Dr. Sani Aliyu is the Director General of the Nigerian Agency for the Control of AIDS (NACA). He recently spoke to healthnews.africa on various issues regarding HIV control in Nigeria with special emphasis on why Pre-exposure Prophylaxis (PreP) is not yet ubiquitously available in Nigeria – even though it has been in the country’s AIDS guideline since 2016 and African countries including Kenya and South Africa are already making PreP available to citizens – especially those at most risk of getting infected with AIDS.
Paul ADEPOJU: While PreP is in Nigeria’s AIDS guideline, investigations showed it has not been implemented yet. What is responsible for this?
Dr. Sani Aliyu: NACA is currently coordinating a prep demonstration study funded by the Bill and Melinda Gates Foundation. The objective of this study is to find out the most effective, efficient, and affordable model for prep roll-out in Nigeria. Information from this study will be used to develop a comprehensive implementation plan.
Nigeria’s HIV data is publicly available but not the estimates of serodiscordant relationships. How many semidiscordant couples are receiving HIV treatment?
With regards to HIV related data , NACA in collaboration with partners is coordinating a nation-wide AIDS indicator survey to provide national reliable data, we will provide specific data for the country once this survey is concluded.
What is the roll-out plan for PreP in Nigeria? When will it really become available?
Specific planning for PreP roll-out will begin immediately following the conclusion of the PreP demonstration study this year because information from the study is needed to plan an informed roll-out.
Without subsidy, PreP is very expensive – about $2,000 monthly in the US. But in Kenya, a month supply costs $36. What is the strategy to ensure the sustainability of PreP in Nigeria?
Sustainability plan and strategies will be part of the comprehensive roll-out plan once developed.
What are the preliminary results from the demonstration studies in Nigeria and how will they impact implementation?
Preliminary results indicate a very positive uptake potential, however, it will be very expensive to provide. Even the developing countries took a while to implement prep due to the resource implications. These are some of the findings that will inform planning for implementation.
Various advocacy groups revealed that PreP is not currently available in Nigeria because of lack of political will on the side of the government. How true is that claim?
That is not true. Of course, resources are limited and we still have a lot of people living with HIV that need treatment. Govt is prioritising the diagnosis and placement on treatment of all persons living with HIV first. PreP will eventually come in but this will require adequate planning followed by a comprehensive roll-out plan based on the results of the demonstration study and the resources are available at the time.
Apart from the Gates Foundation-sponsored demonstration studies, PreP is also being provided by the trust study involving the Population Council. This study is not under NACA but what is the level of involvement of the agency in the study?
The trust study coordinated by Pop Council originally looked at prevalence and incidence of HIV and some STIs in key population in Lagos. The second phase which has not started will incorporate aspects of PreP use in the same population. We are aware of this study and are in close communication with popcouncil.
For Nigerians that cannot wait for government’s PreP plans, where can they get the drug right now?
I am not sure the extent to which Truvada is available commercially. However, NACA will strongly push for Truvada to be widely available in the private sector including community pharmacies for PreP once we have a comprehensive plan available. We believe that individuals opting for PreP should have that choice and ease of access in order to protect themselves.
How much will it cost the country to provide PreP for free, what are the financing options that are being considered?
Details of cost and financing options will be part of the demonstration study findings. This will be made available as soon as the report of the study is ready for dissemination.
Nigeria remains critical in the global fight to end AIDS. How reliable is Nigeria’s data and how will you assess the success or failure of current prevention and management protocols?
The Nigeria HIV Indicator Survey, which is the largest single country HIV survey ever conducted in the world is about half way through completion. The primary objective is to provide reliable Nigeria-specific HIV data. This survey will provide answers to all data related issues once completed including how well we are doing with the 90-90-90 targets.