Skip to main page content
U.S. flag

An official website of the United States government

Dot gov

The .gov means it’s official.
Federal government websites often end in .gov or .mil. Before sharing sensitive information, make sure you’re on a federal government site.

Https

The site is secure.
The https:// ensures that you are connecting to the official website and that any information you provide is encrypted and transmitted securely.

Access keys NCBI Homepage MyNCBI Homepage Main Content Main Navigation
Multicenter Study
. 2018 Apr 17;16(1):32.
doi: 10.1186/s12961-018-0309-x.

Generating evidence for health policy in challenging settings: lessons learned from four prevention of mother-to-child transmission of HIV implementation research studies in Nigeria

Nadia A Sam-Agudu  1   2 , Muktar H Aliyu  3   4 , Olusegun A Adeyemi  5   6 , Frank Oronsaye  7 , Bolanle Oyeledun  7 , Amaka G Ogidi  8 , Echezona E Ezeanolue  9   10
Affiliations
Multicenter Study

Generating evidence for health policy in challenging settings: lessons learned from four prevention of mother-to-child transmission of HIV implementation research studies in Nigeria

Nadia A Sam-Agudu et al. Health Res Policy Syst. .

Abstract

Background: Implementation research (IR) facilitates health systems strengthening and optimal patient outcomes by generating evidence for scale-up of efficacious strategies in context. Thus, difficulties in generating IR evidence, particularly in limited-resource settings with wide disease prevention and treatment gaps, need to be anticipated and addressed. Nigeria is a priority country for the prevention of mother-to-child transmission of HIV (PMTCT). This paper analyses the experiences of four PMTCT IR studies in Nigeria, and proffers solutions to major challenges encountered during implementation.

Studies included and findings: Multicentre PMTCT IR studies conducted in Nigeria during the Global Plan's assessment period (2011 to 2015) were included. Four studies were identified, namely The Baby Shower Trial, Optimizing PMTCT, MoMent and Lafiyan Jikin Mata. Major common challenges encountered were categorised as 'External' (beyond the control of study teams) and 'Internal' (amenable to rectification by study teams). External challenges included healthcare worker strikes and turnover, acts and threats of ethnic and political violence and terrorism, and multiplicity of required local ethical reviews. Internal challenges included limited research capacity among study staff, research staff turnover and travel restrictions hindering study site visits. Deliberate research capacity-building was provided to study staff through multiple opportunities before and during study implementation. Post-study employment opportunities and pathways for further research career-building are suggested as incentives for study staff retention. Engagement of study community-resident personnel minimised research staff turnover in violence-prone areas.

Conclusions: The IR environment in Nigeria is extremely diverse and challenging, yet, with local experience and anticipatory planning, innovative solutions can be implemented to modulate internal challenges. Issues still remain with healthcare worker strikes and often unpredictable insecurity. There is a dire need for cooperation between institutional review boards across Nigeria in order to minimise the multiplicity of reviews for multicentre studies. External challenges need to be addressed by high-level stakeholders, given Nigeria's crucial regional and global position in the fight against the HIV epidemic.

Keywords: HIV; Health systems research; Implementation research; Implementation science; Nigeria; PMTCT.

PubMed Disclaimer

Conflict of interest statement

Ethics approval and consent to participate

All four studies were approved by the Nigerian National Health Research Ethics Committee. The INSPIRE (MoMent and LJM) studies were also approved by the Ethics Review Committee of the World Health Organization. Additionally, the Baby Shower Trial was approved by the Institutional Review Board (IRB) of the University of Nevada Reno; the Optimizing PMTCT study was approved by the IRB of Vanderbilt University; and MoMent was approved by the IRB of the University of Maryland Baltimore.

Competing interests

The authors declare that they have no competing interests.

Publisher’s Note

Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.

Figures

Fig. 1
Fig. 1
Geographical scope of the four PMTCT implementation research studies in Nigeria
See this image and copyright information in PMC

Similar articles

See all similar articles

Cited by

References

    1. UNAIDS . The Global Plan towards the elimination of new HIV infections among children by 2015 and keeping their mothers alive, 2011–2015. 2011. - PubMed
    1. Hamilton E, Bossiky B, Ditekemena J, Esiru G, Fwamba F, Goga AE, et al. Using the PMTCT cascade to accelerate achievement of the Global Plan goals. J Acquir Immune Defic Syndr. 2017;75(Suppl 1):S27–s35. doi: 10.1097/QAI.0000000000001325. - DOI - PMC - PubMed
    1. UNAIDS . 90–90–90: An Ambitious Treatment Target to Help End the AIDS Epidemic. 2014.
    1. UNAIDS . Report on the Global AIDS Epidemic. 2016.
    1. UNAIDS . On the Fast Track to an AIDS Free Generation: The Incredible Journey of the Global Plan Towards the Elimination of New HIV Infections among Children by 2015 and Keeping Their Mothers Alive. 2016.

Publication types