‘We Would Push for Novel, Transparent Ways to Fund HIV/Aids Treatment’ – NACA DG
Dr Sani Aliyu is the Director-General of the National Agency for the Control of AIDS (NACA). In this exclusive interview with Daily Trust, Dr Aliyu,who has headed and participated in several medical and academic boards in the United Kingdom, spoke on his blueprint to reposition the agency,improve the national HIV/AIDS response and latch onto new treatment methods among others. Excerpts:
Only about 860,000 of the 3.2 million people living with HIV in the country are estimated to have access to anti-retroviral drugs .What are you doing to improve access to treatment for HIV patients?
It is really important that patients are able to access treatment and we are looking at all kinds of interventions that can help to improve this.
In the first place, if you don’t have a HIV centre close to you, you are not going to go for a HIV test. We have expanded the number of HIV testing centres significantly over the last one to two years and most of the PHCs in the country now have access to testing for HIV in terms of access to treatment. With our partners, we have been up scaling treatment , at the moment we have close to 900,000 people on antiretroviral therapy.
A lot of things prevent people from keeping unto therapy; it might range from issues relating to stigma – they don’t want people to know that they are taking treatment – and difficulty as well in going to the hospital to collect their medication.
It is very important that we make HIV treatment as easy as possible for the patients so that once they go on their treatment they can continue for life.
One salient issue in the area of HIV response in the country is government funding. Nigeria still mostly depends on donors, what is the implication of this?
At the moment we estimate that about 75% of HIV/AIDS response is funded by international donors;about 25% is funded by the federal government, mostly followed by state governments.But we have been pushing for novel ways of mobilizing resource for the HIV response, for example we don’t have a lot of engagement with the private sector.
The private sector can contribute significantly towards providing HIV care in terms of funding. We also have the National Health Insurance Scheme and some state governments are also introducing health insurance scheme of their own.
And we have been liaising closely with these agencies so that we can get HIV into the NHIS so that people who already pay into the health insurance scheme can access treatment.
Remember the cost of HIV Therapy has been coming down, by the moment we estimated that it is about N50,000 to treat HIV per patient per year that is not allowed to compare to any advantages you have – people are able to live longer, people are able to give birth to children that are not infected with the virus, people are able to overcome their susceptibility to infections such as TB .
It is certainly an investment worth doing and as Mr. President said in his speech at the World AIDs Day we would be looking at creating drug revolving fund because HIV services really do not fit well with our budget size.
There’s a lot of work going on in the background and we hope over the next one to two years, with the amount of money coming in from government sector and private sector we will be able to upscale and reduce dependence on donor agencies.
What are your plans towards repositioning NACA?
We have had challenges in the last few years, we have looked at our systems and our processes and we would strengthen them. One thing I can say clearly is that we are going to operate a very transparent and accountable system as far as NACA is concerned, because this is the only way we can continue to guarantee donors support coming in.
We are also going to engage with our partners, we are going to engage with our federal ministries and we will stick to our main mandate.
In terms of priority moving forward, there are two issues that are really key to address; number one is the issue of mother to child transmission of HIV. If you look at the few births in Nigeria only about 30% of pregnant women with HIV are currently on treatment. A lot of countries in the world no longer have children being born with HIV maybe because of the amount of resources they have put in to prevent HIV transmission and indeed even in Nigeria, there are pockets of really good work like in Kaduna State we have a community where they have actually eradicated the transmission of HIV among pregnant mothers simply by concentrating on that community and making sure every pregnant mother is tested and placed on treatment so that they don’t transmit the virus to their children.
We owe it to our children as Mr. President said, it is unacceptable for children in this era when you have treatment available for children to be born with HIV. NACA will really push, together with our partners, to make sure that we, as a nation do not have children born with HIV.
During the conference many speakers mentioned Option B+. What is it about and what is the prospect of implementing it in Nigeria?
Option B+ refers to testing a pregnant mother for HIV, if she is found to be positive she is placed on treatment, but the difference is after delivery she continues on treatment for her life time.
The advantage is that not only are you able to keep a mother healthy but you are also able to stop lost follow up because in the past when mothers are placed on treatment during pregnancy, after the child has been delivered and confirmed HIV negative, the mother stops treatment and we lose them, and by the time we get the mother back, maybe they have developed a really severe infection that is life threatening, this way you keep those who go into treatment.
A lot of studies have shown that doing this not only reduces the risk of transmission to partners and other members of the community, it also reduces the risk of catching other infection such as tuberculosis and overall it improves our patient outcome. In terms of affordability, we predict that out of the 177,000 pregnant women living with HIV, at the moment about 53,000 are on treatment; we have a gap of about 120,000.If you translate that to the current cost of treatment in US dollars, that comes close to about 40 million US dollars. Surely you can’t tell me that is not an investment worth making. So it is affordable for a country.
A lot of challenges we have with prevention of mother to child transmission of HIV is because of access to maternity services.We would be working with the primary healthcare centers so that as antenatal care services get delivered to the communities right down to the PHCs which is something that minister of health at the moment is striving at.We at NACA will latch on to this opportunity so that as mothers go to antenatal clinic, not only would they be offered a package of treatment for malaria, anemia and nutritional status but we would also test them for HIV and give them HIV treatment.
What is your take on local production of anti-retroviral therapy?
My view is that we engage the private sector to ensure that ARVs are produced in Nigeria. They are produced in other countries including India.We have the second largest number of people living with HIV in the world, sustainability of HIV programme lies in pushing down the cost of HIV treatment to as low as possible.
This is one way we can get engagement with state governments. Local production of ARVs would provide jobs for Nigerians, and we would be able to bring down the cost of the drug itself. It is a priority area for government and we would be engaging with the pharmaceutical industry.
What were the key outcomes of the recent HIV prevention conference organised by NACA?
It was a successful conference. We had over 1,400 participants. A lot of presentations were done. The main aim really was to look at the latest studies, evidence on prevention, and see how we can translate that into practice in Nigeria.
We know that a lot of work has been going on in this field but what is changing in the area of HIV prevention is that we are now talking not only about using barrier contraception, the traditional things like condoms, staying faithful, but we are looking at using treatment itself as a prevention measure because if a patient has HIV infection and has virus in the blood the risk of transmission is about 20 per 1,000 but that risk comes down when you take treatment.
It was the first conference of its kind and I am proud it took place at a time I was coming in as the DG of NACA.
SOURCE Daily Trust,