Background The 2013 WHO guidelines incorporated simplified and more effective antiretroviral regimens for the purposes of preventing mother-to-child transmission of HIV. With ideal implementation of these recommendations, perinatal HIV transmission could be reduced to less than 2%. However, loss to follow-up (LTFU) has the potential to erode the success of programs and a number of studies report high rates of LTFU within the prevention of mother-to-child transmission (PMTCT) care cascade. We evaluated the timing and magnitude of LTFU in a large programmatic PMTCT cohort in Nigeria in order to focus future efforts to reduce loss in this high burden setting. Methods From 2004-2014, the APIN/Harvard PEPFAR program supported antenatal HIV screening for nearly one million pregnant women and provided PMTCT care to over 30,000 women. The care cascade for women enrolling in the PMTCT program includes antenatal, delivery, and infant follow-up services through 12-18 months of life. In this retrospective cohort analysis, we examined data collected between 2004-2014 from 31 clinical sites in Nigeria and assessed the numbers of mothers and infants enrolled and LTFU at various points along the care cascade. Results Among 31,504 women (median age 30, IQR: 27-34) entering PMTCT care during the antenatal period, 20,679 (66%) completed the entire cascade of services including antenatal, delivery, and at least one infant follow-up visit. The median gestational age at presentation for antenatal care services was 23 weeks (IQR: 17-29). The median infant age at last follow-up visit was 12 months (IQR: 5-18). The greatest loss in the PMTCT care cascade occurred prior to delivery care (21%), with a further 16% lost prior to first infant visit. Of the 38,223 women who entered at any point along the PMTCT cascade, an HIV DNA PCR was available for 20,202 (53%) of their infants. Among infants for whom DNA PCR results were available, the rate of HIV transmission for infants whose mothers received any antenatal and/or delivery care was 2.8% versus 20.0% if their mother received none. Conclusions In this large cohort analysis, the proportion of women LTFU in the PMTCT care cascade was lower than that reported in previous cohort analyses. Nevertheless, this proportion remains unacceptably high and inhibits the program from maximally achieving the goals of PMTCT care. We also provide the largest analysis to date on rates of perinatal HIV transmission, with low rates among women receiving NNRTI- or PI-based regimens, approaching that reported in clinical trials. However, among mothers who received any antenatal care, infant outcomes were unknown for 48%, and women presented later in pregnancy than that recommended by current guidelines. Implementation research to evaluate ways to improve integration of services, particularly transitions from antenatal to delivery and pediatric care, are critically needed to reduce LTFU within PMTCT programs and achieve the ultimate goal of eliminating pediatric HIV infection.

In North-central Nigeria where HIV is prevalent, ART started before pregnancy is enormously effective in preventing mother-to-child transmission. Adoption of WHO 'Option B+' deserves serious consideration in such settings.

Background: Induction of labour (IOL) is a common procedure that remains a relevant Obstetric procedure. The maternal and perinatal outcomes are paramount hence the need to review the intervention in order to implement needed change. Objectives: To determine incidence, indications, outcome and complications of induction of labour at the Jos University Teaching Hospital (JUTH), Jos, Nigeria. Methods: This was a retrospective study reviewing 584 women who had IOL in JUTH from January 2004 to December 2007. Parameters selected for review include parity, gestation age, outcome and cervical state prior to IOL. Results: Four hundred and eighty women had vaginal deliveries (82.2%). There were fifty two induced on account of antepartum Intra Uterine Foetal Deaths (IUFD), while 1.5% of the deliveries ended up as still births, 10.5% had birth asphyxia and neonatology review and care. Thirty two patients had various complications after IOL. There were no maternal mortalities. Conclusion: Parity and presence of IUFD were found to influence the outcome of IOL.

Aim: To determine the prevalence of HIV infection and associated risk factors among rural pregnant women in Plateau state, Nigeria. Study Design: The study involved a cross-sectional study of pregnant rural women in antenatal clinics (ANCs) in five (5) rural villages of Mangu Local Government area of Plateau State, North Central Nigeria. Methodology: A total of 248 pregnant women with mean age of 26 years were recruited through a random sampling method during ANCs with pre and post counseling initiated and a structured survey questionnaire used. Venous blood samples were collected using needles and syringes, thereafter transported to a central point at Gindiri, centrifuged and serum sent to Plateau Specialist Hospital virology laboratory for HIV testing. Results: Participants with less than six (6) months planned postpartum sexual abstinence(cultural to abstain from Sexual Intercourse during pregnancy) were 8 times significantly more likely (OR 8.2; 95% CI 1.4, 42.0) to be infected compared with those who observed more than six (6) months planned postpartum abstinence. Also, women from polygamous marriages had a five-fold greater and significantly odds (OR 5.36; 95%CI 1.3, 24.5) of being HIV positive compared to women from monogamous marriages. Furthermore, parous women were 4 times significantly more likely (OR 4.66; 95%CI 1.1, 20.0) to be infected than nulliparous women. Previous exposure to malaria and educational status were not significantly associated with HIV infection. Conclusion: HIV prevalence was 3.2% (95% CI; 1.5-6.5)comparable to Nigerian's current overall prevalence rate and high lights need to eliminate preventable risk factors and relevance of male involvement in HIV prevention especially during pregnancy including ANCs, Care, Treatment and Support. There was higher rate of HIV infection among women who did not abstain from sexual intercourse during pregnancy suggesting multiple partnerships and need for marital faithfulness especially from the men during pregnancy.