CATHOLIC CARITAS FOUNDATION OF NIGERIA AMREF HEALTH AFRICA INTERNATIONAL CONFERENCE SAFARI PARK HOTEL, NAIROBI NOVEMBER , 2014 EVALUATION OF REPEAT TESTING BY KNOWN HIV-POSITIVE CLIENTS ON OVERALL HIV TESTING RATES IN PMTCT OUTREACH SETTINGS IN NORTH-CENTRAL NIGERIA 1

CATHOLIC CARITAS FOUNDATION OF NIGERIA OUTLINE Introduction Description Findings Lessons learned Conclusion 2

CATHOLIC CARITAS FOUNDATION OF NIGERIA INTRODUCTION Nigeria’s HIV prevalence (4.1%) places her among the nations with high HIV burden. Consequently, a five-year plan to scale-up HIV Counseling and testing (HCT) services was developed by Government of Nigeria in This abstract reviews lessons learned from a two-day PMTCT services expansion program in 22 faith-based primary health care facilities in three states in Nigeria (Nasarawa, Kaduna and Plateau) 3

CATHOLIC CARITAS FOUNDATION OF NIGERIA MAP OF NIGERIA SHOWING INTERVENTION STATES 4

CATHOLIC CARITAS FOUNDATION OF NIGERIA FACILITIES NASARAWA (6)KADUNA (6)PLATEAU (10) ERCC PHC, KEFFIECWA CLINIC, KIBORIECWA CHC, MIANGO BASSA ECWA PHC, ARACOCIN PHC, YELWACOCIN PHC, SHENDAM ERCC DADEREHOPE FOR THE VILLAGE CHILD FOUNDATION, JACARANDA ECWA HEALTH CLINIC, RIMI RURAL HEALTH CENTRE, AGWAN TASHI SALEM MEDICAL CENTER, KAFANCHAN ECWA HEALTH CLINIC, TUDUN WADA ERCC PHC, MURYAECWA PCH, ANGWAN BAWA SAMINAKA COCIN PHC, DAFFO ERCC PHC, KARSHIASSEMBLIES OF GOD HOSPITAL, SAMINAKA ECWA PHC, ZABOLO COCIN PHC, AMPANG WEST COCIN PHC, GYEL ECWA HEALTH CLINIC, MARIRI COCIN PHC, GINDIRI 5

CATHOLIC CARITAS FOUNDATION OF NIGERIA DESCRIPTION Caritas Nigeria expanded HCT/PMTCT services to 22 faith- based facilities in July The expansion process followed a staged approach: Site assessments using a site assessment tool Analysis of data gathered from site assessment tools Selection of sites for PMTCT services Start-up trainings on HCT/PMTCT/EID were conducted Facility-led community mobilization with advocacy visits to the community gate keepers e.g. district head, leaders of religious groups and women groups 6

CATHOLIC CARITAS FOUNDATION OF NIGERIA DESCRIPTION (2) A 2-day activation schedule where Caritas Nigeria team worked with the facility and community The first day was reserved for pregnant women and nursing mothers, while the second day was for both general population and pregnant women/nursing mothers The activities included HIV pre-test counseling and general information, HIV testing, post-test counseling, commencement of pregnant positive clients on ARV prophylaxis, linkages for CD4 and other baseline investigations and referrals for clients that could not be managed in a PMTCT site The facility team were also empowered to carry on with follow-up for positive clients who were referred or in denial 7

CATHOLIC CARITAS FOUNDATION OF NIGERIA FINDINGS A total of 3276 persons had HCT including 1016 (31.0%) pregnant women/nursing mothers, comprising:  840 (82.7%) pregnant women and  176 (17.3%) nursing mothers. A total of 44 (4.3%) tested positive to HIV among the pregnant women/nursing mothers. Out of the 44 positive patients:  16 (36.4%) were placed on ARV prophylaxis  3 (6.8%) were referred out  6 (13.6%) refused to accept their result  19 (43.2%) of the positive pregnant women/nursing mothers were those who already knew their HIV status and later said they were taking HIV drugs in other facilities 8

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LESSONS LEARNED Repeat HIV testing by known HIV positive people consume resources that can be used to reach those who truly do not know their status, thus, militating against the HIV scale-up plan Hence, implementers of HIV testing in outreach settings need to strike a fine balance between strong community mobilization and effective sensitization to those who need the HIV test This will help reduce the pressure on the known positives to take part in outreach interventions 10

CATHOLIC CARITAS FOUNDATION OF NIGERIA CONCLUSIONS HIV testing in outreach settings requires effective sensitization More work needs to be done by the HIV community to develop a protocol that will address repeat testing by known positives 11

CATHOLIC CARITAS FOUNDATION OF NIGERIA Dr. JOHN OLAWEPO MBBS, MPH, PMP ;