‘Achieving an end to AIDS is possible and attainable’

How do you think Nigeria can best control its HIV/AIDS epidemic?This could be achieved through research & development in service delivery; retention in the treatment cascade; task shifting & sharing to fill human resources gaps; better drugs including long acting formulations; vaccines & microbicides; technology Transfer; AU Road Map for manufacture of drugs; South – […]

How do you think Nigeria can best control its HIV/AIDS epidemic?
This could be achieved through research & development in service delivery; retention in the treatment cascade; task shifting & sharing to fill human resources gaps; better drugs including long acting formulations; vaccines & microbicides; technology Transfer; AU Road Map for manufacture of drugs; South – South cooperation (BRICS) and Trips Agreement.
One must say that domestic funding is quite important.  However ending AIDS is possible and desirable, but will depend on building on successes, learning from failures and implementing to scale – Behavioural, Biomedical and Social/ Structural interventions.  
There is a need to develop new diagnostics -including for early post-exposure infection, vaccines, prevention, long-acting/ slow release antiretroviral drugs, and a cure.
Continued strong leadership of world leaders, international support and engagement of national governments while looking into prevention programs which needs re-invigorating.
Virtual elimination by 2030 is possible in principle – we have the tools.
We need a new phase with accelerated action, increased focus and innovations.
There are challenges but they should not deter us.
We won’t end AIDS tomorrow but it has to be part of our long-term vision for the post-2015 development agenda.
What will it take to end the AIDS scourge?
As a country we need to implement and scale strategic and core intervention such as knowing the nature of the country’s epidemic and the best combination prevention to use.
Very importantly knowing  the geographical variation,  key populations (Most At Risk Population – MARPS), Young People, Scale up HIV Prevention (Combination Prev), HCT, PMTCT,  Voluntary Male Medical Circumcision, NPT – PrEP and Treatment as Prevention are issues that should be prioritized.
Other areas of importance should be to scale up HIV treatment using the 2013 WHO Guidelines which speaks to adherence, Gardner Cascade and P4P4P4.

Explain P4P4P?
This simply means “pay for performance for patients,”. This involves providing financial or other reward for patients to get tested, engage care, stay in care, and achieve viral suppression.
This kind of incentive has worked well in encouraging women to attend Antenatal Care, I mean the  (ANC, conditional cash transfers) (88).
It could also be used in chronic care – dependent on patient adherence, including hypertension, diabetes, smoking, and obesity.
Though it might be difficult to sustain in low and middle income countries because of lack of resources or funds as the case may be.

What is PrEP?
Pre-exposure prophylaxis (PrEP) is the use of antiretroviral drugs by uninfected people to avoid HIV acquisition.
This has shown remarkable results where it has been applied effectively.
Trials have typically evaluated either oral TDF/FTC or TDF alone, studies of other drugs and modes of administration have started while Topical TDF gel has also been tried as vaginal microbicide, with coitally dependent use.
Four trials have been completed; one was stopped; one has been reduced by stopping some trial arms.
Meanwhile early treatment is the major push in biomedical prevention proving that early treatment can reduce viral load to undetectable levels, reducing or eliminating the chance of HIV transmission.

Evidence  has shown that the protection effect is strong (96% in HPTN 052, the one trial completed)The attraction of the “magic bullet”?
In HIV-1 serodiscordant couples, early treatment and PrEP are one of the best forms of treatment. Both PrEP and ART have been demonstrated to provide substantial protection against HIV-1 infection. For both PrEP (five trials) and early treatment (one trial) protection is tightly related to adherence.
Adherence is very high in serodiscordant couples. Studies have shown (PrEP and early treatment), while it is lower in others (PrEP).
Anyway taking a cue from family planning: more prevention options result in  better prevention outcomes.
Though many challenges remain, mathematical modeling could guide use of ART and PrEP in couples for implementation.

Is this the right time to talk of ending AIDS especially in Nigeria?
According to the UNAIDS Global Report (2012) , People living with HIV  amount to about 35.3 million though new HIV infections  have fallen by 33% since 2001. Among adults and adolescents the virus decreased by 50% or more in 26 countries while there was a decline by 52% among children.
However AIDS-related deaths fell by 30% since its peak in 2005.  In 2012,  deaths recorded amounted to 1.6 million as against the 2.3 million in 2005. All in all 36 million persons have died since the start of the epidemic.
In the case of the Antiretroviral therapy – 9.7 million PLWHV (2012) (People Living with the HIV/AIDS virus) are living with the virus and on drugs. But with the WHO guideline 61%  became eligible under 2010 WHO G/lines with another 34% becoming eligible under 2013 WHO G/lines.
According to the same report TB-related deaths in people living with HIV have fallen by 36% since 2004 but TB remains the leading cause of death among people living with HIV.

How would you rate investments in AIDS so far?
US$ 18.9 billion was available from all sources for the AIDS response in 2012. Estimated annual need by 2015 is currently between US$ 22-24 billion. In 2012, low- and middle-income countries increased domestic investments for HIV, accounting for 53% of all HIV related spending.

Tell us a little about the epidemic in Nigeria?
Nigeria HIV Prevalence ( as collated from the country Anti-natal care records , 2010 reveals that  Nationwide the country’s prevalence stabilized around   4 %, but 12 + 1 states carry  higher (70%) burden.
Nigeria is behind target in several important indicators:
Only 2 out of 5 people in need of ART treated (target 80% by 2015).
Only 30% of HIV positive pregnant women receive prophylaxis against mother child transmission (target 80%).
Only 25% of HIV spending domestic (target 50%).