INCIDENCE OF HUMAN IMMUNE DEFICIENCY VIRUS (HIV) AND ASSOCIATED RISKS FACTORS AMONG PREGNANT WOMEN ATTENDING DUTSE GENERAL HOSPITAL

Page Title…………........................................................i

2.1 Hiv In Nigeria ……………………………………………………………………………….6

2.2 Hiv/Aids In Sub Saharan Africa …………………………………………………………….7

2.3 Socio Cultural Factors ………………………………………………………………………8

2.4 Economic Factor …………………………………………………………………………….11

2.5 Epidemiology Of Hiv ……………………………………………………………………….11

2.6 Susceptibility Of Women To Hiv Infection  ………………………………………………12

2.7 Effect Of Pregnancy On The Natural History Of Hiv Infection …………………………..13

2.8 Effect Of Hiv Infection On Pregnancy ……………………………………………………13

2.9 Mother Mother-To-Child Transmission …………………………………………………. 14

2.10 Intervention To Prevent Mother To Child Transmission Of Hiv ……………………….15

3.1 Study Area ………………………………………………………………………………..17

3.2 Sample And Sampling Techniques ………………………………………………………17

3.3 Method Of Data Collection ……………………………………………………………….17

3.4 Method Of Data Analysis: ………………………………………………………………...18

3.5 Ethical Consideration ……………………………………………………………………..18

 

Despite substantial worldwide success in the diagnosis and treatment of HIV and AIDS, new infections remain a considerable challenge. UNAIDS portrayed the situation in 2018 as a prevention crisis (UNAIDS, 2018). Studies have shown that around 60% of new adult HIV infections in Sub-Saharan Africa occur in women; this gender disparity is especially pronounced among adolescents and young adults, where the incidence of HIV among females is up to eight times higher than among males (UNAIDS, 2018).

The prevention of sero-conversion in pregnancy is particularly important among this at-risk population. Excessive levels of viral load, which occur during primary infection, represent the most significant risk factor for mother-to-child transmission. Therefore, pre- and perinatal acquired maternal HIV infections contribute considerably to the overall paediatric burden of HIV, accounting for around one third of new infections in children (Liu and Li, 2017). 

Several studies have been conducted to determine HIV incidence during pregnancy; a meta-analysis of these studies showed a pooled rate of 4.7/100 person-years. The risk of acquiring HIV was significantly higher among pregnant women in the African countries. In the meta-analysis, incidence estimates in three assessed studies from Nigeria were below the average HIV incidence estimate among pregnant women in Sub-Saharan Africa (Drake and Richardson 2014).

Although pregnant women appear to have a higher incidence of HIV compared to non-pregnant women, the evidence is rather ambiguous when it comes to the effect of pregnancy on HIV acquisition (Gray and serwadda, 2005). Some studies have suggested pregnancy may have a protective effect, attributing the reported higher HIV incidence among pregnant women to other confounding elements including behavioral factors typically associated with youth, such as being more sexually active and having male partners with more external sexual relationships. Other studies have suggested that pregnancy may impose a risk for HIV acquisition because of pregnancy-related immunological or hormonal changes, including elevated estrogen and progesterone levels leading to increased ectopy (hyperplasia of the columnar epithelium, hyperemia and stromal edema), resulting in elevated susceptibility to HIV among pregnant women (Gray and Serwadda, 2005) . Although the general risk factors for HIV seroconversion are known, it is not yet clear which of them are specifically relevant to pregnant women.

Nigeria is among the parts of the world that have been burdened most by HIV; there are 1.3 million people living with HIV in the country. The annual number of new infections has decreased from 160.000 in 2010 to 83.500 in 2015. The overall incidence rate in Nigeria was 0.76% in 2014 and is estimated to go down to 0.46% by 2020 (HIV and AIDS, 2015). Services for prevention of mother-to-child transmission (PMTCT) are well established in the country, and antiretroviral drug coverage has significantly expanded and now includes 95% of the pregnant women living with HIV, while in 2010 PMTCT coverage was only 31% (UNAIDS 2018). However, there seems to be a paucity of literature on the incidence of HIV infection during pregnancy in Nigeria. The last study to be conducted on this topic was a prospective study carried out in 2005 in Rakai District (Gray and Serwadda, 2005). This study showed a higher risk of HIV acquisition among pregnant women, suggesting the need for preventative measures during pregnancy in order to protect mothers and their babies. Nonetheless, there has not been a study of rates of new HIV infection in Nigeria since then. As a result there are substantial unanswered questions regarding both the HIV incidence in the country in general and more specifically with regards to risk factors that are particularly relevant during pregnancy. The objectives of our study were therefore to determine the incidence of HIV seroconversion among pregnant women in Dutse general hospital, and to identify socio-demographic, health-related and behavioral risk factors for contracting HIV during pregnancy. Fort Portal municipality in Dutse general has been one of Health facility with HIV-affected pregnant women. The high HIV incidence among pregnant women in Dutse general emphasizes the importance of retesting for HIV during pregnancy. This has already been recommended by WHO as an essential component. Current guidelines recommend testing women as soon as they enter ANC, and retesting pregnant women in the third trimester, during delivery or shortly thereafter (WHO 2015). However, it remains unclear whether these practices are implemented systematically in most health facilities given that many of them have limited resources and often face overcrowded ANC wards and staff shortages.

The incidence of HIV among pregnant women especially in an area like Dutse metropolis is beyond the caring capacity as so many people are struggling for their survival and for that they strive in changing the business area in which they leave their maternal domicile in to Lagos, Abeokuta, Illorin, Imo and the rest just to have something for their family.  However, the cases of HIV persist as they comes in contact with those who claimed prostitution as the survival path and along the way they transferred it to their wives living at home while they make it home. As Dutse General Hospital became the health center of so many villages, homestead and areas, people especially pregnant women come for antenatal and prenatal/postnatal care where the existence of the diseases will be notice henceforth. Despite all the availability of preventive measures and interventions, such as antiretroviral therapy (ART) and healthcare services, there is a concerning trend of increasing HIV diagnoses among pregnant women in the hospital. This why because they are afraid of seeking help from the heart-to-heart center of intervention. This mark the problem that imitate the concept of this study.

The prevention of sero-conversion in pregnancy is particularly important among this at-risk population. Excessive levels of viral load, which occur during primary infection, represent the most significant risk factor for mother-to-child transmission. Therefore, pre- and perinatal acquired maternal HIV infections contribute considerably to the overall paediatric burden of HIV, accounting for around one third of new infections in children (Liu and Li, 2017).

The aim is to access the incidence of HIV among pregnant women attending dutse general hospital, Jigawa State.

And the objectives includes;

Null-hypothesis HO: There is no any HIV incidence or associated risk factors among pregnant women attending Dutse General Hospital.

Alternative hypothesis HA: There is significance HIV incidence with so many risk factors among pregnant women attending Dutse General Hospital.

The research was focused on the Incidence of Human Immune deficiency virus and associated risk factor among pregnant women attending Dutse general hospital in other to improve health of pregnant women and reduced the transmission of diseases.