Coverage of HIV testing among pregnant women in Nigeria: progress, challenges and opportunities

Abstract

Objective This study assessed the progress, opportunities and challenges in scaling up of HIV testing for pregnant women in Nigeria. Methods Data were retrieved from the 2016–2017 fifth multiple cluster survey. Adjusted and unadjusted logistic regression models were used to examine demographic factors associated with HIV testing while controlling for geopolitical zones. Results At the population level, the coverage of HIV testing among pregnant women increased by 10% points from 32.8 to 42.7% between 2013 and 2017. Also, the coverage of antenatal HIV testing grew by 20 points, from 50.1 to 70.5% over the period. However, women were still more likely to be tested for HIV during pregnancy if they were older than 24 years [adjusted odds ratio (AOR) 1.33, 95% CI 1.04–1.69], had higher education [AOR 6.94, 95% CI 5.07–9.49], resided in urban areas [AOR 1.26, 95% CI 1.07, 1.50] and belong to richest wealth quintile [AOR 7.43, 95% CI 5.72–9.66]. Conclusion Our findings suggest that progress has been made in scaling up of antenatal coverage of HIV testing. However, the level of HIV testing during pregnancy remains low and far below the 95% national target. Appropriate interventions are needed in resource-poor communities where antenatal care utilization is very low.

Prenatal care coverage and correlates of HIV testing in sub-Saharan Africa: Insight from demographic and health surveys of 16 countries

“…As such, programme implementers must make an effort to reach the missing pregnant women in the HIV care cascade. Also consistent with previous research [2,34,36] women who had secondary or higher education, who owned health insurance and who resided in the wealthiest households were more likely to be tested for HIV during pregnancy compared to those who did not have formal education, did not have health insurance and lived in the poorest households. This finding was significant in most countries studied, indicating socioeconomic gaps in ANC coverage of HIV testing.…”

“…Our study is timely, considering the global need for evidence to support the achievement of the UNAIDS 95-95-95 targets [31]. Understanding the gaps in coverage of HIV testing during pregnancy is critical for designing programmes to address the gaps and ensure even progress in SSA [2,32]. Our analysis showed uneven progress in expanding access to HIV testing during pregnancy in SSA.…”

“…Success in eliminating MTCT is vastly uneven in SSA. While Southern and Eastern African countries such as Comoros, Malawi, Rwanda, South Africa, Burundi, and Uganda have seen a remarkable decline in MTCT transmission of HIV, many countries in West and Central Africa like Angola, Equatorial Guinea, the Gambia, Mali, and Niger have experienced an increase in transmission rate [2]. The intensification of the existing PMTCT program and scaling up of a nationwide program to accelerate MTCT elimination in Malawi, Zimbabwe, and South Africa have resulted in MTCT at 6-12weeks postpartum rate comparable to the 'global north' [3][4][5][6][7].…”

“…In South Africa and Botswana and like most SSA countries, the opt-out policy was implemented and pregnant women are educated about HIV. However, despite the acceptability and implementation of the opt out strategy [17], there is evidence a large proportion of women who received ANC are not tested for HIV in some SSA countries [2,18].…”

“…Even though HIV testing is generally available in all West African countries, the challenge remains to ensure women access prenatal care and also ensure all women who do are tested as part of prenatal care. In Nigeria, for example, about 30% of women who received prenatal care were not tested for HIV [2]. As such, significant gaps remain in terms of universal testing of women who present for antenatal care.…”