18 , 19 , 21 , 22 , 24 , 35 – 37 ].…”

Section: Resultsmentioning

confidence: 99%

Generating evidence for health policy in challenging settings: lessons learned from four prevention of mother-to-child transmission of HIV implementation research studies in Nigeria

Sam-Agudu

Aliyu

Adeyemi

et al. 2018

Health Res Policy Sys

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BackgroundImplementation research (IR) facilitates health systems strengthening and optimal patient outcomes by generating evidence for scale-up of efficacious strategies in context. Thus, difficulties in generating IR evidence, particularly in limited-resource settings with wide disease prevention and treatment gaps, need to be anticipated and addressed. Nigeria is a priority country for the prevention of mother-to-child transmission of HIV (PMTCT). This paper analyses the experiences of four PMTCT IR studies in Nigeria, and proffers solutions to major challenges encountered during implementation.Studies included and findingsMulticentre PMTCT IR studies conducted in Nigeria during the Global Plan’s assessment period (2011 to 2015) were included. Four studies were identified, namely The Baby Shower Trial, Optimizing PMTCT, MoMent and Lafiyan Jikin Mata. Major common challenges encountered were categorised as ‘External’ (beyond the control of study teams) and ‘Internal’ (amenable to rectification by study teams).External challenges included healthcare worker strikes and turnover, acts and threats of ethnic and political violence and terrorism, and multiplicity of required local ethical reviews. Internal challenges included limited research capacity among study staff, research staff turnover and travel restrictions hindering study site visits. Deliberate research capacity-building was provided to study staff through multiple opportunities before and during study implementation. Post-study employment opportunities and pathways for further research career-building are suggested as incentives for study staff retention. Engagement of study community-resident personnel minimised research staff turnover in violence-prone areas.ConclusionsThe IR environment in Nigeria is extremely diverse and challenging, yet, with local experience and anticipatory planning, innovative solutions can be implemented to modulate internal challenges. Issues still remain with healthcare worker strikes and often unpredictable insecurity. There is a dire need for cooperation between institutional review boards across Nigeria in order to minimise the multiplicity of reviews for multicentre studies. External challenges need to be addressed by high-level stakeholders, given Nigeria’s crucial regional and global position in the fight against the HIV epidemic.

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“…Women in both study arms had access to antenatal HIV testing, continued/prompt initiation of ART, Option B PMTCT regimens, infant feeding counseling, EID, and infant referral for ART if diagnosed HIV-positive (19,20). Detailed descriptions of participant recruitment have been previously published (19)(20)(21)(22).…”

Section: Participant Recruitmentmentioning

confidence: 99%

Causes and Predictors of Mortality among HIV-Exposed Infants in Rural North-Central Nigeria: Results of a Simple Verbal Autopsy Survey

Ozigbu

Erekaha

Chinaeke

et al. 2020

Preprint

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Background HIV-exposed infants (HEI) who die before diagnosis or treatment initiation, or who die in spite of being HIV-free constitute missed opportunities for reducing infant mortality. Verbal autopsy (VA) has been successfully applied in the collection of data to determine symptoms and circumstances surrounding death among infants, children and adults among populations that lack vital registration systems. There is little available data on rates and causes of death among HIV-exposed infants (HEI) in Nigeria. We used VA to characterize attributable causes and predictors of mortality among HEI in rural North-Central Nigeria.Methods Pregnant women living with HIV and HEI were enrolled at rural primary healthcare facilities and followed-up for 12 months, post-delivery. A simple 21-item VA instrument was used to collect infant mortality information from mothers, other family members, mentor mothers, and/or healthcare workers. Attributable causes of death were determined by physician coding. Multivariate logistic regression was performed to determine independent predictors of mortality.Results Data from 455 HIV-exposed infected and uninfected fetus/infant-mother pairs were analyzed. All mothers received anti-retroviral therapy. Seventy-five (16.5%) fetuses/infants died during gestation and within 12 months post-delivery. Forty (53.3%) deaths occurred in utero . The 12-month infant mortality risk among HEI in our study was 88.7/1,000. Among the 35 live-born infants, birth asphyxia (6/17, 35.3%) and sepsis (7/18, 38.9%) were the most common causes of death in the neonatal and post-neonatal periods, respectively. Unadjusted estimates showed that a greater proportion of deceased infants had mothers who did not deliver at a health facility (53.3 vs 31.8%, p=0.003), and who were newly HIV-diagnosed during pregnancy (69.3 vs 50.8%, p=0.029). Infants receiving nevirapine prophylaxis within 72 hours were less likely to have died (aOR = 0.40, 95% CI: 0.2-0.9).Conclusions Early HIV diagnosis and treatment among women of child-bearing age, maternal access to facility delivery and timely infant antiretroviral prophylaxis should be programmatically strengthened to reduce HEI mortality. Additionally, robust monitoring and evaluation systems are needed to track and record deaths among HEI.

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Correlates of facility delivery for rural HIV-positive pregnant women enrolled in the MoMent Nigeria prospective cohort study

Cited by 16 publications

References 29 publications

A mixed-methods assessment of disclosure of HIV status among expert mothers living with HIV in rural Nigeria

A mixed-methods assessment of disclosure of HIV status among expert mothers living with HIV in rural Nigeria

Generating evidence for health policy in challenging settings: lessons learned from four prevention of mother-to-child transmission of HIV implementation research studies in Nigeria

Causes and Predictors of Mortality among HIV-Exposed Infants in Rural North-Central Nigeria: Results of a Simple Verbal Autopsy Survey

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