By Godwin Emmanuel,
Heartland Alliance International, Nigeria
And
New HIV Vaccine and Microbicide Advocacy Society
Nigeria is important for the success of current efforts to end the AIDS epidemic by 2030. It has the second highest population of people living with HIV. It has a high mother to child transmission rate and the highest number of orphans living with HIV in the world. The country also has the highest number of annual new HIV infections in the world. For the country, a successful HIV treatment program is as critical as a successful HIV prevention program.
The national HIV response had always believed in the viability of using a combination of HIV prevention tools – biomedical, behavioral and structural tools – to address its HIV epidemic. To improve its biomedical response, the Federal Ministry of Health revised its guidelines on use of antiretroviral therapy in 2016 to include use of tenofovir based regimen as Pre-exposure prophylaxis. Along with this was also a HIV management guideline change to test and treat. These guideline changes were indeed a major shift in the right direction.
The country is currently hosting a HIV pre-exposure prophylaxis (PrEP) demonstration Project targeting sero-discordant couples. PrEP is the use of antiretroviral drugs to prevent HIV infection. The policy can therefore enhance the prospect for use of lessons learnt from the demonstration project to begin the scale up of access to PrEP. Recently, at the Civil Society Accountability Forum that held on the 13th and 14th of November 2017, the Director General of NACA did note that the government will ensure subsidized access of PrEP to sero-discordant couples.
On the 30th of November, 2017, the Federal Ministry of Health in collaboration with UNAIDS, USAID, CDC and implementing partners conveyed a stakeholders’ meeting to discuss the development of a roapmap for PrEP use in Nigeria. The New HIV Vaccine and Microbicide Advocacy Society had long advocated for the need to develop this roadmap to enhance various actors in the field to articulate plans in ways that will ensure measureable impact of the use of PrEP as part of the combination prevention package in Nigeria. Participants at the meeting agreed on the need for such a roadmap moreso that PEPFAR was planning to roll out PrEP access to key populations this December 2017.
Participants at the meeting reached a consensus that the Federal Ministry of Health should harmonize PrEP access related materials developed by both WHO and PEPFAR for use as guidelines on PrEP access. This materials should be harmonized and reviewed by the FMoH before its public use. The FMoH and its partners should develop and implementation and sustainability plan that also addressed access of PrEP through the one stop shops and other possible access points for persons at substantial risk for HIV. Key barriers to PrEP access should be identified – including policy and legal barriers – and addressed.
The Federal Ministry of Health was mandated to inaugurate a Technical working group before the next meeting scheduled to hold in the second week of January 2018. The technical working group should meet to review and adopt the developed harmonized WHO and PEPFAR documents, review a national policy framework on PrEP access and explore the feasibility of public private partnerships to fund and sustain PrEP access. The Ministry should also start to spearhead public dissemination of information about PrEP with emphasis on ensuring there are no mixed messages on PrEP and condom use.
One more outstanding action needed to enhance PrEP access: registration of a tenofovir based regimen for use as PrEP in Nigeria. Gilead is currently working with its partner in-country to get Truvada registered for use as PrEP with the food and drug regulatory agency in Nigeria (NAFDAC). When this is done, the feasibility of getting other persons to access Gilead through other health sectors in Nigeria would improve. Dr Oliver Ezechi of the National Institute of Medical Health reported that they have had multiple requests from individuals for the prescription of Truvada for use as PrEP in his institution. Some doctors will withhold writing such prescriptions if the drug is not registered for use as PrEP. The registration and licensure for use of tenofovir based antiretroviral drugs as PrEP in Nigeria will enhance PrEP access and hopefully turn around the HIV tide in Nigeria.
No comments