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 strategies as part of its sustainability plan for HIV response in the country.
How has the COVID-19 pandemic affected HIV response in Nigeria?
The COVID-19 pandemic, especially the lockdown has affected our ability to provide all the services that we have been offering to people and to identify new cases and place them on treatment. However, we are gradually returning to normalcy and we are hitting our targets in terms of monthly number that we identify afresh 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 faring in suppressing the virus because it is very critical to suppress the 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, 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, they 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 the stakeholders working round the clock to identify how we can track the 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 checking drastically HIV transmission and reducing deaths from the virus in controlling HIV epidemic.
Are there plans for local production HIV drugs?
There is that possibility, we have been in talks 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, it is a big one. 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 understand the benefits they stand to gain by operating in the country; it will be a source of employment and 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 will 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 will be able to cross it and the focus now is that we have changed the way we procure our drugs to ing directly from the manufacturers; this gives us 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 with our money. If I am adding 50,000 more people yearly and the budget I have has not changed much, I have to change strategy and part of my strategy change is to ensure that I use the 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. Second, we are working on HIV trust fund, this has been in the works 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-driven 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 address the issue of shortage of drugs, shortages of kits, shortages of consumables by the time our major partners and donors begin to pull out. Also, bringing the state onboard and making sure that the state drives the response. Health is on the concurrent list and it is not fair for the federal government to drive the response and entirely own it. Most of the facilities which provide these services belong to the state and patients that access the service belong to the state, the service providers also belong to the state. It therefore makes sense for the state to be the government in 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 of HIV activities
Our contribution from the centre will be to ensure that the states are not lacking when it comes to drugs and other things, but in terms of the states proving coordinating role, in terms of the state providing logistics, contributing in buying kits to identifying the citizens, we think these are the things the states should be able to do.