Abstract:
The 2013 WHO HIV guidelines provided effective antiretroviral regimens to reduce perinatal transmission to
below 2%. The option-B approach of providing antiretroviral drugs was adopted by Nigeria, which contributed 32% of global
gaps in Preventing Mother to child transmission (PMTCT). In Plateau State, which had 7.7% HIV prevalence, incessant
ethnoreligious conflict created challenges impacting on HIV service delivery and access to treatment centers. PMTCT
diagnostics conducted by the lead HIV implementing Partner (IP), revealed that several communities in Jos, Plateau State,
lacked HIV treatment centers, but were also unable to access existing centers because of conflict related partitioning of Jos,
calling for specialized strategies and collaboration to scale-up to affected communities. To bridge existing challenges related to
distrust amongst communities, the intervention strategy identified six community oriented resource persons (CORPs), of same
ethnoreligious dispensation as people in affected communities, who also possessed HIV programing competencies, to lead the
intervention. The project methodology included engagement of community gatekeepers and Plateau HIV stakeholders, who
generated context specific strategies to enter these communities and scale-up HIV/PMTCT. The lead CORPs included a female
public health/HIV physician, another clinician who owned a community hospital, a HIV laboratory personnel, a HIV trained
Data officer, a religious cleric/youth leader and a female expert patient cum member of Federation of Muslim women
association of Nigeria (FOMWAN). Collaborating with various stakeholders, they birthed a community faith based
organization they called Muslim Health Initiative of Nigeria (MUHIN). This served as platform for community engagement to
scale-up HIV/PMTCT services. The Lead HIV Partner supported, engaged and funded MUHIN to provide context specific
scale-up to address existing gaps. MUHIN identified, assessed, upgraded and activated twenty-eight community clinics for
HIV/PMTCT service deliver, building on existing Maternal, child and New-born health (MNCH) structures. They providedHIV trainings, MNCH materials, national data-capture tools and capacity building to the identified facilities, staff and CORPs.
They stratified according to facility capacity, and linked them using the Hub-and-spoke model, to provide HIV testing,
PMTCT and Antiretroviral therapy (ART) services. In order to bridge existing human resource for health gaps existing at the
clinics, community health workers and HIV positive women who had successfully completed PMTCT programs were engaged
and trained according to task shifting and task sharing (TSTS) guidelines, in preparation for HIV/PMTCT activation using
HCT as entry. We conclude that detailed diagnostics, planning and utilization of context-specific strategies including TSTS are
critical for successful project outcomes.
