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J Acquir Immune Defic Syndr. 2016 Aug 1;72 Suppl 2:S161-6. doi: 10.1097/QAI.0000000000001066.

Identifying and Prioritizing Implementation Barriers, Gaps, and Strategies Through the Nigeria Implementation Science Alliance: Getting to Zero in the Prevention of Mother-to-Child Transmission of HIV.

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1Department of Epidemiology and Biostatistics, Global Health and Implementation Research Initiatives, Division of Health Sciences, University of Nevada, Las Vegas, Las Vegas, NV; 2HealthySunrise Foundation, Enugu, Nigeria; 3Department of Health Policy and Management, Gillings School of Global Public Health, University of North Carolina at Chapel Hill, Chapel Hill, NC; 4Centre for Clinical Care and Clinical Research, Abuja, Nigeria; 5Partners for Prevention, Education, Training, Treatment and Research, Abuja, Nigeria; 6Division of Epidemiology and Prevention, Institute of Human Virology, University of Maryland, Baltimore, MD; 7Institute of Human Virology, Abuja, Nigeria; 8AIDS Prevention Initiative, Abuja, Nigeria; 9School of Public Health, Harvard University, Cambridge, MA; 10Maryland Global Initiatives Corporation, Baltimore, MD; 11Enhanced Health Access Initiatives, Abuja, Nigeria; 12Family Health International, Abuja, Nigeria; 13Center for Integrated Health Programs, Abuja, Nigeria; 14Solina Health, Abuja, Nigeria; 15Excellence Community Education Welfare Scheme, Abuja, Nigeria; 16Excellence and Friends Management Consult, Abuja, Nigeria; 17ProHealth International, Abuja, Nigeria; 18Catholic Caritas Foundation Nigeria, Abuja, Nigeria; 19Federal Ministry of Health, Abuja, Nigeria; 20National Agency for Control of AIDS, Abuja, Nigeria; 21Vanderbilt Institute for Global Health, Vanderbilt University Medical Center, Nashville, TN; 22Fogarty International Center, National Institutes of Health, Bethesda, MD; 23Office of the US Global AIDS Coordinator, US Department of State, Washington, DC; and 24Eunice Kennedy Shriver National Institute of Child Health and Human Development, National Institutes of Health, Bethesda, MD.



In 2013, Nigeria accounted for 15% of the 1.3 million pregnant women living with HIV in sub-Saharan Africa and 26% of new infections among children worldwide. Despite this, less than 20% of pregnant women in Nigeria received an HIV test during pregnancy, and only 23% of HIV-infected pregnant women received appropriate intervention following HIV diagnosis. This article reports findings from 2 structured group exercises conducted at the first Nigeria Implementation Science Alliance Conference to identify (1) barriers and research gaps related to prevention of mother-to-child transmission (PMTCT) and (2) potential strategies and interventions that could address PMTCT challenges.


Two 1-hour structured group exercises were conducted with 10 groups of 14-15 individuals (n = 145), who were asked to brainstorm barriers and strategies and to rank their top 3 in each category. Data analysis eliminated duplicate responses and categorized each of the priorities along the HIV care continuum: HIV diagnosis, linkage to care, or retention in care.


Participating stakeholders identified 20 unique barriers and research gaps related to PMTCT across the HIV continuum. Twenty-five unique interventions and implementation strategies were identified. Similar to the barriers and research gaps, these interventions and strategies were distributed across the HIV care continuum.


The barriers and strategies identified in this study represent important pathways to progress addressing MTCT. The deliberate involvement of state and federal policy makers, program implementers, and researchers helps ensure that they are relevant and actionable.

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