ASSESSING THE LINKAGE BETWEEN PREVENTION- OF- MOTHER-TO"CHILD-TRANSMISSION OF HIV AND ADULT ART SERVICES IN TWO NIGERIAN MILITARY HEALTH FACILITIES

(A CASE STUDY OF KADUNA STATE)

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Author

Presented To

Department of Medicine

ABSTRACT
HIV is one of the contributory factors to cause of death among women of reproductive age. Mother-to-child transmission (MTCT) of HIV accounts for about 10% of all new infections. As a prevention strategy, PMTCT programme was designed to cater for HIV positive pregnant women during pregnancy, labor, and delivery and post partum periods to prevent the transmission of HIV infection from mother to child. Effective models of the PMTCT programme are designed to have strong referral linkages to the adult ART services, in order to achieve continuity of care for mother and child, following delivery. This linkage is to ensure that not only the children are born free of HIV but also the mothers live prolonged quality lives, with quality adult ART care. The study was conducted to determine the proportion of women accessing PMTCT who were referred to the adult ART clinic, the proportion of referred HIV positive mothers who reached and accessed ART services, identify the factors associated with PMTCT-ART service linkage and determine the rate of uptake of antiretroviral treatment by HIV positive women, when referred from the PMTCT clinic to adult ART clinic in the selected facilities between January, 2009 to December 2013. Methods: A cross sectional study was conducted in two military health facilities in Kaduna state. The facilities were selected using a multi stage sampling technique and the women were selected using systematic sampling technique, after which a review of their health records was conducted. These women were traced to their homes and a structured questionnaire was administered to 372 respondents comprising of those who were liked and those who were not linked to adult ART services to obtain information on why they were linked or not. The respondents were described xvi by socio-demographic characteristics. Three (3) sessions of focus group discussion as qualitative method among doctors, nurses and health records personnel working in the facility to identify the risk factors associated with non linkage to adult ART services were conducted. Results: A total of 372 women of reproductive age who assessed ANC and PMTCT services were selected from the two facilities. Mean age of women who were not linked to ART services was 30.9(± 4.9) while for those linked to ART services was 31.4(±4.6). Of the 5720 women who assessed ANC services, 574(10%) assessed PMTCT services in these facilities. Only 3.3% of the 151 eligible women had no indication of referral to ART. Similarly, only 4.1% of the eligible women with no indication of referral traced at ART clinic, which was further emphasized by the responses from the focus group discussion where clients not returning for their CD4 count results, stigmatization and non disclosure to partner as factors that militated against good linkages. While more than 53.2% of the eligible women already on ART were traced to the ART clinic. One hundred and fifty-three (153) which was 98.1% of the women were referred to adult care and support services. A proportion of about seven percent(7%) of ART eligible women missed the opportunity of accessing ART services due to the weak referral linkages in the facilities At bivariate and multivariate analysis level, referral status, CD4 eligibility were found to be statistically significant. Conclusion: The weak referral linkages found in these facilities was found to be associated with CD4 eligibility and referral status. Also the place of delivery of baby, poor ANC-PMTCT service integration, self stigmatization, non-disclosure to partner and security challenges were identified from the FGD as associated factors. Therefore, there is need to entrench effective service integration by involving all relevant staff and departments in the care and support of the PMTCT clients in These facilities.