Nigeria is one of the 22 countries identified by the WHO to account for 90% of pregnant women living with HIV. Despite expansions of HIV prevention programs in Nigeria, only 14% of pregnant women were tested for HIV; only 27% of HIV-infected pregnant women received WHO recommended antiretroviral (ARV) therapy; only 11% of HIV-exposed infants received ARV prophylaxis for prevention of mother-to-child HIV transmission (PMTCT) and only 3.9% of exposed infants received appropriate testing within two months and an estimated 51,000 infants became infected with HIV in 2013. Risk of perinatal transmission is increased when a pregnant woman is co-infected with HIV and hepatitis B virus (HBV) infection which remain endemic in Nigeria where liver cancer is now the most common cause of cancer death. Children with sickle cell disease (SCD) are also at increased risk of HIV due to frequent blood transmission and an estimated 50-80% of these children die before their 5th birthday. Despite availability of simple inexpensive interventions such as penicillin prophylaxis, hepatitis B vaccine or antiretroviral prophylaxis, implementation remains inconsistent. In 2013, we demonstrated that the Healthy Beginning Initiative [HBI], a congregation-based intervention that uses prayer session to identify pregnant women early, baby shower to implement an integrated testing (HIV- plus hepatitis B and sickle cell genotype) and baby reception for follow up is acceptable and effective in increasing HIV testing among pregnant women. For this application, we will develop and test the feasibility, acceptability and usability of a web-based database and medical decision model that captures results for HIV, HBV and sickle cell genotype obtained during HBI participants; store data in a secure, web-based database; encrypt data on a smart card which is given to participants, and make these data available at the point-of- delivery using a cell-phone application to read the smart card. Data on the web-based database can also be accessed directly using the cell phone application. Evidence exists that when clinician have maternal records available at the point of delivery, they are more likely to initiate antiretroviral prophylaxis for HIV-exposed infants, administer first dose of hepatitis B vaccine with 24 hours for infants born to women who have positive hepatitis B surface antigen and screen infants born to mothers with sickle cell trait to allow early identification and initiation of penicillin prophylaxis for infants who have sickle cel disease. The ultimate endpoint for the Phase III trial is reduction in mortality among children wit sickle cell disease and prevention of perinatal transmission of HIV and HBV infections. This proposal is collaboration among Sunrise Foundation (local PEPFAR-supported partner in Nigeria); University of Illinois Urbana-Champaign (concept mapping, focus group and key informant interviews); Xavier University (data management and analysis) and University of Nevada, Reno (overall oversight and evaluation of program effectiveness).
Integrated approaches to seek, test, treat and care for pregnant women to prevent perinatal transmission of diseases and identify infected/affected infants to allow for early intervention to reduce transmission, morbidity and death are urgently needed in resource-limited settings. We propose to develop and test the feasibility, acceptability and usability of a web-based data platform and a medical decision model that is integrated with a community-based screening program for HIV, HBV and sickle cell genotype that will store data in a secure web-based database; capture data in a chip imbedded 'smart card', and use a cell phone application to read the card to make data available at the point-of-delivery. Evidence shows that when clinician have maternal records at the point of delivery, they are more likely to initiate antiretroviral prophylaxis for the HIV-exposed infant, give the first dose of hepatitis B vaccine to an infant born to a mother who is positive for hepatitis B surface antigen within 24 hours of birth and screen infants born to mothers with sickle cell trait to identify sickle cell disease and implement intervention such as penicillin prophylaxis.
