As the world takes stock of 21 years, stemming the spread of HIV/AIDS and develop new protocol towards Universal Health Coverage in HIV, stakeholders fear the country’s programme may actually be heading towards a crisis.
At a one-day sensitization meeting on Treatment Optimization Project for Lagos based Civil Society Organization, stakeholders expressed concerns that, with increasing number of People Living with HIV (PLHIV) failing first line and second line dug treatments and no provision for third line regiment, crisis looms.
Subsequently, there is palpable fear there could be an upsurge in AIDS death and Infections anytime soon if PLHIV who are already on third line drugs continue to receive monotherapy treatments, says Deputy Director Research and Clinical, Nigeria Institute of Medical Research (NIMR), Lagos, Dr Oliver Ezechi.
Health Minister, Professor Isaac Adewole in his address to mark the World AIDS day had noted, “One out of every ten HIV positive persons in the world is a Nigerian”. In absolute terms, an estimated 3.2 million people live with HIV/AIDS in Nigeria, ranking only behind South Africa”.
Adewole had expressed worry that AIDS infection has continued among male having sex with males and female sexual workers.
According to Ezechi, “At NIMR we already have 50 PLHIV who failed first and second line drug treatments. Most of them are young people infected at birth. These ones are supposed to be on the third line drug therapy (like Darunavir, etravirine and raltegravir)but they cannot proceed because the drugs are not in our clinic, they are not part of what donors are funding and, it costs N80, 000 to buy a month supply from outside; many of them cannot afford to buy the drug.
“For now, most of them are on monotherapy treatment just to keep hope alive. For how long, we do not have any idea, we only trust there would government immediate intervention”, lamented Ezechi.
The Deputy Director revealed that Clinicians at NIMR clinic have been using their discretion to give patients only Dolutegravir (DTG), which the country has now adopted as first line drug alongside some of the ones that had failed them like Efavirenz because we cannot just watch these people die.
“But truly, we know the only active drug in whatever they are given is the DTG and this is against the treatment protocol of the World Health Organisation (WHO), he told Healthstyleplus Online”.
Ibrahim Umoru, former chairperson Network of People Living with with HIV/AIDS (NEWPHWAN) expressed disappointment that government which claims that by June 2017 has about 1.050m Nigerians on Antiretroviral drug treatment can truly boost of supporting treatment among only 60,000 Nigerians saying, “The rest of the PLHIV are on donor support and treatment funding”.
He lamented that while South Africa, which equally has a huge burden of PLHIV, is committed to 95% local funding of treating her population with HIV, Nigeria’s commitment remains abysmal at 10% while over 85% are donor-driven.
However, Prof. Adewole has allayed the fears of PLHIV that while the 2017 budget captured N1bn for the procurement of ARV drugs to treat additional 20,000 PLHIV, the 2018 budget has N1.4bn for the same purpose.
Nonetheless, Umoru and Ezechi are still worried that the HIV/AIDS programme of the country is not well structured to allow for continuous funding at all levels of government “especially at Local Governments so that care and treatment can be accessed at Primary Healthcare Centres”.
They observed that the poor transition programme of government for HIV+ Adolescents is also fuelling non-adherence among young people thus contributing to the increase in treatment failures.
According to Umoru, “There has not been provision for youth-friendly clinics and what you find is immediately children grouped from 0-15years get off the Paediatric treatment plan, they are to attend clinics with adults. This is the most crucial time when these young persons become rebellious and drop off”.
Ezechi explained, further, “the minds of young people are wired differently and it is almost impossible and non-practicable to get adolescents sit in same clinic with their parents to receive HIV treatment.
“Once they transit into adults, we lose them because the programme does not capture them separately. Imagine a fifteen or sixteen year- old siting with adults in HIV clinic, that person will not feel comfortable”, said Ezechi.
He thinks time is ripe to create youth-friendly clinics across the country by state governments where young people can be free to express their worries and concerns in atmosphere devoid of stigma and discrimination.
Convener of the meeting, Member, Executive Steering Committee, African Community Advisory Board (AfroCAB) Obatunde Oladapo explained that Nigeria’s pilot programme of transiting to use of DTG in three centres of Lagos University Teaching Hospital, University of Jos Teaching Hospital (JUTH) and Federal Medical Centre Makurdi, is to improve treatment among PLHIV.
According to Oladapo, many countries that have adopted the use of DTG are having good results and the HIV+ community, civil society, media and caregivers need to understand why their support for the adoption of DTG as first line of drug therapy is very necessary.