In eight districts in Taraba state, Nigeria, this project aims to increase uptake of HIV services among children aged 0-14 years and to reduce mother-to-child transmission, by 2022.
Antiretroviral Treatment (ART) is being provided by the state government, though underutilised. Society for Family Health and Institute for Public Health in Nigeria work with context-specific community approaches to reach pregnant mothers and children living with HIV. These will guarantee rapid identification and enrollment in HIV testing and counseling services and antenatal care, by:
- Improving capacities of existing informal health structures such as traditional birth attendants as well as effective community structures such as village health workers and traditional and religious leaders.
- Empowering health facility staff to provide excellent quality testing and counseling services, refer and track PMTCT and ART uptake at higher facilities.
- Promoting health seeking behaviours among pregnant women and children and their caregivers to access testing and counseling services.
In Hausa language Lafiyan Yara means 'well-being of children'.
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.
The project aims to ensure 200,000 children are tested for HIV, of which 400 are estimated to be living with HIV. In addition, the project aims to test 350,000 pregnant women, of whom 10,150 are estimated to be living with HIV.
Following the 90-90-90 targets the project expects to have a total of 9,135 pregnant women to start on treatment while 8,222 should be virally suppressed in the life of the project. With starting treatment and linking mothers to PMTCT services, hiv infections in newborn children will be averted. Finally, we expect a total of 360 children less than 15 years to start treatment while 324 children should attain viral suppression at the end of the project.
Taraba state in Nigeria (3.4 million people) has an HIV prevalence of 2.9%, the highest in the Northeast geopolitical zone and the fourth highest in the country. Antenatal care attendance is 44.5%, lower than the average for the north east geopolitical zone of 62.4%. The estimated proportion of population that are pregnant women and children below 15 years old in the state are 5% and 41% respectively.
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.