A Community-Based Strategy to Improve Identification and Linkage of Pregnant Women to Antenatal and HIV Care Services in Gombe State, Nigeria

Abstract

Abstract Background Nigeria accounts for a significant share of global maternal mortality, and HIV remains a public health threat. Gombe State in northeastern Nigeria contends with profound barriers to healthcare access. This study evaluated the effectiveness of a community-based intervention using trained Community Health Workers (CHWs) to improve early identification of pregnancy and linkage to Antenatal Care (ANC) and HIV services. Methods A quasi-experimental design was employed across six local government areas (LGAs) from January 2020 to June 2021. Three LGAs were randomly assigned to the intervention, where CHWs conducted home visits for pregnancy identification, health education, and referral facilitation. Three control LGAs received standard facility-based care. Data were collected via household surveys and facility records at baseline and endline. Analysis included Difference-in-Differences (DiD) estimation to determine the net intervention effect. Results The intervention group showed significant improvements compared to the control. Early pregnancy identification (<20 weeks) increased from 45% to 78% (DiD: +29 pp, p<0.001). Attendance of at least one ANC visit rose from 58% to 85% (DiD: +22 pp, p<0.001), reducing the coverage gap by 89%. Subgroup analysis revealed the largest gains among adolescents (DiD: +31 pp) and rural residents (DiD: +27 pp). HIV testing uptake increased from 52% to 90% (DiD: +34 pp, p<0.001). Linkage to care for HIV-positive women improved from 65% to 92% (p=0.002). Conclusion A CHW-led, community-based strategy is highly effective in improving early engagement with ANC and HIV services in resource-limited settings. The intervention demonstrated a strong equity-promoting effect. Integration and scale-up of this model within primary healthcare systems is recommended.