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How Nigeria can end AIDS before 2030, by NACA

By Stanley Akpunonu (Lagos) and Nkechi Onyedika-Ugoeze (Abuja)
29 November 2020   |   3:40 am
The gloomy picture painted by UNAIDS that without appropriate attention COVID-19 could cause hundreds of thousands of new Human Immuno-deficiency Virus (HIV) infections, and Acquired Immune Deficiency Syndrome...

COVID-19 could cause hundreds of thousands of new Human Immuno-deficiency Virus (HIV) infections, and Acquired Immune Deficiency Syndrome (AIDS)

NIMR Engages Dispatch Riders To Reach More Of Its 24, 000 Patients
• 50% Of Adolescents Do Not Know Their Status ­– David
• Funding Agencies Unwilling To Procure Third-line Regimen For Patients With Mutant Virus – Akanmu

The gloomy picture painted by UNAIDS that without appropriate attention COVID-19 could cause hundreds of thousands of new Human Immuno-deficiency Virus (HIV) infections, and Acquired Immune Deficiency Syndrome (AIDS)-related deaths between 2020 and 2022 across the world notwithstanding, the National Agency for the Control of AIDS (NACA) says it is possible to end the scourge in the country by 2030.

To achieve this, NACA advocates the need for all Nigerians to get tested, know their status and those that are positively placed on treatment to prevent them from spreading the virus.  

Also, as fears of losing gains in the fight against HIV continue to mount, the Nigeria Institute of Medical Research (NIMR) has institutionalised dispatch riders as a differentiated model of care for HIV patients as part measures to ramp up efforts aimed at containing the disease and reaching a reasonable number of its 24, 000 cumulative patient enrolment.

A Professor of Haematology and Blood Transfusion, at the Lagos University Teaching Hospital (LUTH) Idi-Araba, Lagos State, Alani Akanmu said because of the disruption of service during the lockdown, the outfit kept in contact with patients through phone conversations and zoom, with the support of a non-governmental organisation (NGO) that established a drug collection centre for the members of the community.

Akanmu was, however, quick to explain that UNAIDS by the year 2030 might not be able to announce the end of the epidemic because of the little percentage of people, where the virus has mutated and not responding to administered treatment.

In a new report entitled Prevailing Against Pandemic By Putting People At The Centre, UNAIDS, which called on countries to make far greater investments in global pandemic responses said that COVID-19 could cause an estimated 123, 000 to 293, 000 new HIV infections, and 69, 000 to 148, 000 additional AIDS-related deaths in the next two years (2020 -2022).

But the Director-General of NACA, while speaking at the Adolescent and Young People Programme in commemoration of World AIDS Day, in Abuja, yesterday, noted that the agency wants the next generation to be an AIDS-free generation, adding that without getting tested, the government will not know who needs services at the moment, and who needs to be put on treatment to control the virus. The theme of this year’s World AIDS Day is “Global Solidarity, Shared Responsibility.”

Aliyu said: “Until we get these people that have this virus in them and place them on treatment to prevent them from spreading the virus, we cannot control HIV and we cannot end AIDS by 2030. Every responsible citizen should know their HIV status; if everyone gets tested to know if they have the virus and those who test positive placed on treatment, it will be difficult for the country to achieve the 90:90:90 target by 2030. The more we push to achieve this target, the more difficult it becomes to achieve this target. Whatever control measures put in place without you will not be beneficial and will hamper efforts to control HIV/AIDS.”

Aliyu, an associate professor at the Institute of Human Virology, University of Maryland School of Medicine, United States, therefore, urged parents to give their children the opportunity to know their status to enable the country end AIDS before 2030, adding that there is need for collaborative efforts to fight stigma and discrimination so that people will have the confidence to get tested for HIV.

The NACA boss explained that it is only when people agree to get tested that the dream of getting to 90/90/90 can be realised.
As COVID-19 pandemic continues to threaten the progress that the world has made in health and development, Aliyu said this year provides an opportunity to support people living with HIV/AIDS and people affected by AIDS, adding that Nigeria has chosen as its theme for this year, “United to End AIDS in the Midst of COVID-19 so get Tested,” because this year’s HIV response is different due to COVID-19.  

He added: “We have seen the impact of COVID-19 on HIV programming, even though we are scrutinising our data to find out the real impact of COVID-19 on People Living with HIV, but one thing that we know is that COVID-19 has had a negative impact on the economic life of people living with HIV/AIDS than any other population.”

Aliyu, an epidemiologist and public health specialist pointed out that the agency, with support from UNAIDS and the Federal Ministry of Women Affairs, recently launched a project to Prevent, Protect and Empower (PPE) people living with HIV/AIDS considering that they find it difficult to go to public facilities to collect medication and also find it difficult to earn a living. 

SHEDDING light on steps taken by NIMR to combat the spread of the scourge, the Deputy Director of Research of the institute, Dr. Nkiruka David, who said that the COVID-19 lockdown affected the management and care of HIV patients because most of the patients could not access the hospital at that time, explained that the institute had to double up so as to cover some lost grounds.

She said: “Ahead of the lockdown, we sensitised the patients and urged them to come and pick up their drugs… We gave more drugs than we use to. We gave drugs that can last patients for three months. About 25 per cent more people came to pick up drugs in the month of March than scheduled. During the lockdown, it was not easy for people who do not have a means of transportation because it was grossly limited and we were always here to attend to people.

“Because of the experience with COVID-19 and lockdown, we are now institutionalising dispatch riders as a differentiated model of care for HIV. Instead of them coming over to the institute, we are now delivering their drugs to them. With this, people can get their drugs as at when due,” David, who is also the Head of Department of Clinical Sciences stated.

She continued: “There are real fears of losing gains in the fight against HIV that is why we are doing what we are doing… We did not carry out a lot of laboratory tests initially because the institute was the site of a COVID-19 diagnostic, and the laboratories had a lot to do with COVID-19 testing. So, we decided to shield our patients unless in emergency situations.”

With the country’s HIV prevalence standing at 1.4 per cent, she said it was imperative that it continues to reduce, not by people dying, or more people getting infected, but by everyone knowing their status.

The deputy director of research, who regretted that more than 50 per cent of adolescents do not know their status so as to take necessary precautions said, “people should know their status; if they are positive, they should enrol for care and be placed on treatment; have the virus suppressed, and have the opportunity to live a full life. If one is negative, he would be counselled on how to remain negative and if positive, he would also be counselled on how not to transmit to others.

“The treatment works. It pains me when I hear someone dying of AIDS. No one should die anymore. Nigeria is not doing badly, but we still have room for improvement and to make sure that positive cases are brought in for treatment,” David said.

AKANMU, while expressing pessimism that the virus could be contained by 2030 as earlier thought because of the little percentage of people, where the virus has mutated and not responding to the treatment administered, explained that when an individual does not take drugs correctly as prescribed or fails to adhere to the treatment regimen, the virus can easily mutate and make it very difficult to manage.
According to him, in Nigeria, about one to two per cent of the 1.2 million patients on treatment failed second-line regimen treatment and they need the third line regime to be able to remain alive and well.

He continued: “None of the funding agencies that we have today is ready to procure the third line regimen or salvage regimen. This is because the money used to treat one patient on a third-line regimen can cater for about 10 patients on a first-line regimen. The Nigerian government took another big step and decided to procure the third line regimen for the few Nigerians that having the resistance.”

However, Akanmu stated that there was a stringent measure put in place to access the third line regimen, but not many Nigerians are able to meet the requirements and the drugs almost got expired.

“That stringent measure was an error. Before a patient is able to get a third-line regimen, there would be evidence that he has developed resistance, and has a problem because the test costs between N45, 000 to N50, 000 and not everyone could afford that.

“Again, the government did not get the drugs early this year, so there were issues and we had to do some reforms, and work out alternatives for those on the third-line regime. But last September, the government procured drugs for the third-line regimen in a move that represents a huge investment on the part of the government,” he said.