Dr Godwin Emmanuel

Godwin Emmanuel

World AIDS Day has come and gone, yet we must not fail to examine some of the gaps that must be urgently bridged as a nation.

Each year, thousands of children are born with HIV, largely due to inadequate access to testing and treatment during pregnancy. The Joint United Nations Programme on HIV/AIDS (UNAIDS) estimates that Nigeria contributes about 22% of global paediatric HIV cases which indicates the urgent need for innovative approaches to curb MTCT.

Eliminating mother-to-child transmission of HIV in Nigeria is an achievable goal, but it requires innovative approaches that can address the unique barriers faced by women in underserved communities.

This brings me to a recent study in Lagos and Kano which demonstrated how HIV self-testing kits offer a practical, effective, and scalable solution to our MTCT challenges.

The study interrogates an initiative seeking to integrate HIV Self-Test (HIVST) kits into TBA services as part of a broader strategy to eliminate MTCT. The intervention targeted underserved communities where healthcare access is limited, leveraging the trust and accessibility of TBAs to distribute self-testing kits and provide essential counselling. This study, led by Dr Toriola Adebayo of Lagos State University Teaching Hospital and Dr Usman Bashir of Aminu Kano Teaching Hospital, articulates the role of local expertise in advancing healthcare solutions tailored to community needs. In this intervention, 182 TBA clinics across three local government areas (LGAs) in Lagos and Kano States were equipped with HIVST kits. TBAs received extensive training on the administration of the tests, pre-and post-test counselling and linkage to care for those who tested positive.

Among the 1,982 pregnant women enrolled in the study, pre-intervention testing rates were markedly low, with just 60% in Lagos and 38% in Kano having ever been tested for HIV. After the introduction of HIVST, testing uptake surged, with all participants voluntarily using the kits during antenatal visits.

The results were promising:

• HIV Positivity Rate: An overall positivity rate of 0.8% was recorded, with slightly higher rates in Lagos (1.1%) compared to Kano (0.8%).
• First-Time Testers: Remarkably, 80% of those who tested positive were undergoing HIV testing for the first time.
• Linkage to Care: All HIV-positive individuals were successfully linked to ART services, demonstrating the effectiveness of the TBA-led model in bridging gaps in healthcare access.

The success of this initiative exemplifies how HIVST can become a cornerstone of affirmative action against paediatric HIV infections, which was also a critical focus of World AIDS Day observances.

As evidenced by the success of the Lagos and Kano initiatives, when confidentiality, stigma reduction, and leveraging trusted community figures like TBAs are prioritised, HIVST has the potential to transform PMTCT efforts across Nigeria. This is even more so with sustained investment, community buy-in, and political will. This can move us closer to a future where no child is born with HIV and every mother has the opportunity to live a healthy, fulfilling life.

HIV Self-Testing

HIV self-testing kits offer a simple, private, and effective means of determining one’s HIV status. These kits allow individuals to test themselves using a saliva sample or a small drop of blood, with results available in minutes. The convenience and confidentiality of this method are particularly appealing to those who might avoid traditional testing due to stigma or fear of disclosure.

Advantages of HIV Self-Testing for Pregnant Women

1. Confidentiality and Privacy: For many women, the fear of being judged or ostracised often prevents them from seeking HIV testing. HIVST kits allow individuals to test in the comfort of their homes or a private setting, without fear of disclosure. This is particularly crucial for pregnant women, who may face compounded stigma if diagnosed with HIV.
2. Increased Testing Uptake: The intervention in Lagos and Kano demonstrates that when provided with confidential and convenient testing options, more women are willing to know their HIV status. Early diagnosis is key to initiating ART, which can reduce the risk of MTCT to less than 1%.
3. Empowerment Through Knowledge: Knowing one’s HIV status empowers women to take control of their health and make informed decisions about their pregnancies. For HIV-positive mothers, this includes accessing treatment to prevent transmission to their babies.
4. Stigma Reduction: By normalising HIV testing as a routine part of antenatal care, HIVST kits help to reduce the stigma associated with the disease. When more people test and share their experiences, it creates a ripple effect, encouraging others to do the same.

Challenges and Considerations

While the benefits of HIVST kits are clear, their implementation is not without challenges. For instance:

• Education and Awareness: Many women in rural areas are unfamiliar with self-testing and may require additional support to use the kits correctly.
• Linkage to Care: Ensuring that those who test positive are seamlessly connected to ART services is critical. This requires a robust referral system and follow-up mechanisms.
• Cultural Sensitivities: In some communities, discussing HIV remains taboo. Tailored communication strategies are needed to address these cultural barriers and build trust.

The Role of Traditional Birth Attendants

Traditional birth attendants (TBAs) hold a unique and trusted position in many Nigerian communities, especially in rural areas where access to formal healthcare is limited. Their deep cultural connections and established relationships with pregnant women make them ideal partners in promoting maternal and child health initiatives. By equipping TBAs with HIV self-testing (HIVST) kits and training them in counselling and care linkage, this initiative has shown how they can play a pivotal role in preventing mother-to-child transmission (PMTCT) of HIV.

The impact of TBAs extends beyond HIV testing. With proper training and resources, they can serve as advocates for a wide range of maternal and child health needs. They are well-positioned to educate women about essential topics such as nutrition, immunisation, and safe childbirth practices, fostering healthier communities overall. The integration of HIVST into their services complements these efforts by addressing a critical gap in antenatal care, especially for women who might otherwise avoid testing due to stigma or logistical challenges.

Incorporating HIVST into the work of TBAs not only enhances PMTCT outcomes but also strengthens the broader healthcare system in underserved areas. By bridging the gap between formal healthcare providers and remote communities, TBAs contribute to a more inclusive approach to healthcare delivery. Their involvement ensures that lifesaving services reach those most in need, empowering women to take control of their health and the health of their children.

Scaling Up: A National Strategy for Eliminating Mother-to-Child Transmission of HIV

Eliminating mother-to-child transmission (eMTCT) of HIV is a critical goal for Nigeria as the country continues to bear a heavy burden of new paediatric HIV infections. To maximise the impact of HIVST, a coordinated national strategy is essential, and it must include policy integration, community engagement, training and capacity building, and monitoring and evaluation.

As we mark World AIDS Day 2024 with the theme, “Take the Rights Path: My Health, My Right!”, it is a chance to strengthen our efforts to stop mother-to-child transmission of HIV and explore ways to make this goal a reality. The success of the Lagos and Kano initiatives shows how HIV self-testing kits can make testing and care easier and more accessible for everyone. This day reminds us of the need for innovative and inclusive approaches that protect the health and rights of women and children, especially in Nigeria.

Dr Godwin Emmanuel is the Managing Partner/Impact Officer of MOZUK Future Solutions Limited.