Lafiyan Yara

Taraba state, Nigeria has an HIV prevalence of nearly 3%, the highest in the northeast geopolitical zone. The rate of antenatal care attendance is 44.5%, one of the lowest in the region and lower than the average for the northeast geopolitical zone of 62.4%. Drivers of the HIV epidemic include low levels of awareness about vertical transmission and HIV in general, norms that promote multiple concurrent sexual partnerships and perceptions of low risk. Girls start having sex at the age of 12, which contributes to a high rate of teenage pregnancy in the state.

In recent times, Taraba state has had to host a significant number of internally displaced persons from crisis ridden states because of its relatively stable security situation. There are also limited or no donor funded HIV interventions happening in Taraba leaving a gap in the continuum of care for HIV. Drivers of the HIV epidemic include norms that promote multiple concurrent sexual partnerships, low risk perceptions, low awareness of HIV and poor literacy rates. There is a low awareness of mother-to-child transmission of HIV. In addition, in northern Nigeria women are likely to visit traditional birth attendants for antenatal and postnatal care which hinders HIV counselling and testing access. Gaps therefore exist in early infant diagnosis at the facility level. As a consequence, a large number of people living with HIV remain undiagnosed, including children and pregnant women.

The overall project goals are to increase access and uptake of HIV services among children (0-14 years) and to reduce HIV transmission from mother to child, in Taraba state by 2022, with the aim to achieve:

• Improved case finding of HIV positive children through improved access of pregnant women to antenatal care services
• Improved health seeking behaviours for HIV services among pregnant women and children
• Improved quality of care delivered by health providers at formal health facilities
• Research agenda to inform HIV programs and policies for children under 15 years of age.

The theory of change across the outlined outcomes is:
Early detection for HIV has the propensity to reduce infant, child and maternal mortality. Increased access to antenatal services by pregnant women should enhance uptake of HCT and PMTCT services. Consequently, it lowers the births of HIV positive children. Similarly, improved access of community members to testing and counseling services increases finding of HIV positive cases, enrolment in care, viral load suppression and reduced mortality among pregnant women and children.
Furthermore, better health seeking behaviours among all community members means that they are informed and motivated to voluntarily seek testing and counseling services as a result of recognised benefits including reduced mortality. Likewise, improved capacity of health providers to provide quality services through enhanced knowledge and skills, medicine and diagnostic tools availability, job aids, confidentiality of HIV positive patients without stigmatisation, and appropriate support will significantly motivate health facility attendance by community members and in turn, improve health outcomes.

In the intervention local governments areas of Bali, Gashaka, Jalingo and Zing, the
percentage of women referred for HIV testing services increased from:

• 16.9% to 87.7% through support from trained traditional birth attendants
• 17.3% to 79.7% through the support of village health workers
• 25.9% to 36.4% with the support of patent and proprietary medicine vendors
• 9.3% to 80.0% using a combined approach

The project has had numerous impacts during the implementation period – from 2019 to 2022:

• The project mobilised 122,181 pregnant and lactating women and provided them with health education on HIV prevention, referral to a healthcare facility for HIV testing services and antenatal care.
• A total of 117,338 pregnant women were tested for HIV and 698 were confirmed HIV positive. 665 started antiretroviral therapy.
• 334,109 children and adolescents were mobilised for testing, of which 323,761 tested for HIV and 459 were found to be HIV positive. 431 children commenced treatment at the time of diagnosis.
• 109 early infant diagnosis samples collected for infants 0-12 months showed a negative result while two results were positive for HIV infection.
• Almost all identified positive clients started treatment (99.3% of positive pregnant women; 94.2% positive children).
• The project contributed to increased knowledge of HIV transmission, prevention, and risk among project participants through community outreach and sensitisation. In  particular, participants had a better understanding of prevention of vertical transmission and how to reduce risk for infants.
  

The Aidsfonds Kids to Care model empowers communities to strengthen the links between communities and health facilities to find, test, treat and retain children, and pregnant and lactating mothers, living with HIV in care. The Kids to Care model is built on the following foundation principles:

• Community-owned and community-led
• Builds on existing community structures
• Child and family centred
• Builds on government frameworks and policies
• Key stakeholders are meaningfully involved from the beginning
• Interventions are informed by data
• Committed to sustainability and long-term support

More about the Kids to Care model can be found here