ART SERVICES SCALE UP IN NIGERIAART SERVICES SCALE UP IN NIGERIA

SUCCESSESSUCCESSESCHALLENGESCHALLENGES

andandWAY FORWARDWAY FORWARD

TEAM NIGERIATEAM NIGERIA

BACKGROUNDBACKGROUND• Location: West Africa• Size: 923,768 sq km • Population: 149 million

– Birth rate - 37/1000; Death rate 16/1000

– Life expectancy ( F=48, M=47yrs) – Population growth 2%

• HIV Prevalence – ANC 2008 - 4.6%– NARH 2010 - 3.6%

• Mostly HIV1 subtype A, G and A-G• The first two cases of HIV

identified in 1985• Over 800, 000 PLWHA require

ARVs• Risk factors include

– Prostitution– High prevalence of STIs – Int’l trafficking of women– Polygamy – Poverty

• No of PLWH- 2.95 million (male-

1.23, female- 1.72 million)

• Annual HIV + Birth- 56,681

• Cumulative AIDS Death- 2.99

million (male- 1.38, female- 1.61)

• Annual AIDS Death- 280,000

(male- 123,000, female- 157,000)

• No requiring ART- 833,000 (Adult-

740,000, Children- 92,000)

• New infection- 380,000 (Adult-

323,000, Children- 57,000)

• Total AIDS orphaned- 2.23 million

1.8

3.8

4.5

5.4

5.8

5.0

4.44.6

0.0

1.0

2.0

3.0

4.0

5.0

6.0

7.0

1991 1993 1995/96 1999 2001 2003 2005 2008

Year

Pre

vale

nce (

%)

National HIV Prevalence Trend 1991 – 2008National HIV Prevalence Trend 1991 – 2008

HIV PREVALENCE BY STATES 2005HIV PREVALENCE BY STATES 2005

Adamawa

Abia

Oyo

Ogun

Lagos

Osun

Ekiti

Ondo

Kwara

Edo

Delta

BayelsaRivers

AkwaIbom

CrossRiverImo

Ebonyi

Kogi

Benue

Nasarawa

Niger

Plateau

Taraba

GombeBauchi

Y obe

Borno

Kaduna

Kebbi

Zamfara

Sokoto

Katsina

Kano

Jigawa

FCT

Emergency Plan Focus States

2.1 – 4.0%

KEYKEY

6.1 – 8.0%

>8.0%

1.0 – 2.0%

4.1 – 6.0%

ART SCALE UPART SCALE UP• ART started in tertiary hospitals in 2002

• Initial numbers (Adult = 10,000; Children = 5,000)

• Funding (PEPFAR, GFATM, DFID, GoN)

• Rapid scale up from 13 sites to 393 sites• Infrastructural upgrade• Capacity building for HCWs• Laboratory back up• Robust M&E system• Standardized ARV & other Commodity LMIS

– Forecasting– Inventory management– Pool procurement (Donors, GoN, Private)– Warehousing (Central, Regional) & Distribution (Axios, Chan MP)– Reporting – Combine Request Requisition & Issue (Form) Logistics

• Total # on treatment (SAPR10)– Adult = 289,953 – Children = 18,283

• Majority of patients on 1st line regime (97%)• Decentralizing ART to PHCs2004

2010Sc

ale

up

SITE DISTRIBUTION BY OWNERSHIP AS AT 2009 (UNGASS 2010)SITE DISTRIBUTION BY OWNERSHIP AS AT 2009 (UNGASS 2010)

SITE DISTRIBUTION BY LEVEL OF CARE SITE DISTRIBUTION BY LEVEL OF CARE (UNGASS 2010)(UNGASS 2010)

STRENGTHSSTRENGTHS

• Political will and substantial donor

support

• Updated national guidelines, SOPs

and job aids

• Locally developed IEC materials

• Updated national training

curriculum

• Good M&E structure

• A national scale up plan

• A dynamic Technical Working

Groups

• ATM task team

• Good logistics system

LESSONS LEARNTLESSONS LEARNT• Effective political commitment is

essential • Primary prevention is utmost• Collaborations with stakeholders

especially NGOs, CBOs, donor agencies, multilateral and bilateral gov’t agencies

• Strengthening linkages with all HIV/AIDS interventions

• Implementation of routine HIV testing and rapid HIV testing

• Community ownership through community capacity building

• Dynamic IEC strategy needed to motivate community

• Need to conduct operational research in issues emerging in the HIV/AIDS

• HIV related mentoring is helpful in solidifying skills

CHALLENGESCHALLENGES

• Donor driven procurement of

commodities

• Vertical disease programming

• Weak health systems, inadequate HRH

• Low coverage of ART despite increased

sites

• Sub-optimal quality of service in many

facilities

• Weak health information management

systems,

• Need to develop M&E systems that

meet multiple needs

• Identifying trends & Using Data Sets for

secondary analysis

• Commodity stock-outs

WAY FORWARDWAY FORWARD• Primary Prevention• Advocacy and sensitization• Continue to build systems for improved access

and capacity strengthening in all ramifications• Competing for funding to support operational

research• Maintain the highest level of good business

practice and high quality care and treatment• Continue to receive technical assistance from

donor agencies• Involvement of other stakeholders including

FBOs and private health care providers • Effective monitoring and evaluation• Health system strengthening (logistics and

supplies)• Political commitment• Community mobilization for participation and

action (use of stand alone HCT centers in communities to increase number of women in reproductive age group for testing).

Thank youThank you

MerciMerci