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

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Abstract

Introduction:

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.

Methods:

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

Results:

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.

Discussion:

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.

Conclusions:

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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