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2018 World AIDS Day – Time For Reflection

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World AIDS Day, marked December 1st every year since 1988, is an international day dedicated to raising awareness of the Human Immunodeficiency Virus (HIV) pandemic and to remember those who have died of the disease. For healthcare workers and indeed government and other stakeholders, three decades is enough a period to reflect on our journey in the fight against the debilitating disease.

This year’s theme for World AIDS Day is: “Know Your Status,” which is a laudable effort towards achievement of the UNAIDS  90-90-90 targets. The aim of the UNAIDS targets is, by 2020, 90% of people living with HIV should know their status, 90% of identified HIV positive cases would be initiated on Anti-Retroviral Treatment (ART) and 90% of persons on ART would have achieved viral suppression.

The first case of HIV/AIDS in Nigeria was reported in 1986. Since then the number of people living with HIV or AIDS (PLWHA) has steadily increased with the epidemic moving into a ‘generalized’ state. The prevalence of HIV rose from 1.8% in 1991 to a peak of 5.8% in 2001, before declining to a nadir of 3.0% in 2014. Although the prevalence may be relatively low compared with other countries in sub-Saharan Africa, the country’s large population means that up to 3.2 million people are estimated to be living with HIV in Nigeria.

The HIV epidemic has further weakened and threatened to overwhelm the Nigerian health care system, increased the number of orphans and increased the cost of achieving set developmental goals by decreasing the size of the workforce, mainly adults in their most productive years of life (15-60 years). The high manpower-intensive sectors of the economy are mostly affected; including the agricultural, educational and health sectors as well as the rural economy. In summary, the impact of HIV/AIDS on Nigeria’s social fabric and on its economic development and well-being continue to be pervasive and, unless controlled, will continue to undermine the quality of life of Nigerians.

There is high commitment to fight HIV/AIDS in Nigeria, as evidenced by the initiation of the Presidential Council on AIDS, the National AIDS/STD Control Program (NASCP), and the National Agency for the Control of AIDS (NACA) which is a multi-sectoral agency including members from many government ministries and civil society. At the state level, State Action Committees on AIDS (SACA) have been established, while at the local level there are Local Action Committees on AIDS (LACA). The mission of NACA is to provide an enabling policy environment and a stable ongoing facilitation of proactive multi-sectoral planning, coordinated implementation, monitoring and evaluation of all HIV/AIDS prevention and impact mitigation activities in Nigeria.

In his speech during last year’s World AIDS Day commemoration, the Director General of NACA, Dr Sani Aliyu- stated that: “in the last six years, we reduced new HIV infections by 56% and annual AIDS related death by 22%”. He applauded President Muhammadu Buhari of Nigeria, for demonstrating strong political will to improve access to ART in Nigeria when, a year earlier, he launched the Fast Track Plan (FTP) to place additional 50,000 Nigerians living with HIV on ART each year. He also ensured that the 60,000 PLHIV receiving ART in Abia and Taraba States under the National Comprehensive AIDS Programme for States (NCAPS) continued to be served since the inception of his administration in 2015. In addition, the National Economic Council has committed to the implementation of an earlier resolution that committed 1% of the State’s monthly federal allocation to funding HIV programmes from 2018.

Dr Aliyu emphasized that “While we commend ourselves for these achievements, we acknowledge the huge unmet need for ART; only about one third of the 36 states and FCT have surpassed 50% ART coverage. The rate of Mother- to- Child Transmission, MTCT of HIV in Nigeria is still unacceptably high. We certainly need to do more at the federal and state levels to take ownership of our HIV/AIDS response and close the gaps.”

HIV Testing and Counselling (HTC)

Testing is the only way to know for sure if you have the virus. If you’ve already tested and your result is positive, you’ll be advised to start anti-retroviral treatment as soon as possible. Treatment is the only way to manage HIV and prevent it from damaging your immune system. It also reduces the risk of passing HIV on to others.

WHO is supporting countries to address gaps in the cascade of prevention, testing and treatment services. HIV testing services include the full range of services that should be provided together with HIV testing: counselling (pre-test information and post-test counselling); linkage to appropriate HIV prevention, treatment and care services, and other clinical and support services; and coordination with laboratory services to support quality assurance and the delivery of correct results.

Prevention, Treatment and Care

Prevention activities include prevention of mother-to-child (PMTCT), prevention of sexual transmission, prevention of medical transmission as well as prevention services within HIV counseling and testing. Treatment and care activities in Nigeria include; provision of antiretroviral drugs (ARVs) and services to eligible patients; laboratory support for diagnosis and monitoring for HIV-positive patients; adult and pediatric care and support; management of Tuberculosis and HIV co-infection (TB/HIV); and support for orphans and vulnerable children (OVCs). It also entails standardized training package for service providers, implementation of a quality pre-ART program, management of opportunistic infections and clinical mentoring.

Pharmaceutical care and supply chain

The focus of HIV Pharmaceutical care and supply chain is essentially on Pharmaceutical system strengthening to ensure access to quality pharmaceutical products, effective pharmaceutical services and uninterrupted availability of health commodities to achieve desired health outcomes. The country is implementing integrated supply chain management system (SCMS) for the management of HIV/AIDS medicines, laboratory commodities and consumables.

The greatest achievement of the HIV response to date has been the unprecedented global expansion of access to ART. Although only 680 000 people were receiving ART in 2000 (most of them in high income countries), by June 2017, this number had risen to 20·9 million people (18·4 million–21·7 million), or 57% of all people living with HIV worldwide. In Nigeria alone, 1,093,233 persons were accessing treatment at the end of June 2018. In 2016, an estimated 1·6 million deaths were averted worldwide as a result of ART.

Laboratory System strengthening

Development of functional laboratory systems is a key component of sustainable health care systems. Global efforts to ameliorate the burden of HIV and associated infections as well as devastating outbreaks of infectious diseases such as Ebola, have illuminated the need for further support of global laboratory systems development. Effective laboratories and functioning national laboratory systems require a competent workforce, effective leadership and management, and an underpinning of laws and regulations that ensure quality of services. Good policies, shapes processes and mechanisms for optimal laboratory system performance and international cooperation as required by the International Health Regulations.

Partnerships and community

In addition to treatment and prevention services, partners are supporting infrastructural improvement through the renovation of some facilities to create an environment that is conducive for clients and promote quality and best practice. Partners are putting in place mechanism for tracing clients who default in treatment and in collaboration with community minimizing stigma and discrimination.

Today, inclusion of civil society and people living with HIV is standard practice of many HIV related decision-making bodies. Non¬governmental representatives, including from organizations and networks of people living with HIV, are now routinely involved in national HIV related advisory bodies. Vigorous activism persists in many countries and regions. However, as the incidence of HIV infections and AIDS related mortality have decreased, and as funding for civil society activities has diminished, so have the magnitude and intensity of AIDS activism.

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The majority of external funding for HIV/AIDS programs in Nigeria is coming from PEPFAR, the Global Fund, and the World Bank. As at 2018, Nigeria has so far received more than US$ 1.4 billion and US$ 4 billion from Global Fund and the United States PEPFAR programme respectively to deliver HIV programmes in the country.

Conclusion:

The future course of national response to the HIV and AIDS epidemic depends on a number of factors including levels of HIV and AIDS-related knowledge among the general population; social stigmatization; risk behavior modification; access to quality services for sexually transmitted infections (STI); provision and uptake of HIV counseling and testing; and access to care and anti-retroviral therapy (ART), including prevention and treatment of opportunistic infections.

Good health services are those which deliver effective, safe, high quality health interventions to the people who need them, and where they need them, and with minimum waste of resources. These interventions may target individuals or entire populations, whether defined by geography (e.g. national, district or local) or characteristics (e.g. gender, age, nature of illness, occupation, behavior). In the case of HIV, health services need to take into account that people living with HIV or most-at-risk of infection often face stigma and discrimination because of their infection or because they may belong to groups with particular behavioral or disempowering characteristics.

HIV services should, where feasible, be integrated with broader health services, in co-located sites where possible, with the aim of improving both HIV-related and non-HIV-specific health outcomes; greater integration of HIV and global health must preserve and build on key attributes of the HIV response, including participatory community and civil society engagement and an ironclad commitment to human rights, gender equality, and equitable access to health and social justice.

There should be renewed focus on surveillance and research for HIV integrated program in collection, reporting and use of data for evidence-based decision making. Stakeholders should facilitate dissemination of key findings, lessons learned and best practices through technical reports and peer reviewed publication.

Happy World AIDS Day!

Acknowledgement: Excerpts from FMOH, NDHS, NACA, WHO, UNAIDS, PEPFAR, USAID, CDC, Lancet commission, I-TECH, AVERT and other reference materials.

Being a synopsis of selected HIV/AIDS Literature by Pharmacist Yusuf Babaye – Country Representative, International Training & Education Center for Health(I-TECH), Malawi.





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