Friday, 7 November 2014

Anti-retroviral Drugs: Experts Worry Over Fate Of 15m Nigerians With HIV



By: Chioma Umeha

There is anxiety over Nigeria's preparedness to meet the Global AIDS Response Programme (GARPR) target.   With  barely 18 month  to the GARPR deadline,  fears are rife that the country may miss the target. According to the  GARPR target, 15 million people living with HIV should be treated with antiretroviral (ARVs) drugs. This is because an estimated 1,449,166 still cannot access ARVs after 26 years that AIDS was first reported in the country, even as 3,459,363 people live with HIV (PLWH). This issue may be a big deterrent to the attainment of the 2015 Global AIDS Response Program (GARPR) indicator and target four according to experts. The latest Global AIDS Response Country Progress Report (GARPR) from National Agency for the Control of AIDS (NACA) shows that Nigeria accounts for 73.4 per cent gap in the number of people receiving antiretroviral therapy in low and middle income countries, by region, from 2002 to 2011.

Members of Good Living Initiative with others in Lagos during last World AIDS Day (WAD) with the theme: “Getting to zero: Zero new HIV infection”
Though records show that there are eight million people on antiretroviral drugs following massive scale up of programmes, there were 388,864 new infections in 2011. Also, the country is among those with high AIDS death burden despite the drop in the annual national median HIV prevalence from 4.6 per cent in 2008 to 4.1 per cent last year. According to the UNGASS target / indicator the gap in the number of people receiving antiretroviral therapy dropped from 94.56 to 70 per cent between 2007 and 2010 and rose again to 73.4 per cent according to the GARPR 2012 target / indicator. In the United Nations General Assembly Special Session on HIV/AIDS (UNGASS) 2007 target / indicator, the country showed 94.56 per cent gap in the number of people receiving antiretroviral therapy according to International Centre for AIDS Care and Treatment Program (ICAP) record. In the UNGASS 2010 target / indicator, the country showed 70 per cent gap in the number of people receiving antiretroviral therapy according to the Federal Ministry of Health (FMOH 2009) While GARPR 2012 target / indicator showed 73.4 per cent gap in the number of people receiving antiretroviral therapy according to2011 records from FMOH. Corroborating, Dr Oliver Ezechi, Clinical Sciences Division NIMR in an interview said that the country showed a gap of 73.4 per cent in the number of people receiving antiretroviral therapy in low -and middle-income countries, by region, between 2002 and 2011. 

Experts believe that this trend is worrisome in view of the 2015 target to ensure that at least 80 per cent of adults and all children in the country have access to comprehensive quality HIV and AIDS treatment. This is a cause for big concern in view of th country’s preparedness to ensure that at least 80 per cent of adults and all children on ART have access to quality management of opportunistic Infections by 2015. With an estimated population of 162,265,000, Nigeria is the most populated country in sub- Saharan Africa, a region which carries the globe’s heaviest burden of HIV/AIDS. The most recent HIV Seroprevalence figure represents about 3.5 million people infected with HIV, ranking the nation as third among the countries with the highest HIV/AIDS burden in the world, next only to India and South Africa Although the national median prevalence of HIV has taken a downward turn in recent years, the absolute number of people living with HIV has increased by almost half a million people in three years and AIDS related mortality has also slightly increased in the same time period to about 217,148 annual deaths attributed to AIDS. 

While the annual AIDs death was 192, 000 in 2008, it rose to 217,148 last year. The country carries the second heaviest burden of HIV in Africa and has an expanding population of People Living with HIV (PLHIV). Despite challenges in scaling up access, institutional reforms and political commitment to tackle the diseases, the country has seen more citizens placed on life saving medication. In line with the World Health Organization (WHO), guidelines, government recently adopted antenatal care (ANC) sentinel surveillance as the system for assessing the epidemic. The national HIV Seroprevalence level, obtained from sentinel surveys of antenatal care attendees, increased from 1.8 percent in 1991 to 5.8 percent in 2001 and then declined to 5.0 percent in 2003 and further to 4.4 percent in 2005. This was followed by a rise to 4.6 percent in 2008 and then a recent decline to 4.1 percent in 2010. According to the ‘Brief on the HIV response in Nigeria’ from National Agency for the Control of AIDS (NACA) HIV incidence has fallen by more than 25 per cent, in 33 countries including Nigeria, between 2001 and 2009. However the number of new infections is still outpacing the number of those placed on treatment, the report said. 

When Prof. John Idoko, the Director-General, National Agency for the Control of AIDS (NACA), announced last December that more than N700 billion is needed to achieve universal access to antiretroviral (ARVs) drugs in the country, many keen watchers of the health industry were worried over the preparedness of the country to get towards zero AIDS-related death. He explained that there was a huge gap between persons accessing antiretroviral drugs and those requiring them, stressing that government must commit resources towards meeting their need. “Presently, only 432,000 persons living with HIV (PLHIV) are accessing the drugs in contrast with the 1.5 million people needing it. “We have realised that the Federal Government need to commit more funds to this cause; drugs are critical as they interrupt transmission,” he said. He reasoned that since the country was the second most burdened by HIV and AIDS in the world, hence the need to gather support to help in fighting the scourge. Idoko urged government to focus more on making HIV treatment cheaper by reducing the cost of drugs and tests, adding that there was the need to strengthen the health systems. The Director-General lamented that 12 states had HIV burden, adding that PMTCT gap should be closed by ensuring that all pregnant women had access to services to reduce new infections. Also, Prof. Innocent Ujah, Director General, Nigerian Institute of Medical Research (NIMR), Yaba, Lagos, said “the goal of zero HIV relateddeaths in our country is achievable. 

However, efforts must be made to strengthen and scale up our services to ensure that all infected persons are identified and enrolled into care and that all who are eligible for antiretroviral drugs (ARVs) are getting them regularly and consistently.” But Ujah regretted that the country’s heavy dependence on donors’ support for ARV provision will deter the actualization of the Millennium Development Goals (MDGs) and 2015 target of achieving zero AIDS-related death. This informed choice of the national theme for the World AIDS Day celebration last December which is “Resourcing the national response towards zero AIDS-related death.” He insisted that the role of human capital and financial resources are vital to achieving the objective of zero-related death due to HIV/AIDS, adding that this is at the background of the global theme. His words: “This theme is in line with the global theme where ownership of the national response is key to HIV/AIDS prevention, control, treatment and care. Human capital and financial resources are central to achieving the objective of zero-related death due to HIV/AIDS. “At the moment a large proportion of the supplies for HIV care including ARVs and laboratory supplies are provided by donors. With the global economic downturn and consequent donor fatigue, the governments of Nigeria (Federal, State and Local) must improve their response for national ownership and this informed last year’s national theme of resourcing the national response towards zero AIDS-related death,” the DG said. “We note that although this is a big challenge, we believe that with public advocacy to the policy makers at the Federal, State and Local Governments, achieving this objective is not impossible,” he added. - See more at:

This story was published in Daily Newswatch on March 21, 2013.

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