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

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.