LAS VEGAS — Churches and other faith-based centers could be prime venues to test pregnant women for HIV and to link those who test positive with treatment, according to new research published in The Lancet Global Health.
In random trials led by UNLV professor Echezona Ezeanolue in Nigeria as part of the “Baby Shower Project,” pregnant women offered prenatal screenings for HIV and other ailments at a monthly church-run baby shower were 11 times more likely to opt for HIV testing than those encouraged to go for routine HIV screening at local health facilities.
Sub-Saharan Africa is home to around 87 percent of the 1.5 million pregnant women with HIV and more than 90 percent of children with HIV, according to Joint United Nations Programme on HIV/AIDS (UNAIDS) estimates. Despite the increasing availability of simple, inexpensive, and highly effective drug regimens to prevent mother-to-child transmission of HIV, a third of HIV-infected women do not start treatment during their pregnancy, resulting in about 210,000 new child infections every year.
“There are many reasons why these numbers have not improved, but poor access to routine HIV screening remains a critical problem,” explains Dr. Ezeanolue, study lead author and director of global health and implementation research initiatives for UNLV’s School of Community Health Sciences.
Ezeanolue said that most pregnant women in sub-Saharan Africa access HIV screening through the healthcare system. But in many countries, including Nigeria, only a third of deliveries take place in hospitals and less than 3 percent of healthcare facilities have established services for the prevention of mother-to-child transmission.
“We have been looking for new ways to reach out and offer sustainable community-based testing programs to pregnant women to eliminate new HIV infections among children,” he said.
Faith-based organizations are highly influential across Africa, especially in Nigeria, and religious leaders play critical roles in the fight against AIDS.
Ezeanolue and colleagues conducted a cluster randomized trial of 40 churches in rural southeast Nigeria. Pregnant women attending half the churches participated in a monthly baby shower, where they were offered free on-site screenings for HIV, malaria, sickle-cell genotype, and Hepatitis B, and given basic health education and kits containing delivery supplies. A control group of pregnant women attending the other 20 churches were encouraged to pursue prenatal care on their own at health facilities where HIV testing was available.
HIV testing rates were significantly higher in the baby shower group (1,514 of 1,647 women, or 92 percent) than in the control group (740 of 1,355 women, or 55 percent). Women attending the baby showers were also six times more likely to be connected to HIV care and start drug therapy.
“Most communities in sub-Saharan Africa have at least one religious center even when there are no accessible health facilities,” Ezeanolue said. “Our findings show that simple culturally-adapted faith-based programs such as the Baby Shower Project can effectively increase the uptake of HIV testing among pregnant women in resource-limited settings.”
The research — conducted in collaboration with scientists from New York University, University of Nigeria and University of Nevada, Reno — was funded by the U.S. President’s Emergency Plan for AIDS Relief (PEPFAR) and the National Institutes of Health (NIH). In September, NIH awarded Ezeanolue additional funding to expand the project through development of software and a web database that easily transmits screened patients’ HIV, Hepatitis B and sickle cell test results to hospitals and clinics, increasing the likelihood that facilities initiate intervention.
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