As Nigeria works to reach the goal of ending AIDS as a public health threat by 2030, SADE OGUNTOLA chronicles plans underway to sustain the gains from the HIV response in the years ahead.
NIGERIA’S HIV prevention, care, and treatment programme has made significant progress in achieving the UNAIDS laid out 95-95-95 fast track targets to end the HIV epidemic by 2030 – “95–95–95 testing and treatment targets achieved within all subpopulations and age groups.”.
These targets call for 95% of people living with HIV (PLHIV) to be diagnosed, 95% of all diagnosed PLHIV to be on sustained antiretroviral therapy (ART), and 95% of all PLHIV on ART to have viral suppression by 2025.
By December 2021, the Nigerian programme had identified 89% (approximately 1.77 million) of the estimated 1.9 million PLHIVs, 97% of whom were receiving ART and 95% of whom were virally suppressed.
The Nigeria HIV programme is largely supported by international donors, namely the US president’s emergency plan for HIV/AID relief (PEPFAR) and the global fund to fight AIDS, tuberculosis, and malaria (GF-ATM) in strategic partnership with the government of Nigeria in what is known as the National HIV Alignment Programme.
In 2021, the two donors contributed 98% (71% PEPFAR and 27% GF-ATM) of the reported $799 million in total HIV expenditures. This donor-funded HIV programme also supports delivery of tailored HIV prevention, care, and treatment services to KPs through One Stop Shops (OSS).
One Stop Shops is a stand-alone service site addressing the entire spectrum of HIV care while minimising access barriers, integrated community ART services, and government public health facilities.
However, international donors have begun transitioning HIV control programmes to country governments to continue their financing, management, and implementation as a form of sustainability strategy towards ownership.
The sustainability of the national roadmap for Human Immunodeficiency Virus (HIV) remains at the forefront of the government’s plan as Nigeria gets nearer to epidemic control of the disease.
It is an ongoing national dialogue on the sustainability of the HIV response in Nigeria that included an engagement workshop for civil society organisations and community leaders in Abuja recently.
It was to update civil society organisations and community leaders on plans, processes, and expected outcomes of the new business model and Nigeria’s HIV sustainability roadmap development process.
Director General of the National Agency for the Control of AIDS (NACA), Dr Temitope Ilori, who spoke at the national dialogue, declared that still much needs to be done in order to ensure that HIV is no longer a public health threat by the year 2030 and therefore, the government’s intent to be accountable for the national HIV response in Nigeria.
“We believe that as a government, we need to be accountable for the national HIV response in our country,” she added.
Dr Ilori declared that civil society organisations and community leaders are major stakeholders in the sustenance of the national roadmap for the human immunodeficiency virus and in achieving an AIDS-free generation.
Communities have been the first responders to the AIDS response for the last four decades. UNAIDS Country Director, Dr Leo Zekeng, noting the key role of communities in HIV response, declared that ensuring a sustainability agenda is key to avoiding people dying.
“If we cannot sustain the gains that we have now in the response, within the next six months, new infections will start rising again. And we will see more people dying. So, community will be key in delivering those services, especially the hard-to-reach areas, and it is stopping stigma and discrimination because sustainability will mean different things to different people.”
Dr Zekeng, however, declared that building the skills of civil society organisations and community leaders for the HIV response is important for good outcomes for Nigeria’s New Business Model and the HIV sustainability roadmap development process.
He urged civil society organisations and community leaders to have a unified voice regarding community-led responses and engagement with partners as the government takes the central lead in the national HIV response in Nigeria.
No doubt, the global fight against HIV is at a critical point where the infection is no longer looked at as an emergency but as an infectious disease crisis that has been battled. Regardless of this, the United States President’s Emergency Plan for AIDS Relief (PEPFAR) coordinator in Nigeria, Dr Funmi Adesanya, said maintaining treatment Programmes and addressing equity gaps is still critical in sustaining HIV response in Nigeria regardless of declining donor resources.
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Adesanya, represented by PEPFAR’s Multilateral Advisor, Dr. Margaret Shelleng, said PEPFAR’s future trust is that the large majority of the HIV prevention, treatment, and care programmes should be led by government or delivered by other domestic entities with community engagement and government accountability for a sustainable response.
According to her, “It does not mean that donors are exiting. It just means that their roles and responsibilities will change. As we work towards sustaining HIV’s response, it is clear that the transition of leadership and even the programme and implementation to the sub-national level will be a critical step in ensuring long-term success.
“This doesn’t only require political will, but the active involvement of civil society organisations and community leaders. You are at the heart of the response. Your role in advocacy, service delivery, and holding governments and donors accountable is essential, particularly with underserved populations and key populations.”
In his remarks, Executive Secretary of the Country Coordinating Mechanism for the Global Fund, another donor supporting Nigeria’s HIV response, Ibrahim Tajudeen, said civil society organisations should take responsibility for the health of Nigerians by sustaining the gains made in HIV control.
“If we continue to see it solely as the government’s responsibility, we cannot sustain our achievements. Sustainability will require collaboration,” he added.
Tajudeen declared the need for input of civil society organisations into the national health budget process and solutions to already identified problems in HIV control in a bid to sustain gains made on its control in Nigeria.
Ibrahim Abdulkadir, National Coordinator of the Network of People Living with HIV and AIDS (NEPWHAN), advocated for a unified voice from persons living with HIV, particularly at the state levels, and a change in funding mechanism to ensure that NEPWHAN has funds to lead interventions in support of HIV control in the community.
He revealed that NEPWHAN had received N600,000,000 in global funds to engage community-led NGOs for HIV response programmes, attributing this achievement to NEPWHAN’s innovative support for the cause.
Dr Yewande Olaifa, a deputy director at the NACA, said in her presentation on “The New Business Model and the HIV Sustainability Roadmap,” the global HIV community has actively begun planning for a sustainable HIV response beyond 2030.
She said that the new sustainability approach to HIV control calls for country-driven and owned processes that leverage country data and information to chart the pathways for country-level strategies and actions to achieve and sustain impact.
According to her, the process is expected to foster open and honest dialogue on the future of the HIV response, the transformations needed to ensure that responses across the globe are not in danger of putting millions of lives and livelihoods at risk, and the financing commitments needed for scale and impact.
Dr. Olaifa said a long-term sustainability of the HIV response will require different strategies and delivery modalities than what is required to scale up prevention and treatment services and enablers to reach the 2030 target of ending AIDS as a public health threat.
“The roadmap is not about donor exit; it is also about sustaining the response as it currently stands, but it is about transforming the response and making countries to lead and shape their own HIV response,” she added.
Olaifa said planning for sustaining HIV response beyond 2030 is particularly important because AIDS resources are flattening because of competitive financing in the global environment. Countries are getting closer to the epidemic transition point and need to redesign the response to sustain impact, among other reasons.
“We’re looking at redesigning the donor-partner relationship with the country from direct service delivery, which is what they’re currently doing now, to technical support to the mandated structures in the country.
“Now that we’re about to achieve epidemic control, we do need to begin to engage other people so that they know that we have succeeded, but there’s still work to be done.
“So, the new business model is actually midway to our sustainability agenda. It is government-led implementation, donor-dominant funding. They’ve not pulled it out. But funding is actually beginning to dip.
“With the change in arrangements, we have an opportunity with the resources available to begin to do things ourselves while they provide technical supports. But the true sustainability agenda is us as a country being responsible for implementation and dominantly funding the implementation.”
Representative of UNAIDS, Dr Murphy Akpu, in his lecture entitled “Vision Setting for Government-led Sustainable HIV Programmes at State Level in Nigeria,” said under the new business model for HIV control, some state-level interventions may be required to be discontinued because of the restructure of partners’ resources.
“A lot of resources, particularly human resources, were thrown out into the field to go and look for at-risk populations and test them. They looked good to be done because the resources are there and it solves the problem, particularly the community ART groups that were rolled out to support retention in care and to bring viral testing to the community.
“As it is right now, the HIV programme is even hijacking some of our responsibilities. Because they want to come to your house, test you in your house, and give you money or even carry you in their vehicle and take you to the hospital. When the donor money is gone, those things may not be doable beyond that point.
“So those are the negotiations that need to happen at the state level, and civil society organisations and community leaders also need to be part of that. But again, they will now determine what they can pick because it’s about sustainability and not doing it the way the partners do it.”