2016 Nigeria

Strategies for the prevention of pediatric HIV / Study of social barriers accompanying adolescent HIV in Nigeria

Summer 2016

Led by Nadia Sam-Agudu, MD, School of Medicine, Institute of Human Virology

Students (school affiliation): Megan Belich (social work), Katherine Nelson (nursing), Erika Saunders (pharmacy), Daniel Lee (medicine), Gloria Rinomhota (pharmacy)

Project summary

The overall goal of the primary research study entitled, ”The impact of mentor mother programs on prevention of mother-to-child transmission of HIV (PMTCT) service uptake and retention-in-care at primary health care facilities in Nigeria” is a prospective cohort study that is currently in its fourth year. This study compares retention rates among HIV-positive pregnant women who are paired with a mentor mother to those who receive standard care. It is estimated that only 10-20% of HIV+ pregnant women in Nigeria receive PMTCT services and women who do received services usually have poor retention. Nigeria seeks to find efficient and sustainable interventions to provide more HIV+ pregnant women with more psychosocial and other support services.

The second project focused on identifying the social barriers for adolescents living with HIV to attend boarding schools which is considered a rite of passage in Nigeria. The team worked on developing a conceptual framework that included issues around relationships and trust, HIV knowledge, disclosure, stigma and discrimination, school climate, privacy and confidentiality, clinical care and medications. Students also developed focus group questionnaires for different two groups: 1) parents and guardians of adolescents living with HIV and 2) teaching and medical staff of ART clinics and schools; and key informant interview questionnaires for adolescents living with HIV and key individuals at the Ministry of Health and Ministry of Education.

The two studies were in different stages--one was coming to an end while the other was in its formative stage. This provided students the opportunity to observe how processes and tasks evolve over the course of a research study. Their work on the MoMent study involved tracking, data entry, site visits and creating questionnaires while their work on the adolescent project involved study design and developing questionnaires.

Reflections

“Working on a team with four students from other disciplines allowed for interdisciplinary collaboration that we didn’t get to experience through our programs. Everyone had something to contribute. I think by the end we all had a better sense of how we can collaborate with these other disciplines once we begin working. We received such a warm welcome from the staff at the Institute of Human Virology Nigeria. They really made us feel like a part of the team from the moment we arrived--bringing us up to speed on the status of the study and assigning and guiding us in our tasks. We were able to experience the day-to-day life in their office. Seeing all the challenges that come along with executing a large research project in Nigeria put into perspective all the work that goes behind the research that we use everyday in each of our fields." - Katherine Nelson

“As a social worker I'm constantly looking at the person-in-environment model when making an assessment. When looking through that lens in another country combined with its cultural context is a wonderful challenge. I'm grateful for this experience to expand my understanding of how other cultures approach mental health. I gained knowledge and understanding of how research is done effectively, and furthermore, how data can then inform policy and programming.” - Megan Belich

"Clinically, I was able to learn firsthand from the health professionals at the clinics about adolescent HIV. I learned how records are kept and how counseling is done in an environment extremely different from American hospitals. I was able to take this live experience, along with our team’s discussions, and realize how health care overall is developing in a foreign country. From this, I gained more appreciation, humbleness, and compassion for people overall.  Professionally, I strengthened my communication skills, along with my ability to work with other disciplines, who think differently than me.  I am so blessed to have had this experience because I truly learned more about myself and others than I would have ever learned solely attending pharmacy school. I encourage everyone who is able to, to apply for a global health opportunity." - Erika Saunders

“I love seeing the research numbers and data. However, this global health grant provided the opportunity to put these results within the framework of the Nigerian community. Through conversations with community members and team members with diverse backgrounds and interests, I was able to appreciate the true impact of our research efforts. Additionally, I was able to process the breadth of work that is required for a research project by working at the end of one (MoMent) and the beginning of another (Adolescent).” - Daniel Lee

“The global health project to Abuja, Nigeria was crucial in expanding my education and understanding of global health. I learned so many things that I know I will never find in a textbook. We had an opportunity to hear from an IHVN staff member working on the Adolescent HIV project. She emphasized the difficulty parents face when disclosing the child’s HIV status and explaining why adherence to their HIV medication is crucial. She elaborated on how some adolescents accept their status, some stay in denial, some rebel, and other adolescents whose parents have not disclosed their status eventually refuse to take their daily HIV medication until they know the reason why they must do so. This can pose as a challenge for parents because of cultural expectations. Disclosing their child’s HIV status means that parents have to disclose their HIV status to their child. Dr. Nadia, as an African parent, shared how challenging this situation can be since African children look up to their parents as superiors. For a parent to disclose his or her HIV status, they have to open up themselves to a level of vulnerability that is very difficult for most African parents. As an African child myself, I understood and personally related to Dr. Nadia’s perspective when I think about how I would feel about my parents if they had to reach that level of vulnerability. It was a thought I had not considered especially in pediatric and adolescent patients who are HIV positive.” - Gloria Rinomhota

Read the student presentation made at the UMB Institute of Global Health's inaugural global health summit, September 2016.

Read the posters that the students presented at the 2016 annual meeting of the Consortium of Universities for Global Health.

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