‘NAIIS: Nigeria closer to controlling HIV epidemic’

Dr Aliyu Gambo is the Director General of National Agency for the Control of AIDS (NACA). Before his appointment, he was the Country Director of the University of Maryland, Nigeria Office, and Chief of Party of the Nigeria HIV/AIDS Indicator and Impact-Assessment Survey (NAIIS) the world’s largest population based survey on HIV/AIDS. In this interview, […]

Dr Aliyu Gambo is the Director General of National Agency for the Control of AIDS (NACA). Before his appointment, he was the Country Director of the University of Maryland, Nigeria Office, and Chief of Party of the Nigeria HIV/AIDS Indicator and Impact-Assessment Survey (NAIIS) the world’s largest population based survey on HIV/AIDS. In this interview, Dr Gambo speaks on how the survey revealed the true situation of HIV in the country, and why the North West Zone recorded the lowest HIV prevalence, among other issues. Excerpts:

What was the burden estimate of HIV in Nigeria before the NAIIS survey?

Several surveys were done before NAIIS, but they were not as representative at population level like NAIIS.

The last estimate before NAIIS yielded a national HIV prevalence of about 3% with about three million people living with HIV/AIDS.

However, the new estimate by NAIIS tells us the national HIV prevalence is about half (1.4%) of the prior estimate. What this means is if you select 200 Nigerians at random and offer them HIV tests, three out of the 200 are likely to test positive for HIV. The prior estimate says six out of the 200 are likely to test positive. Additional important findings are that Nigerians taking HIV drugs are doing very well in bringing down the level of HIV in them which is very critical in preventing people who do not have HIV from getting the disease; so with good planning Nigeria can control the virus within the next one year or two.

What is the significance of the survey to HIV programming in the country?

NAIIS has helped to rebase the HIV epidemic in Nigeria, showing less burden nationally, and identified locations where the burden is high and where people living with the virus in some of those locations are not reducing the number of virus in them. These are the locations where people are likely getting new HIV infections at the moment and are target areas for redirection of resources for HIV programmes for prevention and control

For the first time, Nigeria knows the impact of 15 years of the country’s PEPFAR programmes through NAIIS and how close we are to achieving HIV epidemic control.

What were the key findings of the survey and how will they impact on the country?

The key findings of NAIIS are that the HIV prevalence in Nigeria is not as high as we earlier thought. In fact, it is half of what we earlier presumed and used.

In monetary terms, this means we now need money to take care of about 1.9 million or less people living HIV/AIDS instead of 3.2 million. In terms of control it will be faster to get 1.9 million on treatment and reduce the virus in them to stop or bring transmission to the lowest level for Nigeria to achieve epidemic control, meaning the number of people getting new HIV infection is less than the number dying from HIV.

Some of the findings of the NAIIS survey that President Buhari launched in March showed that the South South had the highest prevalence of HIV, while the North West had the lowest. What do you think contributed to the low prevalence in the North West zone?

If you look at the data released, the North West  zone has the lowest  prevalence of 0.6% while the South South has the highest of 3.1 %. The North East, South West, North Central and South East have their prevalence estimates between these two extremes.

In each zone we have states with estimates higher and lower than the zonal estimate. In the North West Zone, Jigawa and Zamfara have the lowest prevalence of 0.3% each while in the South South, Akwa Ibom has the highest prevalence of 5.5% similar to that of Benue (5.3%) in the North Central.

Looking at Jigawa, Zamfara, Akwa Ibom and Benue, I would pay attention to differences in lifestyle, culture and tradition and less to differences in education and awareness. The dominant religious culture in the North West may explain the low prevalence of HIV similar to the trend observed when you compare North African countries with other countries in Africa.

What are the major contributions of NAIIS and what are the lessons learnt from it?

NAIIS has provided Nigeria with reliable estimates of HIV prevalence. It built the largest sample biorepository in West Africa for Nigeria, equipped the national central laboratory and upgraded over 100 laboratories across the nation.

It also built capacity in young Nigerians for various types of laboratory tests, assays, sample processing, transfer and storage; and real time survey activity monitoring. In addition, NAIIS provided short-term employment to over 6,000 youths.

We learnt from NAIIS that large scale PHIA model surveys can be implemented within short period of time with quality.

Now that  the survey is almost concluded, what next?

The next step is using the result or data generated to guide programme implementation and decision making. Nigeria and PEPFAR are now making informed decisions with respect to resource allocations and efforts to control the virus. Priority is now given to states where the epidemic appears to be raging judging by high prevalence and low level of viral suppression.

I call on the Nigerian populace to contribute to the efforts towards controlling HIV by taking test to know their HIV status and taking action. If you are negative, learn how to continue to remain negative. If however you have the infection learn to keep the virus under check so that it does not disturb you or get out of you to infect others. Call 6222 from any location, someone will provide you information on where to go for help.

What are the major activities of the University of Maryland in Nigeria?

Over the years, the University of Maryland (UMB) has been majorly supporting the government of Nigeria in the areas of treatment and care for HIV AIDS and tuberculosis as well as implementation science research to support HIV-TB programme implementations.

We have been actively involved in supporting the national HIV and TB response for the past 15 years. Over the last four years, we have expanded our support to the government of Nigeria to include building data system, infrastructure and strengthening the national disease surveillance systems.