Anti-HIV progress under threat

• NACA intensifies efforts to increase financing, ownership, sustainability
• Life expectancy in persons with virus near normal with treatment

Worried that the Federal Government contributes only about seven per cent of funding for Human Immuno-deficiency Virus (HIV)/Acquired Immune Deficiency Syndrome (AIDS) activities in the country, the National Agency for the Control of AIDS (NACA) has intensified efforts to increase monetary allocation, ownership and sustainability.

To this end, the Director General, National Agency for the Control of AIDS (NACA), Dr. Sani Aliyu, and selected critical stakeholders held a high profile meeting with the Acting President, Prof. Yemi Osinbajo, at the Villa in Abuja.

Aliyu who presented the Investment Case Model for NACA said the HIV prevalence in Nigeria stands at 3.0 per cent of the population (estimated 3,165,000) living with HIV virus, and with the current protocols requires that all persons infect be enrolled into treatment (antiretroviral therapy or ART) programme to interrupt the transmission of the virus to the uninfected population, thereby truncating the spread of the epidemic.

The DG NACA told the acting President that the treatment programme has 987,132 persons which is just about 31 per cent of those who are eligible to commence HIV treatment and this is largely due to many factors which includes; paucity of funds, capacity to absorb, human resource issues, and health systems issues among others.

The dependency on donor funds for treatment programme in the country was also highlighted as a major challenge by the NACA boss, he said the United States government contributes 73 per cent, Global fund provides 18 per cent while only seven per cent of enrollees treatment is being supported by Government of Nigeria he lamented.

Aliyu stated further that donor funding is dwindling and this is already affecting the HIV programme as patients are now being charged fees ranging from N3,000 to N14,000 for laboratory and antenatal in state, national and private health facilities which has become a major impediment to the elimination of mother to child transmission of HIV.

The DG went on to request from the Acting President, Osinbajo to approve the following Prayers:
*To direct the Honorable Minister of Finance, National Planning and Budget and the country director for World Bank to commence the processing of the Third World Bank HIV Prevention Development (HPDPIII) to enable Nigeria augment the expected shortfall in commodity funding as a result of Lower Middle Income Country classification, which will impact on resources available for commodities and programmes by as much as $55million.

*To consider and support the resolution of the 59th national Council of Health that at least 0.5-1 per cent of monthly Federal allocation to states be earmarked for financing the implementation of HIV sustainability roadmap.

*To consider and support the accelerated implementation of universal free antenatal services and abolition of user fees associated with clients accessing Prevention of Mother to-child Transmission (PMTCT) services.

*To consider and direct the National Health Insurance scheme (NHIS) to integrate coverage of patients living with HIV for both testing and in their basic package of care as part of sustainable long term solution to HIV/AIDS funding in the country. Osinbajo told the delegation that Federal government is committed to fighting HIV to finish, he promised to support and follow up on all of the prayers to ensure the HIV epidemic in Nigeria is halted.

Meanwhile, a new study has found that young adults with HIV who get treatment are living longer in North America and Europe. In fact, a 20-year-old with HIV who began antiretroviral treatment in 2008 or later and had a low viral load after a year of treatment has a life expectancy that’s close to that of the general population — around 78 years old, the study found. But life expectancy for people with HIV mostly remains lower than that of the general population, according to the study published in The Lancet HIV.

The researchers said their findings could help reduce stigmatization of people with HIV and help them get jobs and medical insurance. The study should also encourage newly diagnosed HIV patients to begin treatment as soon as possible and stick with it.

“Our research illustrates a success story of how improved HIV treatments coupled with screening, prevention and treatment of health problems associated with HIV infection can extend the life span of people diagnosed with HIV,” said study lead author Adam Trickey, from the University of Bristol in England.

“However, further efforts are needed if life expectancy is to match that of the general population,” he said in a journal news release.“Combination antiretroviral therapy has been used to treat HIV for 20 years, but newer drugs have fewer side effects, involve, taking fewer pills, better prevent replication of the virus, and are more difficult for the virus to become resistant to,” Trickey said.

Modern HIV treatment is very effective and has low toxicity, he noted. Because of this, deaths in people living with HIV are unlikely to drop with further development of drugs.

Trickey said the focus needs to be on people to take their drugs consistently. It’s also important for people to be diagnosed earlier, and to diagnose and treat other conditions that can occur with HIV, such as hepatitis C. He said that treatment for addiction also needs to be available.

Dr. Ingrid Katz, a global health researcher from Brigham and Women’s Hospital in Boston, authored an accompanying commentary. “The introduction of combination antiretroviral therapy [ART] has been one of the great public health success stories of the past 40 years. ART has led to increased survival in people living with HIV, and subsequently to individual and societal gains worldwide, because of the marked improvements in its potency, side-effect profile, and simplicity of use,” she wrote.

Despite this progress, Katz noted, there are still small but persistent gaps in the life span between HIV-positive and HIV-negative individuals.“The concern is greatest in the world’s most vulnerable populations, which include people who inject drugs in Europe and North America, and individuals living in resource-constrained settings globally, where access to early ART initiation has been limited,” Katz wrote.