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. 2021 Sep 19;18(1):62.
doi: 10.1186/s12981-021-00385-5.

Expanding access to HIV services during the COVID-19 pandemic-Nigeria, 2020

Andrew T Boyd  1 , Ibrahim Jahun  2 , Emilio Dirlikov  3 , Stacie Greby  2 , Solomon Odafe  2 , Alhassan Abdulkadir  4 , Olugbenga Odeyemi  4 , Ibrahim Dalhatu  2 , Obinna Ogbanufe  2 , Andrew Abutu  2 , Olugbenga Asaolu  2 , Moyosola Bamidele  2 , Chibuzor Onyenuobi  2 , Timothy Efuntoye  2 , Johnson O Fagbamigbe  2 , Uzoma Ene  2 , Ayodele Fagbemi  2 , Nguhemen Tingir  2 , Chidozie Meribe  2 , Adeola Ayo  2 , Orji Bassey  2 , Obinna Nnadozie  2 , Mary Adetinuke Boyd  2 , Dennis Onotu  2 , Jerry Gwamna  2 , McPaul Okoye  2 , William Abrams  2 , Matthias Alagi  2 , Ademola Oladipo  2 , Michelle Williams-Sherlock  3 , Pamela Bachanas  3 , Helen Chun  3 , Deborah Carpenter  3 , David A Miller  3 , Ugonna Ijeoma  3 , Anuli Nwaohiri  3 , Patrick Dakum  5 , Charles O Mensah  5 , Ahmad Aliyu  5 , Bolanle Oyeledun  6 , Prosper Okonkwo  7 , John O Oko  8 , Akudo Ikpeazu  9 , Gambo Aliyu  10 , Tedd Ellerbrock  3 , Mahesh Swaminathan  2
Affiliations

Expanding access to HIV services during the COVID-19 pandemic-Nigeria, 2020

Andrew T Boyd et al. AIDS Res Ther. .

Abstract

Background: To accelerate progress toward the UNAIDS 90-90-90 targets, US Centers for Disease Control and Prevention Nigeria country office (CDC Nigeria) initiated an Antiretroviral Treatment (ART) Surge in 2019 to identify and link 340,000 people living with HIV/AIDS (PLHIV) to ART. Coronavirus disease 2019 (COVID-19) threatened to interrupt ART Surge progress following the detection of the first case in Nigeria in February 2020. To overcome this disruption, CDC Nigeria designed and implemented adapted ART Surge strategies during February-September 2020.

Methods: Adapted ART Surge strategies focused on continuing expansion of HIV services while mitigating COVID-19 transmission. Key strategies included an intensified focus on community-based, rather than facility-based, HIV case-finding; immediate initiation of newly-diagnosed PLHIV on 3-month ART starter packs (first ART dispense of 3 months of ART); expansion of ART distribution through community refill sites; and broadened access to multi-month dispensing (MMD) (3-6 months ART) among PLHIV established in care. State-level weekly data reporting through an Excel-based dashboard and individual PLHIV-level data from the Nigeria National Data Repository facilitated program monitoring.

Results: During February-September 2020, the reported number of PLHIV initiating ART per month increased from 11,407 to 25,560, with the proportion found in the community increasing from 59 to 75%. The percentage of newly-identified PLHIV initiating ART with a 3-month ART starter pack increased from 60 to 98%. The percentage of on-time ART refill pick-ups increased from 89 to 100%. The percentage of PLHIV established in care receiving at least 3-month MMD increased from 77 to 93%. Among PLHIV initiating ART, 6-month retention increased from 74 to 92%.

Conclusions: A rapid and flexible HIV program response, focused on reducing facility-based interactions while ensuring delivery of lifesaving ART, was critical in overcoming COVID-19-related service disruptions to expand access to HIV services in Nigeria during the first eight months of the pandemic. High retention on ART among PLHIV initiating treatment indicates immediate MMD in this population may be a sustainable practice. HIV program infrastructure can be leveraged and adapted to respond to the COVID-19 pandemic.

Keywords: ART; CDC; COVID-19; HIV; Nigeria; PEPFAR.

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Conflict of interest statement

The authors declare that they have no competing interests.

Figures

Fig. 1
Fig. 1
Impact of innovative strategies implemented to circumvent the challenges of COVID-19 during the CDC Nigeria ART Surge, February–September 2020. PLHIV People living with HIV/AIDS, MMD multi-month dispensing, ART Antiretroviral treatment
See this image and copyright information in PMC

References

    1. UNAIDS Country factsheets: Nigeria 2019 2020. https://www.unaids.org/en/regionscountries/countries/nigeria.
    1. Nigeria FMoH. Nigeria HIV/AIDS Indicator and Impact Survey (NAIIS) 2018: Technical Report. Abuja, Nigeria; 2019.
    1. UNAIDS. 90-90-90: An ambitious treatment target to end the AIDS epidemic. Geneva; 2014.
    1. Dirlikov E, Jahun I, Odafe SF, Obinna O, Onyenuobi C, Ifunanya M, et al. Rapid scale-up of an antiretroviral therapy program before and during the COVID-19 pandemic—Nine States, Nigeria, March 31, 2019-September 30, 2020. MMWR Morb Mortal Wkly Rep. 2021;70(12):421–426. doi: 10.15585/mmwr.mm7012a3. - DOI - PMC - PubMed
    1. Nigeria Centre for Disease Control. 100 days of Nigeria COVID-19 response Abuja, Nigeria: Nigeria Centre for Disease Control; 2020 [updated June 08, 2020; cited 2021 March 15,]. https://ncdc.gov.ng/news/253/100-days-of-nigeria-covid-19-response.

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