Background: Pregnant women bear the greatest burden of people living with HIV in the West Africa sub-region, and the country requires continuous optimal follow-up care for their disease after delivery. Documentation of such very important services is rarely done in this high-burden environment, and hence the present study. Method: A 15-year retrospective review of medical records of HIV-positive pregnant women who attended antenatal care services from January 2006 to December 2020 at the prevention of the mothers-to-child transmission unit of the health facility was carried out to document the HIV service provided at the unit, and the follow-up care at the adult HIV special treatment clinic for the continuation of their HIV treatment. Results: Of the 1245 HIV-positive pregnant mothers reviewed during the period, 702 (56.4%) were between the ages of 26 - 35 years, 1043 (83.8%) were on HIV treatment before their index pregnancy, 202 (16.2%) were diagnosed of HIV infection during their last trimester and labor, while 878 (70.5%) continued their HIV services at adult HIV special treatment clinic after delivery. The predictors of continuous care include: maternal parity with [OR] 0.51 (0.35 - 0.73), p = 0.02, time of presentation in trimester with [OR] 1.54 (1.15 - 2.06), p = 0.003, duration on antiretroviral therapy [OR] 2.14 (1.57 - 2.9) p < 0.0001, time of diagnosis of HIV infection [OR] 16.98 (2.29 - 125.9), p = 0.006 V, and maternal parity with [OR] 0.7 (0.5 - 0.97, p = 0.034), thus translating to younger mother, those on HIV treatment before index pregnancy, those diagnosed during last trimester of pregnancy and labor, those that presented during the 1st or 2nd trimester of their pregnancy, and those with fewer number of children are more likely to continue with optimal HIV services after delivery. Conclusion: The high rate of optimal follow-up care of HIV-positive mothers after delivery in the adult special treatment clinic in this study speaks of the preparedness and good supportive services provided to these mothers in the health facility. However, the high rate of loss to follow-up among this cohort of women requires a more focused intervention during their postpartum period for a better outcome.
References
[1]
UNAID Estimates. Prevalence of HIV, Total (% of Populations Ages 15-49)—Sub-Saharan Africa. https://data.worldbank.org/indicator/SH.DYN.AIDS.ZS?locations=ZG
[2]
Uneke, C.J., Duhlinska, D.D. and Igbinedion, E.B. (2007) Prevalence and Public-Health Significance of HIV Infection and Anaemia among Pregnant Women Attending Antenatal Clinics in South-Eastern Nigeria. Journal of Health, Population, and Nutrition, 25, 328-335.
[3]
Onakewhor, J.U.E. (2004) Human ImmunoDeficiency Virus (HIV) Infection/AIDS in Pregnancy. In: Okpere, E., Ed., Clinical Obstertrics, Revised Edition, UNIBEN Press, Benin City, 253-271.
[4]
Kasonde, G.M., Masaka, M. and Michelo, C. (2018) Trends in HIV Prevalence among Pregnant Women in Lusaka Province, Zambia 1994-2008. Journal of Transmitted Diseases and Immunity, 2, 1-9.
[5]
Okerentugba, P.O., Uchendu, S.C. and Okonko, I.O. (2015) Prevalence of HIV among Pregnant Women in Rumubiakani, Port Harcourt, Nigeria. Journal of Public Health Research, 5, 58-65.
[6]
Fouedjio, J.H., Fouelifack, F.Y., Fouelifa, L.D. and Mbu, R.E. (2017) Prevalence and Associated Factors of HIV Infection among Pregnant Women Attending Antenatal Care at the Yaoundé Central Hospital. International Journal of Reproduction, Contraception, Obstetrics and Gynaecology, 6, 2698-2703. https://doi.org/10.18203/2320-1770.ijrcog20172897
Gay, C.L., Napravnik, S. and Eron Jr., J.J. (2006) Advanced Immunosuppression at Entry to HIV Care in the Southeastern United States and Associated Risk Factors. Aids, 20, 775-778. https://doi.org/10.1097/01.aids.0000216380.30055.4a
[9]
McNaghten, A.D., Hanson, D.L., Aponte, Z., Sullivan, P.S. and Wolfe, M.I. (2004) Gender Disparity in HIV Treatment and AIDS Opportunistic Illnesses (OI). The XV International AIDS Conference, Bangkok, 11-16 July 2004.
[10]
Thompson, M.A., Horberg, M.A., Agwu, A.L., Colasanti, J.A., Jain, M.K., Short, W.R. and Aberg, J.A. (2021) Primary Care Guidance for Persons with Human Immunodeficiency Virus: 2020 Update by the HIV Medicine Association of the Infectious Diseases Society of America. Clinical Infectious Diseases, 73, e3572-e3605. https://doi.org/10.1093/cid/ciaa1391
[11]
National Agency for the Control of AIDS (2015) Global AIDS Response: Country Progress Report, Nigeria GARPR 2015. https://www.unaids.org/sites/default/files/country/documents/NGA_narrative_report_2015.pdf
[12]
Hamilton, E., Bossiky, B., Ditekemena, J., Esiru, G., Fwamba, F., Goga, A.E. and Guay, L. (2017) Using the PMTCT Cascade to Accelerate Achievement of the Global Plan Goals. Journal of Acquired Immune Deficiency Syndromes (1999), 75, S27. https://doi.org/10.1097/QAI.0000000000001325
[13]
Federal Ministry of Health Nigeria (2010) National Guidelines for Prevention of Mother-to-Child Transmission of HIV (PMTCT).
[14]
Rana, A.I., Gillani, F.S., Flanigan, T.P., Nash, B.T. and Beckwith, C.G. (2010) Follow-Up Care among HIV-Infected Pregnant Women in Mississippi. Journal of Women’s Health, 19, 1863-1867. https://doi.org/10.1089/jwh.2009.1880
[15]
Merenstein, D.J., Schneider, M.F., Cox, C., Schwartz, R., Weber, K., Robison, E. and Plankey, M.W. (2008) Association between Living with Children and Adherence to Highly Active Antiretroviral Therapy in the Women’s Interagency HIV Study. Pediatrics, 121, e787-e793. https://doi.org/10.1542/peds.2007-1586
[16]
Fleishman, J.A., Gebo, K.A., Reilly, E.D., Conviser, R., Mathews, W.C., Korthuis, P.T. and HIV Research Network (2005) Hospital and Outpatient Health Services Utilization among HIV-Infected Adults in Care 2000-2002. Medical Care, 43, III-40-III-52. https://doi.org/10.1097/01.mlr.0000175621.65005.c6
[17]
Yakasai, H.B. and Yakasai, B.A. (2022) Socio-Ecological Predictors of HIV Testing in Women of Childbearing Age in Nigeria. Pan African Medical Journal, 41, Article No. 162.
[18]
Country Progress Report—Nigeria Global AIDS Monitoring 2020. https://www.unaids.org/sites/default/files/country/documents/NGA_2020_countryreport.pdf
[19]
Federal Ministry of Health Nigeria (2014) Integrated National Guidelines for Prevention and Treatment of HIV Infection.
[20]
Federal Ministry of Health Nigeria (2020) National Guidelines for HIV Prevention Treatment and Care.
[21]
Branson, B.M., Handsfield, H.H., Lampe, M.A., Janssen, R.S., Taylor, A.W., Lyss, S.B. and Clark, J.E. (2006) Revised Recommendations for HIV Testing of Adults, Adolescents, and Pregnant Women in Health-Care Settings. Morbidity and Mortality Weekly Report: Recommendations and Reports, 55, 1-CE.
[22]
Kaplan, R., Orrell, C., Zwane, E., Bekker, L.G. and Wood, R. (2008) Loss to Follow-Up and Mortality amongst Pregnant Women Referred to a Community Clinic for Antiretroviral Treatment. AIDS (London, England), 22, 1679-1681. https://doi.org/10.1097/QAD.0b013e32830ebcee
[23]
Wang, B., Losina, E., Stark, R., Munro, A., Walensky, R.P., Wilke, M. and Wood, R. (2011) Loss to Follow-Up in a Community Clinic in South Africa-Roles of Gender, Pregnancy and CD4 Count. South African Medical Journal, 101, 253-257. https://doi.org/10.7196/SAMJ.4078
[24]
Wolvaardt, G., Van Niftrik, J., Beira, B., Mapham, W. and Stander, T. (2008) The Role of Private and Other Non-Governmental Organisations in Primary Health Care: Systems Support. South African Health Review, 2008, 223-236.
[25]
Federal Ministry of Health, FMoH [Nigeria] (2014) National HIV Sero-Prevalence Sentinel Survey among Pregnant Women Attending Antenatal Clinics in Nigeria, 201 Fact Sheet. Department of Public Health National AIDS/STI Control Programme, Abuja.
[26]
United Nations Programme on HIV and AIDS, UNAIDS (2018) Ending the AIDS Epidemic, FactSheet. http://www.unaids.org/sites/default/files/media_asset/UNAIDS_FactSheet_en.pdf
