Churches effective locations for increasing HIV testing and treatment among pregnant women

Churches and other faith-based centres could be prime venues for offering HIV testing to pregnant women and linking those who test positive with antiretroviral treatment (ART), according to new research from Nigeria published in The Lancet Global Health.

In the Baby Shower randomised trial, pregnant women offered antenatal screening (including HIV, malaria, and syphilis) 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.

Worldwide, UNAIDS estimates that around 87% of the 1.5 million pregnant women with HIV and over 90% of children with HIV live in sub-Saharan Africa. Despite the increasing availability of simple, inexpensive, and highly effective ART regimens to prevent mother-to-child transmission of HIV, a third of HIV-infected women do not start ART during their pregnancy, resulting in around 210 000 new child infections every year¹.

"There are many reasons why these numbers have not improved, but poor access to routine HIV screening remains a critical problem,"² explains lead author Professor Echezona Ezeanolue from the School of Medicine and Community Health Sciences, University of Nevada, Las Vegas, USA.

"Most pregnant women in sub-Saharan Africa access HIV screening through the healthcare system. But in many countries, like Nigeria, only a third of deliveries take place in hospitals and less than 3% 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 programmes to pregnant women to eliminate new HIV infections among children."²

Faith-based organisations are highly influential across Africa, and religious leaders play critical roles in the fight against AIDS. Nigeria is ranked first among 53 other countries worldwide in church attendance³.

In an effort to increase uptake of HIV testing and ART among pregnant women in hard-to-reach and rural areas, Professor Ezeanolue and colleagues conducted a cluster randomised trial of 40 churches in southeast Nigeria. Pregnant women attending half the churches were offered free onsite antenatal screening (including for HIV, malaria, sickle-cell genotype, and hepatitis B), basic health education, and a Mama Pack of basic clinical supplies for delivery (eg, sanitary pads, clean razor blade, alcohol, and gloves) during a monthly baby shower as part of the Healthy Beginning Initiative. Pregnant women attending the other 20 churches were encouraged to attend prenatal care at health facilities where HIV testing was available (control group).

HIV testing rates were significantly higher in the baby shower group than in the control group (1514 of 1647 women [92%] vs 740 of 1355 women [55%]). Women attending the baby showers were also significantly (six times) more likely to be connected HIV care and start ART.

According to Professor Ezeanolue, "Most communities in sub-Saharan Africa have at least one religious centre even when there are no accessible health facilities. Our findings show that simple culturally-adapted faith-based programmes such as the Healthy Beginning Initiative can effectively increase the uptake of HIV testing among pregnant women in resource-limited settings."²

Writing in a linked Comment, Benjamin Chi and Elizabeth Stringer from the University of North Carolina at Chapel Hill School of Medicine, North Carolina, USA say, "The Healthy Beginning Initiative provides an evidence-based blueprint for how churches and health clinics can collaborate to produce measurable programmatic benefits. By extending such strategies from HIV testing to long-term adherence and retention, these programmes can further deliver on their promise and meaningfully contribute to the elimination of paediatric HIV in the region."

They add, "How the congregation-based intervention would perform in settings where a lower proportion of the population attends church regularly or where HIV prevalence is higher is not known. Plans are already underway to adapt and extend the initiative to mosques in northern Nigeria and Hindu temples in India. Such pilot programmes are needed to confirm the intervention's effectiveness and to help inform broader implementation efforts."