P-E5 Correlates of Facility Delivery among HIV+ Women in Rural North-Central Nigeria: Findings from the INSPIRE MoMent Study

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Facility-based delivery and timely access to PMTCT services are key for HIV-free survival for HIV-exposed infants. In Nigeria, little is known about this indicator and its correlates among HIV+ women, especially in rural areas. We evaluated factors associated with facility-based delivery among HIV+ pregnant women enrolled in a large prospective cohort study.


Demographic & obstetric data were analyzed. Correlates of facility-based delivery were evaluated using χ2 test, and odds ratios were determined.


Delivery data was available for 430 of the 496 women enrolled in 9 districts across 2 states in rural North-Central Nigeria. Overall, 62.8% of women delivered at facility, and 57.6% of women were newly HIV-diagnosed. Median age for women delivering at and outside facilities was identical (27 yrs). Only 19.2% of study participants were primigravidae. Compared to multigravid women, primigravidae were more likely to deliver at facility (OR 2.1, CI: 1.2 to 3.7). None of the other evaluated factors (education, religion, gestational age at booking, new or previous HIV diagnosis) correlated with facility delivery.


Our data suggest that only primigravidity was associated with facility delivery among rural HIV+ women. However, other factors not evaluated eg socioeconomic, commuting distance and availability of 24/7 delivery services at the local health facility may be correlates as well. The high rate of facility deliveries in our study, among HIV+ women, (>60%) compared to that of the general Nigerian population (<40%) suggests that the diagnosis of HIV and initiation of ART, in and of themselves, facilitate hospital births among pregnant women, even in rural areas where healthcare utilization is poor.


Determinants of facility delivery among HIV+ women may be multifactorial and interdependent. Early ART initiation, especially among primigravid HIV+ women, may encourage facility delivery in Nigeria' rural PMTCT program.

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