HIV: ‘Man­power is our great­est chal­lenge in FCT’ is the project Man­ager for the FCT Agency for the Con­trol of AIDS (FACA). He speaks on the ef­forts of the agency to stem the spread of the HIV/AIDS from mother to child in the FCT, and their var­i­ous challe

Dr Uche Okoro

Daily Trust - - HEALTH - By Ruby Leo Dr. Uche Okoro

What does your work en­tail?

FCT Agency for the Con­trol of AIDS is the co­or­di­nat­ing body of all HIV ac­tiv­i­ties in the FCT, both health sec­tor and non health sec­tor re­sponse. HIV is a devel­op­men­tal is­sue. We have other is­sues that re­late to HIV. That is what we call non sec­tor re­sponse.

PMTCT is very im­por­tant for us in terms of try­ing to re­duce the new HIV in­fec­tions through mother trans­mis­sion and we have a five- year strate­gic plan whereby all our HIV ac­tiv­i­ties are be­ing drawn yearly in terms of work plan. So we are scal­ing up in all the sec­ondary fa­cil­i­ties in the FCT. We are pro­vid­ing free HIV, free PMTCT ser­vices in all the sec­ondary fa­cil­i­ties. We are also ex­pand­ing into Pri­mary Health Care cen­tres in the six FCT mu­nic­i­pal coun­cils. Right now, we have more than 180 cen­tres in the FCT where PMTCT ser­vices are be­ing pro­vided.

We have people from fa­cil­i­ties across the six area coun­cils that bring data on how women ac­cess the PMTCT ser­vices, how many women were tested, how many re­ceived their re­sult , how many women were pos­i­tive, how many of them also ac­cept the pre pro­phy­laxis.

Be­cause a cer­tain level of them that are pos­i­tive should be on pro­phy­laxis so that the child will not be HIV pos­i­tive. So all these are data that we gen­er­ate on monthly ba­sis and we an­a­lyse them. Quar­terly, we also visit fa­cil­i­ties to su­per­vise, to make sure that those data they give to us are gen­uine.

So in the FCT, the good news is that PMTCT ser­vices are free. We are happy that our women are com­ing out to ac­cess ser­vices. In­fact, our ma­jor prob­lem now is man power to at­tend to the num­ber of women com­ing out for ser­vices. We are happy that our preg­nant women are com­ing out. You know that glob­ally, Nigeria is not do­ing well in PMTCT. Nigeria con­trib­utes 30 per cent of the bur­den. That is why both the federal govern­ment and the FCT specif­i­cally are do­ing ev­ery­thing to see that no child is born pos­i­tive even if the mother is HIV pos­i­tive.

Does the de­liv­ery of HIV pos­i­tive moth­ers tally with those who at­tend ante natal clinic?

We have a very good turn out of women for ante natal but some of them, for one rea­son or the other, do not come back to deliver. This wor­ries us be­cause the essence of PMTCT is to en­sure that a child that is be­ing de­liv­ered is neg­a­tive and labour is a very cru­cial is­sue or point whereby a child can be­come pos­i­tive if it’s not be­ing han­dled in a proper cen­tre.

We have a lot of is­sues. Some pri­mary health care cen­tres are not well-staffed. You have only CHEW staff in some of the cen­tres han­dling ante natal. Some people may not feel com­fort­able go­ing to deliver where a man is tak­ing de­liv­ery. So its an is­sue. The pri­mary health care is solely un­der the lo­cal govern­ment and it is their duty to make sure that the pri­mary health care func­tions in terms of em­ploy­ment, in terms of com­modi­ties avail­abil­ity.

Our chal­lenge is mak­ing sure that the right health care worker at that level are avail­able at all the time. So it is a big chal­lenge for us, not only in the FCT, even across the coun­try to en­sure that the cen­tres are ac­tu­ally equipped in terms of staff and com­modi­ties.

In the FCT, we are try­ing to see how we can en­gage with them. We are try­ing to see how we can pro­vide equip­ment to some of the pri­mary health care cen­tres where we know that there is a high turnover of preg­nant women. We go out of our way to see how we can see to it that those cen­tres are fully equipped. On the is­sue of staff, it’s a pol­icy is­sue that we can­not in­ter­vene. So it’s a chal­lenge in that di­rec­tion. That is why we see in some in­stances that the sec­ondary fa­cil­i­ties are over stretched and overwhelmed with preg­nant women be­cause the pri­mary health care cen­tres near­est to them are not ad­e­quate.

What strate­gies have you put in place to en­sure that they give birth in the health cen­tres af­ter

at­tend­ing ante natal?

One of the strate­gies is that we are en­gag­ing ward de­vel­op­ment com­mit­tees. In each of the ward, there is a struc­ture at ward level to en­sure things move smoothly. We have tried to pro­vide some lit­tle funds through the ward de­vel­op­ment com­mit­tee to en­sure that the preg­nant women within their ward ac­tu­ally ac­cess ser­vices in the near­est pos­si­ble cen­tre. Be­cause they can­not force some­body; some­body who say, I will not deliver here. There’s no way you can force a woman. But you should be able to pro­vide other al­ter­na­tives. Since there is no mid­wife here and all the CHEWS are all male and you don’t feel com­fort­able, there is an al­ter­na­tive which the ward de­vel­op­ment com­mit­teeS are also as­sist­ing us to make sure that the re­fer­ral are done and the woman also ac­cess those ser­vices in the near­est pos­si­ble cen­tres that she can be able to deliver.

The SURE-P and MSS pro­grammes are also as­sist­ing us in that di­rec­tion to make sure that the mid­wives in these two schemes are also be­ing posted es­pe­cially to those pri­mary health care cen­tres that we have high turn over of preg­nant women.

FCT is one of the high risk states. What other mea­sures are you putting in place to re­duce the preva­lence?

The good thing we have done in the FCT is that we have been able to look at our pre­vi­ous in­ter­ven­tions and com­pare with the present. We ask our­selves, why is it that we are not get­ting it right. Now, what we are do­ing is that, based on the data we have, we rec­og­nize that the FCT epi­demic is mixed con­cen­trated epi­demic. What it means is that there is a pop­u­la­tion we call, Most At Risk Pop­u­la­tion. These are fe­male sex work­ers, men hav­ing sex with men and IDUs.

In the FCT, the HIV preva­lence among them is rel­a­tively high and there is a link­age be­tween this tar­get pop­u­la­tion and the gen­eral pop­u­la­tion. In the past, all our em­pha­sis had been on the gen­eral pop­u­la­tion. We ne­glected this Most At Risk Pop­u­la­tion. Even though their pop­u­la­tion is quite very few but this is the reser­voir of in­fec­tions. So in 2012, we did what we call an epi­demi­o­log­i­cal ap­praisal. What it means is that, we are able now to do map­ping of hotspots in FCT. As we are talk­ing now, we know ex­actly how many hotspots are in the FCT six area coun­cils. We also have es­ti­ma­tions of the Most At Risk Pop­u­la­tions in each of these hotspots. We are now plan­ning how we can carry out tar­geted in­ter­ven­tions in each of these pop­u­la­tions.

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