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AN ASSESSMENT OF PREVENTION OF MOTHER TO CHILD TRANSMISSION (PMTCT) OF HIV/AIDS IN ENUGU HOSPITALS

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Abstract

Introduction: Pregnant women living with HIV are at high risk of transmitting HIV to their infants during pregnancy, birth or through breastfeeding and without any interventions, between 20% and 45% of infants may become infected with an estimated risk of 5- 10% during pregnancy, 10-20% during labour and delivery, and 5-20% through breastfeeding.  Objective: This study assessed the prevention of mother to child transmission PMTCT programmes in Enugu hospitals.

Method: This was a cross-sectional survey study involving 129 participants comprising 32 PMTCT workers and 97 HIV/AIDS pregnant and breast feeding mothers were sampled using purposive sampling technique from 4 hospitals within Enugu urban. Data was collected using a pretested questionnaire PMTCT Assessment Questionnaire. Analysis was done with SPSS and test of significance done with chi-square and one-way Anova at p value of <.05 level of significance.

Results: Results showed that PMTCT services such as antiretroviral therapy and caesarean sections were available in 62.5% of the facility each; HIV testing and voluntary counselling were 100% available, whereas safer infant feeding counselling (81.8%) was mostly available in hospitals in Enugu urban. Qualified PMTCT service providers (Counsellors, Doctors, Lab. Technicians, Midwives, Nurses, Pharmacists, Programme Manager,) were highly available in hospitals in Enugu urban with means above 4.00, with only Health Educators and Social Workers being slightly and not available with means below 4.00. PMTCT materials such as (HIV test Kits, Reagents, CD4 Count Machine and centrifuges with means above 4.00, were all highly available. Whereas ART Drugs, Incubators, Microscopes and Power Plants with means below 4.00 were all moderately available respectively in hospitals in Enugu urban. However, Washers (x =2.81) as a PMTCT material were slightly available and Spectrophotometer (x = 1.56) was not available in hospitals in Enugu.  There was a high level of utilization of PMTCT materials (Voluntary counselling, HIV Testing, Anti-retroviral Therapy and Safer Infant Feeding counselling) by patients with means above 4.00. However, Caesarean section was adjudged to be slightly utilized with means below 4.00.  PMTCT services (Antiretroviral therapy, Caesarean section, HIV testing, safer infant feeding counselling and voluntary counselling) in both government and private hospitals are significantly available of X2 (1, 97) = 31.19, 15.68, 51.97, 35.89, and 26.81 respectively, all at p<.01 level of significance. Based on level of education, patients’ level of utilization of PMTCT services in both government and private hospitals in Enugu urban did not differ F(1, 96) = .68, 3.36, 2.04,.007, and .061respectively, all  at p>.05 level of significance. Finally, government and private hospitals’ PMTCT service providers did not differ in identification of factors influencing the patients’ level of utilization of PMTCT services in both government and private hospitals in Enugu urban of F(1, 31) =  .04, 2.61, 2.63, .671, .073,.595,.048,.369, .153, .261, .515, .440, .515 and .002 respectively, all  at p>.05 level of significance.

Conclusion: Most PMTCT services were available with attendant health workers. However, effort should be made by government and stakeholders in PMTCT programmes should step up in their involvement towards achieving holistic PMTCT programme in Enugu State.

CHAPTER ONE INTRODUCTION

1.1   Background Information

Over 78 million people have been infected with HIV since the start of the epidemic in the early 1980s. [1] In 2012, AIDS-related illnesses were the 6th leading cause of death worldwide. [2] HIV statistics for the end of 2013 indicate that around 35 million people are currently living with HIV worldwide, 38 percent less than in 2001. [3] In the same year, around 2.1 million people became infected with HIV and 1.5 million died of AIDS-related illnesses. HIV and AIDS are found in all parts of the world; however some areas are more affected than others.

Globally, at the end of 2011, 34.0 million (31.4 million-35.9 million) people were living with HIV, including 3.4 million (3,000,000-3,800,000) children less than 15 years of age. [4] In that same year, 330,000 {280,000-390,000] children acquired human immunodeficiency virus (HIV) infection. [5] This represents a 43% decline since 2003 and a 24% drop since 2009. [5] In 2010, about 250,000 (220,000-290,000) children, aged less than 15 years, died from acquired immunodeficiency disease syndrome (AIDS) related causes. [4] Sub-Saharan Africa continues to bear the burden of the HIV pandemic, with Nigeria as one of the countries with the highest burdens of paediatric AIDS. [5] In 2011, Nigeria had an estimated 440,000 children, less than 15 years, living with HIV. [5]

So, the emergence of the Human Immune Deficiency Virus (HIV) infection has increased the already heavy burden of disease and death among women and children in low and middle-income countries. [6] Pregnant women living with HIV are at high risk of transmitting HIV to their infants during pregnancy, birth or through breastfeeding and without any interventions, between 20% and 45% of infants may become infected with an estimated risk of 5- 10% during pregnancy, 10-20% during labour and delivery, and 520% through breastfeeding. Following the above developments, Mother-to-child transmission (MTCT) accounts for 90% of HIV infections in children under the age of 15 years. [4] Prevention of mother-to-child transmission (PMTCT) has become a key public health priority in Nigeria, a country faced with 56,681 annual HIV-positive births and more than 210,000 women living with HIV. [7] Prevention of mother to child transmission (PMTCT) of HIV is a global interventional program initiated by the United Nations Organization to protect the children of the world from the scourge of the HIV pandemic.

The national PMTCT programme in Nigeria commenced in 2002 with supports from the World Health Organisation (WHO) and The United Nations Children’s Fund (UNICEF). [9] An estimated 430,000 children were newly infected with HIV in 2008, over 90% of them through mother-to-child transmission (MTCT). Without treatment, about half of these infected children will die before their second birthday. Without intervention, the risk of MTCT ranges from 20% to 45%. With specific interventions in nonbreastfeeding populations, the risk of MTCT can be reduced to less than 2%, and to 5% or less in breastfeeding populations. In 2008, MTCT of HIV was reported as the most common route of transmission among the paediatric age group in the National Hospital Abuja. [10] The importance of PMTCT in reducing paediatric morbidity and mortality cannot therefore, be overemphasised.

Nigeria was adjudged the country with the highest burden of MTCT in the world 210,000 HIV positive women are pregnant every year. Contributing to that high MTCT burden in Nigeria is high population size, HIV prevalence in general population and among pregnant women. More than 3.6 million adults and children were estimated to be living with HIV in 2005 and the 2010 national sentinel survey report estimated the HIV prevalence among pregnant women attending antenatal care services (ANC) at 4.1%.

Owhonola stated that out of 2.1 million children living with HIV globally in 2008, Nigeria accounted for 220,000 or over 10 percent. Most of these children were infected through MTCT. Pregnant women across the developing country must be tested for HIV.

Prevention of mother to child transmission of HIV/AID programmes must be scaled up to include all mothers and babies no matter how impoverished or geographically isolated they may be, and where prevention of mother to child HIV transmission is accessible, it must be delivered consistently and with the most effective drugs available. The best chance for a child to survive is to have healthy parents. Medical, psychological and social support should thus be improved for infected mothers and other families. [13] There is relatively low antenatal attendance – only 58% of pregnant women attend at least one antenatal clinic visit and only 35% deliver in health facilities. [11,14]

The initial target date of 2010 was reviewed with a new dateline and targets set. These were, to provide access to at least 90% of all pregnant women to quality HIV counselling and testing by 2015, to provide access to at least 90% of all HIV positive pregnant women to more efficacious prophylaxis by 2015 and to provide access to at least 90% of HIV exposed infants to more efficacious ARV prophylaxis by 2015. Other goals were to provide access to at least 90% of HIV positive pregnant women to quality infant feeding counselling by 2015 and to provide access to at least 90% of all HIV exposed infants to early infant diagnosis services by 2015.

There are about 1,216 PMTCT service points across the Nigeria presently. [15] In 2009, 18.7% of pregnant women living with HIV received antiretroviral (ARV) agents to reduce the risk of MTCT, showing a significant increase in PMTCT coverage from 5.3% in 2007, although the coverage for ARV prophylaxis during the breastfeeding period has still remained low. [16] Providing ARV prophylaxis to pregnant women living with HIV has prevented more than 350,000 children from acquiring HIV infection since 1995 and resulted in a 24% decline in newly infected children since 2004. [4]

Historically, the discovery of human immunodeficiency virus (HIV) infection in 1981 and its subsequent emergence as a leading global epidemic are well documented. [17-19]

HIV is transmitted from an infected person to an uninfected person by two major modes, namely, horizontal transmission and vertical transmission (or mother to child transmission (MTCT)). [20, 21]

Horizontal transmission refers to transmission between two individuals who exist separately. It covers the commonly known routes of transmission in the adult such as through unprotected sex with an infected person, transfusion with infected blood and blood products, sharing of contaminated needles and other contaminated instruments, among others. This mode accounts for 90% of all HIV infections and is the sole mode of infection in the adults.

Vertical (or mother to child) transmission refers to the situation where an infant of an HIV-infected mother acquires the HIV infection from the mother at one or more of the following stages: Transplacentally in the uterus during pregnancy, perinatally during the process of labour and delivery, and postnatally during breastfeeding. [22, 23] Strategies to reduce MTCT focus on these periods of exposure and include the use of ARVs, caesarean section before onset of labour or rupture of membranes, and complete avoidance of breastfeeding. [16] These combined interventions when followed effectively, reduce the risk of MTCT to as low as 1-2%. [24] Without intervention 30-45% of all infants born to HIV positive mothers will be infected and 10-20% will be infected through breastfeeding. [25] Early infant diagnosis (EID) programs can be used to evaluate the impact of PMTCT, as well as substantially improve the survival rates. [24]

“Prevention” refers to helping people avoid getting sick or identifying diseases early so treatment can begin. There are two types of preventive services:

Clinical preventive services are immunizations, disease screenings and behavioural counselling interventions delivered to individuals in clinical settings. These services are designed to prevent disease or to detect conditions that are not yet apparent to the patient, allowing for early treatment. [26]

Community preventive services are policies, programs and services that aim to improve the health of the entire population or specific sub populations. Examples of community preventive services are programs that: increase the amount of time students spend in primary education (PE) class, provide diabetes self-management education in community gathering places or increase the price of harmful products, such as tobacco.

Therefore, PMTCT of HIV and AIDS is the act of stopping a mother from transmitting or passing HIV and AIDS to her child during pregnancy, labour, delivery and breastfeeding. In response to the MTCT threat and in line with the global declaration of commitment to universal access to HIV prevention, treatment, care, and support and global efforts to reduce paediatric HIV infections, the Nigerian National PMTCT program was launched in 2002 employing a comprehensive four-pronged approach:

  1. Primary prevention of HIV infection among women of reproductive age group and their partners,
  2. Prevention of unintended pregnancies among women infected with HIV,
  3. Prevention of HIV transmission from women infected with HIV to their infants and
  4. Provision of treatment, care, and support to women infected with HIV, their infants and their families.

Global HIV/AIDS Initiative Nigeria (GHAIN) supported all aspects of the “FourProng” approach using evidence-based strategies. Primary prevention was a core program area in GHAIN, featuring abstinence and being faithful messages, condom use, HIV testing and counselling (HTC). Offer of FP services to prevent unintended pregnancies among women infected with HIV as well as prevention of prenatal transmission services were integrated within the Maternal and Child Health (MCH) services. Women infected with HIV, their infants and their families’ accessed treatment, care and support through integration, referral and linkages to care and treatment services.

The approach for primary prevention included advocacy, community mobilization and dialogue, focused group discussion, electronic media intervention, distribution of related media material and peer education. Guided by the principle of integrating PMTCT into MCH services, GHAIN articulated its support around increasing access to and quality of PMTCT. Existing MCH structure and human resources constituted the platform of GHAIN support to PMTCT. To be selected as a PMTCT site, a health facility has to have a pre-existing and functional ANC, maternity, child welfare and pharmacy services preexisting.

Improving Access to PMTCT MCH service delivery points were carefully selected, taking into account the PMTCT roll out provision in the national and state strategic plans, the patient load and the state specific HIV prevalence when available. The phased support to health facilities was agreed with state health authorities. Facilities with high ANC and maternity patient load were prioritized. GHAIN pioneered the implementation of PMTCT in secondary level hospitals in Nigeria and later supported decentralization to primary health centres and in communities. Upon selection of health facilities, GHAIN strengthened the capacity to deliver existing routine MCH services and to add on PMTCT interventions. [27]

The mother-to-child transmission (MTCT) of HIV, however, refers to the transmission of HIV from an HIV-positive woman to her child during pregnancy, labour, delivery or breastfeeding. MTCT is by far the most common way that children become infected with HIV (90 percent). [28]

Without treatment, the likelihood of HIV passing from mother-to-child is 15-45 percent. However, antiretroviral treatment (ART) and other effective interventions like; voluntary counselling, (VC), HIV testing, Obstetric intervention or caesarean section (CS) and safe infant breast feeding;  for the prevention of mother-to-child transmission (PMTCT) can reduce this risk to below 5 percent. [29]

Effective PMTCT programmes require women and their infants to receive a cascade of interventions including uptake of antenatal services and HIV testing during pregnancy, use of antiretroviral treatment (ART) by pregnant women living with HIV, safe childbirth practices and appropriate infant feeding, uptake of infant HIV testing and other post-natal healthcare services. [30]

The World Health Organisation (WHO) promotes a comprehensive approach to PMTCT programmes which includes:

  • Prevention of new HIV infections among women of childbearing age
  • Preventing unintended pregnancies among women living with HIV
  • Preventing HIV transmission from a woman living with HIV to her baby
  • Providing appropriate treatment, care and support to mothers living with HIV and their children and families. [31]

In 2013, the World Health Organisation (WHO) [32] released new consolidated guidelines on the use of antiretroviral drugs (ARVs) for treating and preventing HIV infection. The guidelines include recommendations for providing lifelong antiretroviral treatment (ART) to pregnant and breastfeeding women living with HIV for the prevention of mother-to-child transmission (PMTCT).

National PMTCT programme options for pregnant and breastfeeding women living with HIV. WHO guidelines recommend that programmers follow Option B+, or Option B, if this is not possible;

Option B+: Option B+ recommends providing lifelong ART to all pregnant and breastfeeding women living with HIV regardless of CD4 count or WHO clinical stage. Moreover, ART should be maintained after delivery and completion of breastfeeding for life.

Option B: Option B recommends providing lifelong treatment only for pregnant and breastfeeding women eligible for ART.

For those eligible for treatment (i.e. with CD4 counts under 500 or at clinical stage 3 or 4), ART should be initiated and maintained after completion of breastfeeding. Those who fail to adhere to first-line ART during pregnancy or breastfeeding should be assessed for second-line ART. In the case of breastfeeding, ART should be stopped one week after the completion of breastfeeding. In the case of replacement feeding, ART should be stopped following delivery of the baby.

For those who are ineligible for treatment (with CD4 counts over 500), ART should be initiated but stopped after delivery and completion of breastfeeding. Again, patients who fail to adhere to first-line ART during pregnancy or breastfeeding should be assessed for second-line ART. In the case of breastfeeding, ART should be stopped one week after breastfeeding ends. In the case of replacement feeding, stop ART after delivery.

For HIV-exposed infants – all infants born to HIV-positive mothers should receive a course of medication linked to the ARV drug regimen that the mother is taking and the infants feeding method.

Breastfeeding – The infant should receive once-daily nevirapine (NVP) from birth for 6 weeks.

Replacement feeding – The infant should receive once-daily NVP (or twice-daily zidovudine (AZT)) from birth for 4–6 weeks.

Malyuta et al. [33] noted that the PMTCT programme has been integrated into existing maternal and child health care services supervised by the ANC Department of Health Care for mother and child, with collaboration from HIV and AIDS specific services. Nobel [34] opined that to achieve wide coverage, PMTCT programme must be integrated into existing public health systems, with services provided by all antenatal and delivery clinics. More so, a health system is a blend of public and private sector in both service delivery and funding organization. Therefore, PMTCT programme should be provided by both government and private hospitals.

Every endeavour, such as PMTCT of HIV and AIDS aims at maintaining its relevance through monitoring and evaluation of its activities. Evaluation is essential to identifying shortcomings in PMTCT of HIV programme and to conceptualize approaches to improve services. [35] This in turn, will improve a programme’s cost effectiveness and long term sustainability and save the most infant lives.

Assessment as defined by Trochim [36] is the systematic acquisition and assessment of information to provide useful feedback about some object. UNICEF, UNAIDS and WHO [37] also stated that monitoring and evaluation activities support implementation of PMTCT programme in that they are systematic ways of learning from experience and using the lessons learned to improve health activities and promote better planning. They can provide information support for local management and strategy, policy and programme formulation and budgeting, and program delivery through various services and institutions.

Olaitan[38] submitted that evaluation is the process of obtaining information on what one is doing towards achieving objectives, how far one could go in achieving the objectives, what constraints hinder the achievement of the objectives, and what to do in order to overcome the constraints of achieving the objectives. This position seems to lend credence to the felt need for obtaining such information on the programme for prevention of MTCT of HIV and AIDS services in hospitals in Enugu urban, Enugu State.

Assessment helps to emphasize the importance of assessing participants, especially the client or users of a programme and stakeholders. Agency for Health Care Research and Quality (AHRQ) observed that potential audiences for quality measurement report for child health care services are the providers and the consumers. [39] In this case, pregnant women and health care providers’ perception measures as well as several measures of the delivery of preventive care may be used to assess the quality of the health plan or programme for PMTCT of HIV and AIDS services in government and private hospitals in Enugu urban. WHO observed that the main providers of health care and their role in child health include two main categories of government and public sector players. [37]

 

Programme assessment, according to Worthen [40] consists of those activities undertaken to judge the worth or quality of a programme. Therefore, in the context of this study, assessment of PMTCT of HIV and AIDS services involve:

  • Input – that is an aspect of assessment which according to Robinson [41] represents a phase in which the evaluator determine the resources and material needed to meet the goals and objectives of the programme,
  • Process – an aspect of the programme assessment that in the views of Robinson [41] and Voelker-Morris [42] is concerned with determination of the effectiveness of the delivery systems employed in the programme during implementation and Product – and aspect of assessment, described by Robinson [41] as focusing on measuring the outcomes of the inputs and proceeds in a programme. The end product of these aspects of evaluation demonstrates the worth or utility of the PMTCT of HIV and AIDS services in hospitals in Enugu urban.

These three models can be involved in two forms of assessment. They are goal assessment and goal free evaluation. In the opinion of McNamara [43] goal assessment is also known as Goal based assessment because goals of the programme are often described in the original programme plan. Goal free evaluation in the opinion of Steecher

is an approach to evaluation in which merit is determined from an examination of programme effects without reference to goals or objectives of the programme.  Results which the programme affected were of focus rather than the intentions of the programme. Goal assessment was therefore, adopted in this study.

As Reported rates of mother-to-child HIV transmission in the absence of any intervention are higher in developing countries (25-45 percent) than in industrialized countries (15-25 percent). [45] Offering HIV testing as part of routine antenatal care, combination antiretroviral drug regimens, and elective caesarean section and advising complete avoidance of breastfeeding has cut MTCT transmission of HIV to below 2 percent among the limited number of HIV-infected women in developed countries. However, in the developing nations where the vast majority of HIV-infected women of childbearing age reside, MTCT rates remain high due to lack of access to feasible, affordable prevention interventions and are compounded by the nearly universal practice of breastfeeding for prolonged periods of time.

Implementing prevention of mother-to-child transmission (PMTCT) interventions poses significant challenges in resource-poor settings. Hence, challenges involved in PMTCT are now greater than envisaged and progress has not been made as expected. [46] This justifies the intentions for this study and highlights the importance of Monitoring  and  Evaluation  (M&E), which  is  an  essential  component  of  PMTCT  activities.  The overall purpose of monitoring and evaluation is to measure programme effectiveness at all levels and guide toward achieving goals and set strategic objectives.  Information obtained from M&E can be used to demonstrate to the programme planners and policy makers that the programme efforts had measurable impacts on the expected outcome.

1.2        Statement of the Problem

The high burden of MTCT in Nigeria is due to a high rate of heterosexual transmission, a higher prevalence of HIV in women of reproductive age, high total fertility rates and poor access to PMTCT interventions. In 2011 it was estimated that about 6.7 million pregnant women (birth rate 41 per 1,000) [47] required HIV counselling and testing (HCT). Of this population, about 222,129 were estimated to be HIV-positive and would give birth to 58,495 HIV-infected babies. [48] In the same year only 17 percent of pregnant women received HCT, while only 16 percent of HIV-positive pregnant women received antiretroviral (ARV) prophylaxis to prevent transmission of the virus to their unborn babies. [49]

It is pathetic to know that over 90 percent of HIV infections in children are acquired through MTCT. As more women become infected, the number of infected infants will grow. Studies indicate that without appropriate PMTCT interventions followed by early infant diagnosis (EID) and paediatric antiretroviral therapy (ART) for infected babies, about 50 percent of those infants born with HIV will die before their second birthdays.[50] Experiences from programmes in more technologically advanced countries and a number of African countries have shown that PMTCT programmes can reduce the risk of MTCT of HIV to as low as 2 percent. Interventions include the use of ARVs as either prophylaxis or therapy for HIV-positive women in pregnancy, labour and during breastfeeding. [49] If this is true, what is the situation of the programme in Enugu State?

Despite the fact that PMTCT programme in Nigeria was initiated in 2002 in six tertiary health facilities (one in each of the geopolitical zones of the country) by the Federal Ministry of Health (FMOH) with support from development partners, much is still desired from the programme. Though, the number of facilities providing PMTCT has increased over the years, with services decentralized to secondary and primary health facilities and some involvement of private institutions. For instance, as at December 2012, a total of 1,320 health facilities [51] offered PMTCT services across the country. The impact of the programme is yet to be witnessed by the populace.

However, this figure represents a small fraction of the total health facilities in the country. The public health care system in Nigeria is not without challenges. A 2011 baseline survey of primary health care services in Nigeria depicts challenges such as poor health infrastructure with inadequate buildings and equipment and inadequate human resource capacity and supervision. [52] There are also weak referral links between different levels of care and weak logistic systems for health care commodities.

Unfortunately, literature has shown that several factors impede the availability and utilization of PMTCT. By implication, one may be tempted to doubt the availability and adequacy of PMTCT resources and the level of utilization of these services by pregnant women. Few studies have been conducted on evaluation of PMTCT programme in terms of availability and utilization, [53,54,55] in some instances, findings of these studies have shown inadequate resources and low utilization of services. In other instances, the findings have shown high utilization. Evaluation of the programme is important to indicate whether the goal of PMTCT programme has been achieved (to reduce or eliminate the risk of MTCT of HIV). Evaluation of this programme is difficult to come by especially in Nigeria. Even though the programme is available in hospitals, the extent to which the services are available, and are utilized should be examined. To this end the present research due to dearth in a research in this area in Nigeria and Enugu State in particular, hence, the present study intends to fill this gap in literature concerning PMTCT of HIV/AIDS programme in Enugu hospitals.

1.3        Study Justification

In June 2011, at the United Nations (UN) High Level Meeting on AIDS, Nigeria and other member nations launched and committed to the Global Plan towards the Elimination of New HIV Infections in Children by 2015 and Helping Mothers Stay Healthy.

Through the National Scale-up Plan Towards Elimination of Mother-to-Child Transmission (EMTCT) of HIV, the country is already aligned with the global targets of reducing new HIV infections in children by 90 percent and reducing AIDS-related maternal deaths by 50 percent by 2015. In order to achieve these ambitious targets, national and state governments; the organized private sector; public, private and traditional health care providers; civil society; networks of people living with HIV and AIDS (PLHIV); and community structures will work collaboratively to improve health care delivery systems, particularly at the primary health care levels where the majority of the people live and the need is greatest.

Voluntary Counselling and Testing (VCT) and other PMTCT role out plans for the Nigeria government are expected to reduce the HIV infection rates at all levels. The results from this study may help inform policy on what the barriers to uptake of PMTCT services are and how to address them. It is against this backdrop and an understanding of the importance of this study and the results thereof may be used to reduce such barriers in the new working areas as follows:

The information generated on the availability of PMTCT services may help pregnant women to know the hospitals that provide the services. This will help to increase the level of utilization of the services by the target population and there will be improvement on quality of life. The information will also help service providers to intensify enlightenment programme on the need for HIV positive pregnant mothers to make use of the services. The data generated may help to see the need to establish more PMTCT sites.

Health workers and parents may find information on evaluation of PMTCT services useful to check whether their hospitals provide full PMTCT programme and to press for improvement in line with the recommendations that will be made for the benefits of child bearing age and their infants. It will also be helpful for hospitals administrators to reorganize and train their staff for full PMTCT programme implementation in their hospitals in realizing their responsibilities in health care provision for pregnant women especially those that are seropositive and their children who vertically acquired the HIV.

The data generated from the availability of qualified PMTCT service providers will help hospital administrators in planning and using multiple approaches to training and retraining the service providers to improve on their skills. The data may also provide basis for/ to recruit qualified staff for rendering PMTCT services in their hospitals.

Generated data on the availability of PMTCT service materials will help the hospital administrators to facilitate procurement of more and recent materials for PMTCT. Donor agencies may also be spurred to procure these materials for the hospitals. It may also help hospital management to solicit for materials from World Health Organization.

This study will provide information on the current achievement of PMTCT, lapses and a way forward in achieving the 2015 vision of elimination of mother to child transmission of HIV/AIDS in the country. Also, it will help in identifying the factors that hinders the progress or effective utilization of PMTCT services.

The results will be submitted to the Department of Community Medicine as a dissertation. The results may also be submitted in a peer reviewed journal for publication.

1.4        Research Questions

The following research questions guided the study:

  1. What PMTCT services are available in Enugu urban hospitals?
  2. To what extent are qualified PMTCT service providers available in Enugu urban hospitals?
  3. To what extent are materials for PMTCT services available in Enugu urban hospitals?
  4. What is the level of utilization of these PMTCT services (Voluntary counselling, HIV Testing, Anti-retroviral Therapy, Caesarean section and Safe Infant Feeding) Enugu urban hospitals?
  5. What factors influence the utilization of PMTCT services in Enugu urban hospitals?

1.5        Hypotheses

The following null hypotheses were tested:

  1. There is no statistically significant difference in the availability of PMTCT services in government and private hospitals in Enugu urban.
  2. There is no statistically significant difference in the level of PMTCT services utilization by patients in Enugu urban hospitals based on their level of education.
  3. There is no statistically significant difference between government and private PMTCT service providers in identification of factors influencing PMTCT utilization in Enugu urban hospitals.

1.6        Objectives of the Study

The major objective of this study was to assess the prevention of mother to child transmission (PMTCT) of HIV/AIDS programmes in Enugu. Specifically, the study was set to achieve the following objectives:

  1. To determine PMTCT services available in Enugu urban hospitals.
  2. To assess the availability of qualified PMTCT service providers in Enugu urban hospitals.
  3. To determine the availability of PMTCT materials in Enugu urban hospitals.
  4. To determine the level of utilization of these PMTCT services (Voluntary counselling, HIV Testing, Anti-retroviral Therapy, Caesarean section and Safe Infant Feeding)in Enugu urban hospitals?
  5. To determine the factors influencing the utilization of PMTCT services in Enugu urban hospitals.

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