We bring you an extract below:
interview
Though a cure for HIV/AIDS is yet to be found, the Director General of NACA Professor John Idoko says couple with different status (one negative and the other positive) can marry, give birth to negative babies, live a normal life, using treatment as prevention.
Using prevention as a major tool of reducing new infections is a theme being focus on. Is this approach working for Nigeria?
Yes, treatment has helped a great deal in reducing new infections in Nigeria. When a person uses ARVs it reduces the viral load and this makes it less possible for the person to infect someone else. This principle is used in reducing transmission of the virus. We will not restrict treatment for pregnant women whose CD4 count is less than 350. We use the HAART option, meaning, we give three drugs from pregnancy, to delivery and when the woman weans the baby. In essence you protect the woman, so she does not transmit the disease during pregnancy to the baby or during delivery or during breast feeding.
The second option is to use two drugs from the time of pregnancy, from 24 weeks to one week after delivery but in addition you will give the baby neverapine syrup. All of these are to prevent transmission through treatment and we have recorded success though we are working towards doubling the success stories.
Tell us about this innovation being funded by donors, to improve prevention?
A lot of emphasis in this summit is on how treatment plays a role in prevention. There are two things recent studies have come up with. First is the Pre-Exposure Prophylaxis. These drugs work to break transmission of the virus from a HIV positive person to an HIV negative person when the latter is exposed to the virus either through sex or other means. Studies have shown that the drugs work for both Men who have Sex with Men (MSM) and sero-discordant couples. I am part of a chore team working on the use of prophylaxis and Nigeria has been chosen as one of the countries where demonstration studies will be carried out to see how it works in certain environments. If we are successful, then, we will scale up the programme.
But for a country like Nigeria where people might ask why we should be using resources on prophylaxis for uninfected persons when we need to double the number of sick people on ARVs, I would like to say that prevention should be the starting point for treatment. For us, we must prevent new infections among sero-discordant couples, the fact is that couples have the desire to live a normal life and to have children. So, once we send our proposal to this committee and we get the funds, we will commence the study in states with high prevalence rates.
Tell us of the PMTCT services in Nigeria and why Nigeria is finding it hard to scale up the services?
All our challenges can be traced to a weak health system. The natural thing is to implement PMTCT at Primary Health Centers (PHCs) during ante-natal. Most PHCs are dilapidated and not fully functional; unfortunately they are located in the rural areas where over 70 percent of Nigerians live. We are trying to introduce PMTCT services to the private hospitals in the urban areas since a large percentage of women are registered with them. For us to scale up PMTCT services, we have to rehabilitate the PHCs, re-train staff, buy new equipment and re-introduce the centers to the people.
We also need to look into the lopsided distribution of health workers. When you look at the South East, the South West, they have enough trained personnel to provide health services. This is not the same in the North. We need to train lower cadre staff to handle PMTCT services in areas where we cannot get higher cadre staff to work in PHCs. Most importantly, we have to integrate PMTCT services into core ante-natal services. Efforts are on to integrate the PMTCT into health programmes for mother and child survival. We are also stepping up intervention for the management of malaria and TB. We are mobilizing communities to key into these programmes.
But Nigeria being a large country with 774 LGAs, it is not easy to get the results we desire, though there has been a lot of improvement in the last two years with support of PEPFAR, The Global Fund and the World Bank who have just given us a grant to provide PMTCT. Due to their support our PMTCT coverage moved from 11 percent in 2009 to 30 percent this year. But we need to get to 70 percent or even 90 percent like some of the countries here at the summit.
There was a session on managing HIV, TB and Malaria. Nigeria is one of the countries which have sought to manage these three diseases holistically. How far have we gone with it?
Let me put in this way, TB is the commonest reason why a PLWHA get sick or dies. Almost 50 percent of the people diagnosed with HIV have TB. So the management of TB is very important, because it complicates the treatment of PLWHAs. Malaria is also important because research has shown that HIV prevalence is high in areas where this disease is endemic. It is a bit technical, but the simplest explanation is that once a person is down with malaria, the cells that contain the HIV virus begin to multiply and once your viral load is high, the person can easily transmit the virus. Again, PLWHA with low immunity easily go down with more complicated cases of malaria like cerebral malaria.
On our part, we don't treat malaria but we work through the AIDS, TB and Malaria (ATM) taskforce chaired by the Health minister. NACA is also fully involved in the integration of services towards maternal and infant survival.
On the control of HIV among commercial sex workers, is our national response tackling this problem?
There are three ways of implementing the combination prevention strategy. This strategy takes into cognizance, behavior, biomedical intervention and structural intervention. For structural approach, we look at those things that put people at risk from the political, socio-cultural and socio-economic perspective.
We have a big problem with commercial sex work in Nigeria. Firstly the commercial sex workers are not organized. A few commercial sex workers have organized themselves into groups but things are still patchy and this makes it difficult for us to reach them.
We have to address the problem of stigma and discrimination, so that they can go for voluntary testing and get treatment for those who test positive. We also need to create job or create the right conditions for income generation, to encourage those who want to leave the profession to do so. Government should think of getting them educated so they can be better informed on how to protect themselves from Sexually Transmitted Infections (STI). We have started the move to create a sex network but it has been difficult. Commercial sex workers are a reality in Nigeria but many people pretend that they don't exist. Those who recognize them criminalize them and this is detrimental to the national response on HIV.
You pledged to improve on research, How far have you gone?
The dearth of research is not only in the academia or in agencies like NACA but even in the media and other sections of society that could function better with it. The word research is no longer respected in Nigeria. We need to reignite interest in research. The biggest challenge has been funding and NACA is seeking means to generate funds for research that will boost the national response to HIV.
Famous universities get international funding for research but government and NGOs hardly fund research in Nigeria. We have established a research unit; last year we brought in two professors on sabbatical and the third is that we have put a research policy together outlining our priorities. A fund has been established for research and we will soon advertise for people to apply to an expert committee which will now select proposals that will be funded by NACA. Plans are underway to fund young scientists and young media scientists to do research.
What will Nigeria take away from IAS 2011?
One is bridging the gap between treatment and prevention, the second is mobilizing resources to sustain our programmes. Resources means, human, capital resources and goods and services. For example we have about 400,000 people on ARVs which is better than the world average. But when you remember that we need to put not less than 1 million people on treatment due to the recent research findings on the need to create universal access, you will agree that we still have a lot of work to do.
The good thing is that we have opportunities; we have good programmes already bought into by our partners. We have funding coming from the Federal Government, the MDG Office, PEFFAR, the Global Fund, the private sector and the World Bank and we have well marshaled plans to fully utilize these funds to make the national response even more effective.
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