Elimination of mother-to-child transmission of syphilis: Is it a reality in Nigeria by 2020?

BACKGROUND: Congenital syphilis is a global health problem, yet it has received little attention in recent years. Despite cost-effective syphilis screening and treatment, it continues to contribute hugely to perinatal morbidity and mortality worldwide. AIMS: To determine the prevalence and treatment coverage trend for syphilis among pregnant women in the national prevention of mother-to-child transmission programme in Nigeria and to evaluate progress towards the elimination of congenital syphilis in the country. METHODS: A retrospective analysis of validated national health sector performance data on pregnant women attending antenatal care at prevention of mother-to-child transmission clinics from 2013 to 2016 in Nigeria. RESULTS: The proportion of new antenatal care attendees who annually received serological testing for syphilis increased from 12.2% in 2013 to 16.3% in 2016 (p-trend<0.0001). Although the prevalence of maternal syphilis decreased from 3.2% in 2013 to 1.4% in 2016 (p-trend<0.0001), the syphilis treatment coverage during pregnancy has decreased from 71.3% in 2013 to 54.9% in 2016 (p-trend<0.0001). CONCLUSIONS: Maternal syphilis screening and treatment in Nigeria are inadequate to meet the elimination aspirations. A rapid scale-up of antenatal care syphilis screening and treatment are crucial to averting an epidemic in Nigeria by 2020.

Redefining the HIV epidemic in Nigeria: from national to state level.

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.