1. Reaching the hard-to-reach: Integrating
HIV Counselling and Testing (HCT) in Maternal New-
born & Child Health (MNCH) Week – in Nigeria
By
Mr Araoye Segilola, Director, PDA
Dr Chukwuma Anyaike, CSG II/Head Prevention
National AIDS/STIs Control Programme (NASCP)
FEDERAL MINISTRY OF HEALTH, NIGERIA

2. 2
Outline of Presentation
• Background
• Objectives of the intervention
• Strategies and Structure
• Links to policy
• Service Delivery
• Successes and Challenges
• Sustainability and Replication
• Awards and Recognition
• Lessons Learned

3. 3
Background information
Located in West African region.
Estimated population 177 millions
Annual
Most populous country in Africa and
10th globally
# Annual pregnancy - 6 Millions
# Health facilities – 22, 726
Total Fertility rate - 5.7%
Comprised 36 states and Federal Capital Territory (Abuja)
# of Local Government Areas - 774

4. 4
Background 2
• Nigeria has the second highest burden of HIV in the world with a National
prevalence of 3.4% and approximately 3.3 million people living with HIV.
• The National mode of transmission study indicates that MTCT accounts for
22% of new infections.
• The number of pregnant women provided with antiretroviral drugs (ARVs)
for the purpose of PMTCT has increased from 13,000 in 2006 to 58,000 in
2013.
• Bottlenecks to eMTCT include inadequate access to HCT, poor uptake of
PMTCT services at the health facilities, barrier due to user fees, traditional
beliefs and practices, stigma and discrimination, missed opportunities due
to parallel programming and funding, lack of adequate infrastructure
including technical competence and man power.
• The MNCH week is an established platform in Nigeria implemented by the
Federal Ministry of Health where Antenatal services are provided to
pregnant women; immunization services to new born and infants; and family
planning to non-pregnant mothers. This provides ample opportunity to
access women of reproductive age including pregnant women with HCT
services.

5. 5
Objectives of the HCT/ MNCH
Integration
• To increase awareness of HIV and uptake
of HCT among women of reproductive
health but especially Pregnant women.
• To effectively link them to nearby health
facility for PMTC services.
• To replicate the findings and strategy to
other states of the federation.

6. 6
Strategies and Structure
• The first documented modeling of HCT in MNCH Week was in
Benue State conducted in June 2013 and generated the framework.
• Creation of enabling environment by the development of guidance
note/document.
• Leveraging on existing MNCH service delivery structures for HCT at
the grassroots.
• Active engagement of the communities, gate keepers, Civil Society(
ASWHAN) and implementing partners
• Several pre-programme meetings with multi-stakeholder planning
before implementation phase.
• Effective Coordination at all levels of health system
• The Programme was health facility based

7. 7
Links to Policy
• It encouraged the health facility delivery of
babies and improved health seeking
behaviour.
• Delivery by skilled health care workers
with the associated advantages
• The use of ARVs for the PMTCT

8. 8
Service Delivery
Coverage Preg. Women &
Tested ( 623 facilities in 5+1 States)
200,000
110,397 108,972
0
50,000
100,000
150,000
200,000
250,000
Target
Actual
 # of HIV +preg. Wome- 1,434
(1.3%)
KADUNA STATE
Target - 53,021
Actual - 39,657 ( 74.8%)
C T & R - 38,429 (72.5% )
HIV+ - 207 ( 0.54%)

9. 9
Successes and Challenges
• Coverage of HIV testing among pregnant women during the week of
the HCT@MNCHWeek initiative was two-fold the coverage of HCT
during routine HCT at ANC in a 6-month period (January-June 2014)
prior to the campaign.
• It also provided opportunity for HCT for women of reproductive age;
takes care of prong 1 of the PMTCT elements.
• In some of the states it provided opportunity for men engagement .
• It provided opportunity for women at hard to reach areas and was
also cost effective.
• It provided a platform for effective linkages and referrals in the
system.

10. 10
Challenges
• The late arrival of HIV test kits in few
states delayed the HIV testing until the
third day of the campaign.
• Paucity of health care workers at the
health facilities.

11. 11
Sustainability and Replication
• Engagement of all stakeholders from the planning stage,
and capacity building at the lower level of care to
integrate HCT into MNCH Week.
• Particular attention was given to supply and procurement
of HIV test kits before the campaign.
• There has also been revision of current tools and data
base to measure and evaluate the HCT and MNCH
services.
• Daily supervision and real-time data collection are
potential success factors.

12. 12
Awards and Recognition
• The success of HCT/MNCH integration has been recognized by the
National Programme to increase uptake of PMTCT services in
Nigeria.
• This has lead to the review MNCH guidance note and integration of
the HCT protocols.
• The data collection tools have also been reviewed for appropriate
integration.
• The strategy has been adopted for replication in other states of the
federation.

13. 13
Lessons learned
• Government leadership and coordination of multi-level stakeholders was
critical to the success of this integration of HCT during the MNCH week
• Adequate and proper engagement of Communities, Gate keepers and civil
society organization was very critical to the achievements made.
• Regular stakeholders meeting was key for coordinated outcome.
• The use of Community Based Organizations enhanced appropriate linkages
and referrals and improved retention in care.
• The HCT/MNCH integration strategy improved health seeking
behaviour/demand creation.
• Innovative demand creation approaches of using clergymen, imams were
helpful in demand creation. Also conduct of additional rounds of demand
creation activities in the community so as to reach those away at work
during the day
• Motivation of staff was also a key factor
• Real-time daily data reporting using mobile phone helped in coordination
and review meetings to inform decision making.

14. 14
Conclusion
• The HCT in MNCH Week initiative is grounded on a valid
rationale of integration of services to increase utilization
of HIV testing and other MNCH services among women
of reproductive age and their under-five children, and
their male partner in Nigeria.
• Under Government leadership, and in partnership with
implementing partners, over 200,000 pregnant women
(3% of annual target) were reached in a week with
integrated HCT and MNCH services.
• Strong community endorsement of the activity was
evidenced through active participation of community
leaders and volunteers from CBO/PLHIV association.

15. 15
Acknowledgements
• UNICEF
• NPHCDA
• USG/PEPFAR
• NEPWHAN
• ASWHAN
• NACA
• SASCP

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Thank you for listening!