By Patience Ivie Ihejirika,
Dr. Aliyu Gambo is the director-general of the National Agency for the Control of AIDS (NACA). In this interview with Patience Ivie Ihejirika, he spoke on the agency’s change of strategy as part of its sustainability plan for HIV/AIDS response in the country.
How has the COVID-19 pandemic affective HIV response in Nigeria?
As we have been saying, the COVID 19 pandemic especially the lockdown has affected our ability to provide all the services that we have been providing to people and to identify new HIV cases and place them on treatment. But now, we are gradually coming back to normalcy and we are hitting our targets in terms of monthly number that we identify new as well as patients that we have already placed on treatment. they are coming to either get their drug refill or have their blood tested to identify how we are succeeding in suppressing the virus because it is very critical to suppress thee virus spread because the more you suppress the spread, the more you succeed in keeping HIV within those people that have it and the more you deny the virus the opportunity to leave them and affect the people who don’t have the disease.
Has the recent disruption in routine healthcare services, including antenatal heightened the risk of mother to child transmission of HIV?
Mother to child transmission is one that we have been struggling with and we are now going back to the drawing board to look at how we can change our strategy regarding the approach to mother to child transmission. We realise that restricting ourselves to only health facility, we will not be able to get near 100 per cent. the worst case scenario it gives us 50 per cent coverage which is not enough so now we are looking at our options of going to the community and getting access to hard to reach area in locations where people are remotely located and we don’t have access to services to provide these services and also creating awareness that we cannot stop mother to child transmission without the help of mothers and fathers, which means that the mother and father must ensure that whenever the woman is pregnant, we must ensure that the pregnancy is tested for HIV of the unborn child.
Is the SDG target on HIV/AIDS by 2030 feasible?
It is feasible given the way we have stakeholders working round the clock to identify how we can identify the remaining people who have not been identified yet and bring them to start taking medication. Our success in identifying these individuals who are within us in the community who have not been identified yet to bring them to start taking medication will determine our ability to reach the target by 2030. We are very hopeful that by 2030, we should succeed in destructing HIV transmission and reducing deaths from HIV in controlling HIV epidemic.
Is there plan for local production HIV drugs?
There is that possibility, we have been in discussion with some big pharmaceutical companies that are globally responsible for manufacturing HIV drugs. If you look at the big market we have here in Nigeria, the Nigerian market is a big market. To be based in Nigeria is like you have the entire West Africa at your disposal for business and we are talking with them to come to understand the benefits they stand to gain an also the benefits our country will gain; it will be a source of employment and a source of revenue for the government. If we have a good pharmaceutical company here in Nigeria, we will not go out to buy drugs from anybody.
What is your sustainability plan for HIV response in Nigeria?
Sustainability is the key because we are now at a point where we are thinking that in the next three or four years, we should control this epidemic. The question now is how do we sustain it when we control it, and without a plan we may find ourselves the same way we struggled with polio which we don’t want. We want to make sure that by the time we reach that bridge, we are able to cross it and the focus now is that we have changed the way we procure our drugs to now buy directly from the manufacturers; this gives us the value for money and allows us to treat more people with less money. For example, the contractors give me the price that is almost twice what the companies give me. I am now having a target to add 50,000 people on our domestic resource, in terms of getting them on treatment, treat with our money. If I am adding 50,000 more people every year and the budget I have has not changed much, I have to change strategy and part of my strategy change is to make sure that I use they money efficiently. I buy from the manufacturers and I get drugs that will treat 100,000 people with money that will only treat 50,000 for me if I am using vendors.
The plan is, first we change the way we do business; where we buy drugs and kits, and we change them and get value for money. Secondly we are working on HIV trust funds, this has been worked in the past two years, we are happy now, we will say we are approaching that stage where we will get the fund launch, which is private sector coordinated just like the CACOVID for COVID. It is private sector drive and we are hoping that sufficient amount of money will be raised and this trust fund from the time it is brought to life will continue to support us with kits, consumables to enable the government to address the issue of shortage of drugs, shortages of kits, shortages of consumables by the time our major partners and donors begin to withdraw. Also, bringing the state onboard and making sure that the state drive the response. Health is on concurrent list and is it not fair for the federal government to drive the response and own the response entirely. Majority of the facility which provides this services belong to the state and patients that access this service belong to the state, service providers that are providing services belong to the state. It therefore makes sense for the state to be under government control. Just the same way the state is in control when it comes to tuberculosis and malaria, the states also need to be in command and control when it comes to HIV.
Our contribution from the centre will be to ensure that the states are not lacking when it comes to drugs. We will make sure that the states are not lacking when it comes to other things, but in terms of the state proving coordinating role, in terms of the state providing logistics, contributing in buying kits to identify the citizens we think these are the things the states should be able to do.