Impact of Community-Based Intervention Versus Control on Antenatal and HIV Service Uptake in Gombe State, Nigeria

Maternal mortality and HIV transmission remain pressing challenges in northern Nigeria, driven by low antenatal care (ANC) attendance, delayed pregnancy identification, and weak HIV service uptake. This quasi-experimental study evaluated the impact of a community-based intervention on maternal and HIV outcomes in Gombe State. Trained community health workers (CHWs) conducted house-to-house visits to identify pregnant women, refer them for ANC and HIV services, and support service follow-up. Data were collected from 1,600 pregnant women 800 at baseline and 800 at endline across matched intervention and control communities using repeated cross-sectional surveys. Difference-in-Differences (DiD) analysis showed that early pregnancy identification improved by 29 percentage points (from 45% to 78%, p < 0.001) and ANC attendance increased by 22 points (from 58% to 85%, p < 0.001) in the intervention arm. HIV testing uptake rose by 34 percentage points (from 52% to 90%, p < 0.001), while linkage to care among HIV-positive women reached 92% in the intervention group compared to 65% in control (p = 0.002). Infant antiretroviral (ARV) prophylaxis coverage was 88% in the intervention group versus 62% in control (p = 0.004), and maternal retention at 36 weeks reached 86% versus 59% (p = 0.006). Subgroup analysis revealed greater gains among adolescents, rural women, and those with low education. The intervention demonstrated high effectiveness and equity, with Number Needed to Treat (NNT) ranging from 2.9 to 3.7 for core outcomes. These findings support the scale-up of CHW-led outreach as a cost-efficient, equity-enhancing strategy for maternal and HIV care in underserved settings.