Identifying and Prioritizing Implementation Barriers, Gaps, and Strategies Through the Nigeria Implementation Science Alliance: Getting to Zero in the Prevention of Mother-to-Child Transmission of HIV

Abstract

Background:In 2013, Nigeria accounted for 15% of the 1.3 million pregnant women living with HIV in sub-Saharan Africa and 26% of new infections among children worldwide. Despite this, less than 20% of pregnant women in Nigeria received an HIV test during pregnancy, and only 23% of HIV-infected pregnant women received appropriate intervention following HIV diagnosis. This article reports findings from 2 structured group exercises conducted at the first Nigeria Implementation Science Alliance Conference to identify (1) barriers and research gaps related to prevention of mother-to-child transmission (PMTCT) and (2) potential strategies and interventions that could address PMTCT challenges.Methods:Two 1-hour structured group exercises were conducted with 10 groups of 14–15 individuals (n = 145), who were asked to brainstorm barriers and strategies and to rank their top 3 in each category. Data analysis eliminated duplicate responses and categorized each of the priorities along the HIV care continuum: HIV diagnosis, linkage to care, or retention in care.Results:Participating stakeholders identified 20 unique barriers and research gaps related to PMTCT across the HIV continuum. Twenty-five unique interventions and implementation strategies were identified. Similar to the barriers and research gaps, these interventions and strategies were distributed across the HIV care continuum.Conclusions:The barriers and strategies identified in this study represent important pathways to progress addressing MTCT. The deliberate involvement of state and federal policy makers, program implementers, and researchers helps ensure that they are relevant and actionable.

Mapping evidence of interventions and strategies to bridge the gap in the implementation of the prevention of mother-to-child transmission of HIV programme policy in sub-Saharan countries: A scoping review

“…The common strategies reported included shared platform for learning and decision-making among stakeholders, 22 health service improvement of processes 2 , 23 , 24 and data-driven quality-improvement approach which was mainly reported in South Africa. 25 , 26 , 27 , 28 This approach included health workers forming information teams to discuss issues relating to performance, forming learning networks which also promote shared learning, and discussing changes and planning for implementation.…”

Adolescent Coordinated Transition (ACT) to improve health outcomes among young people living with HIV in Nigeria: study protocol for a randomized controlled trial

“…Key information that shaped the design of this study came from multiple formative consultations across the Nigeria Implementation Science Alliance (NISA), a collaboration of the 20 largest HIV implementing partners in Nigeria supported by the President’s Emergency Plan for AIDS Relief (PEPFAR) [ 26 ]. NISA-wide consultations held with experienced Nigerian healthcare providers highlighted lack of a transition process for adolescents with common chronic illnesses in Nigeria.…”

Opportunities and challenges to Integrating mental health into HIV programs in a Low- and Middle-Income Country: Insights from the Nigeria Implementation Science Alliance

“…NGT is a structured approach for group "brainstorming", and it is useful for gathering sets of ideas, information, or recommendations and their relative importance from relevant stakeholders (29,30). The duration of the NGT process was 90 minutes and it was facilitated by ve resource persons experienced in NGT (26,28) Before commencing the process, the lead facilitator introduced the topic to the participants and highlighted why it was an important public health issue. He stated the purpose of the research and also explained the modi ed NGT process that was adopted.…”

“…The Nigeria Implementation Science Alliance (NISA) was established in 2015 as a robust partnership of 20 organizations that includes academic and non-governmental organizations, clinical service providers, and policy makers involved in HIV care in Nigeria (26). NISA is aimed at facilitating collaboration among partners, bridging research-to-practice gaps through application of implementation science approaches and implementation research in Nigeria and other countries in Sub-Saharan Africa, and identifying feasible and culturally appropriate strategies for improving public health through research (26,27). Yearly, NISA conferences have focused on "Prevention of mother to child HIV transmission(PMTCT)" (2015), "HIV/AIDS and related infections, adolescents health, STI & Hepatitis B" (2016), "Improving Health through Implementation Science & Research" (2017) and "Evidence-based approaches to enhance quality of care" (2018) (26)(27)(28).…”