ABSTRACT
The percentage of Human Immunodeficiency Virus (HIV) positive pregnant women that receive anti-retroviral treatment in Nigeria is low and has been declining. Consequently, 14% of all new infections among children in 2020 occurred in Nigeria. A detailed analysis of available data was undertaken to generate evidence to inform remedial actions. Data from routine service delivery, national surveys and models were analyzed for the six-year period from 2015 to 2020. Numbers and percentages were calculated for antenatal registrations, HIV testing, HIV positive pregnant women and HIV positive pregnant women on antiretroviral treatment. The Mann-Kendall Trend Test was used to determine the presence of time trends when the p-value was less than 0.05. In 2020, only 35% of an estimated 7.8 million pregnant women received antenatal care at a health facility that provided and reported PMTCT services. Within these facilities, the percentage of HIV-positive pregnant women on anti-retroviral treatment from 71% in 2015 to 88% in 2020. However, declining HIV positivity rates at these antenatal clinics and an absence of expansion of PMTCT services to other pregnant women due to cost-efficiency considerations contributed to a progressive decline in national PMTCT coverage rates. To achieve elimination of mother-to-child transmission of HIV, all pregnant women should be offered a HIV test, all who are HIV positive should be given anti-retroviral treatment, and all PMTCT services should be reported.
ABSTRACT
BACKGROUND: Governments are increasingly recognizing the need to focus limited HIV resources on specific geographic areas and specific populations to have a greater impact. Nigeria, with the second largest HIV epidemic in the world, is an important example of where more localized programming has the potential to improve the efficiency of the HIV response. METHODS: Using Spectrum software we modelled the Nigerian HIV epidemic using two methods: First, we created national HIV estimates using trends in urban and rural areas. Second, we created national HIV estimates using trends from each of the 37 states in Nigeria and aggregated these results. In both instances we used HIV surveillance data from antenatal clinics and household surveys and aggregated the trends to determine the national epidemic. RESULTS: The state models showed divergent trends in the 37 states. Comparing the national results calculated from the two methods resulted in different conclusions. In the aggregated state files, adult HIV incidence in Nigeria was stable between 2005 and 2013 (change of -6%), whereas the urban and rural file suggested incidence was decreasing over the same time (change of -50%). This difference was also reflected in the HIV prevalence trends, although the two methods showed similar trends in AIDS-related mortality. The two models had similar adult HIV prevalence in 2013: 3.0% (2.0-4.5%) in the aggregated state files versus 3.2% (3.0-3.5%) in the urban/rural file. CONCLUSION: The state-level estimates provide insight into the variations of the HIV epidemic in each state and provide useful information for programme managers. However, the reliability of the results is highly dependent on the amount and quality of data available from each sub-national area.