NAIIS: A new dawn in HIV management

On 22/Mar/2019 / In Medical News

The Federal Government has unveiled  the Nigeria HIV/AIDS Indicator and Impact Survey (NAIIS) for measuring the size, distribution and determinants of HIV/AIDS epidemic and the impact of interventions.
It has set a new path in the country’s handling of the pandemic that has ravaged many of its citizens and depleted its active workforce for decades.
Experts described NAIIS as the largest survey on HIV in the world.
Presenting the findings at the Presidential Villa, Abuja, President Muhammadu Buhari noted that the NAIIS’results would inform the country’s response to HIV/AIDS as a public health crisis.
Nigeria, with support from the United States President’s Emergency Plan for AIDS Relief (PEPFAR), the US Centres for Disease Control and Prevention (CDC), and other partners conducted the survey in nine months through a $70 million grant from the US and $20 million from the Global Fund.
Unlike previous surveys that neither matched the country’s size nor produced reliable results to guide planning and response efforts, experts said NAIIS could assist in  the fight against HIV.
Another feature of the survey is that it measured HIV prevalence and viral load suppression, which, ultimately, will allow Nigeria to focus on providing services and resources to areas where the disease is rampart.
There are other glad tidings from the survey. One is that the country’s true position in global ranking of the pandemic is known, and can be backed with data. Findings show that Nigeria’s prevalence rate of HIV/AIDS is at 1.4 per cent. This means 1.9 million Nigerians are living with HIV, a significant improvement to what obtained previously, when the country was estimated to have 3.1 million people living with the deadly virus. With the results, Nigeria has moved to the fourth position among countries worst hit by the HIV epidemic after South Africa, India and Mozambique.
Buhari, elated by the news that fewer people are living with HIV, said the results would provide the government with appropriate information to enable the country end the HIV epidemic before the 2030 target.
“Prior to this major survey, Nigeria had the second largest HIV burden in the world and the highest number of children born with the virus. The availability of accurate and reliable HIV data for the country is crucial for planning effective health interventions to arrest the HIV epidemic and ultimately rid the country of this health threat.
“Recently, the national HIV programme and our development partners have faced challenges in measuring progress against targets and efficiently utilising scarce resources due to gaps in our HIV data. This result will provide the government with information to move forward in the HIV fight based on scientific data. We are already a step ahead in this regard,” he said.
According to NACA Director-General, Dr. Sani Aliyu, the results of NAIIS are products of the best methods and data management procedures by experts in Nigeria, US, UMB consortium of technical partners and the United Nations agencies. He added that the data from the survey had been  scrutinised  by international experts before their release.
Explaining the significance of NAIIS, Aliyu said despite the huge investments made over the years on HIV/AIDS interventions, repeated surveys have failed to demonstrate significant improvement in the epidemic status proportionate to her efforts. Instead, impact data has continued to show a gap between the individuals on treatment and those projected to be in need of services, he said.
“These concerns informed our decision to conduct a more scientifically robust household survey – the Nigeria AIDS Indicator and Impact Survey (NAIIS). NAIIS had a large sample size of 225,000 persons drawn from more than 97,000 households across all the local government areas of Nigeria, making it truly representative of the general population. At any point during the survey, we had at least 3,000 staff collecting and reporting data in the field.
“The survey measured the incidence and prevalence of HIV, level of virological suppression and the epidemiological impact of the HIV programme among different age groups. The NAIIS survey and its findings have greatly positioned Nigeria to objectively assess our performance as a country against internationally set targets for achieving global epidemic control. We now have greater clarity on the extent of the HIV epidemic, the impact of our programmes and even more importantly a clear sense of direction on what we need to do to achieve our goal of eliminating HIV/AIDS in Nigeria by 2030,” Aliyu said. 
At the briefing to analyse the results, Minister for Health Prof. Isaac Adewole said  those infected with HIV, especially pregnant women, should get treatment so they can achieve viral suppression. He added that if all pregnant women have access to antenatal services and are tested during every pregnancy, it will be easy to know and support HIV-positive mothers, thereby ensuring that the next generation is free from HIV.
Although there is a reduction in prevalence, the number of people affected by the disease, especially those not on treatment, is still huge. Based on NAISS findings, HIV prevalence among women is significantly higher at 1.9 per cent; male prevalence is estimated at 0.9 per cent. Among other things, the new data also differentiates prevalence on a state-by-state basis, showing that some states have lower prevalence than previously estimated; while some states higher prevalence than previously assumed.
Seven states – Abia, Taraba, Benue, Enugu, Anambra, Akwa Ibom and Rivers – led the pack of places with high HIV prevalence in the country, having prevalence of two per cent and above. Thirteen states (plus Federal Capital Territory (FCT) are categorised as having medium prevalence rate between 1.0 per cent and 1.9 per cent. They are Borno, Gombe, Adamawa, Kaduna, Plateau, Nasarawa, Cross River, Imo, Edo, Delta, Bayelsa, Lagos and Ogun.
The other states are considered to have low prevalence, below 1.0 per cent. Broken down into geo-political zones, what this means is that all states in the Northwest zone, except Kaduna, have low HIV prevalence. Likewise, all states in the Southwest zone, except Lagos and Ogun, also have low prevalence. However, the story is mixed in the North-central where there is low, medium and high prevalence.
NAIIS also revealed that seven states account for 50 per cent of the estimated number of persons living with HIV (PLWH), with 80 per cent of PLWH estimated to be living in 19 states and FCT. In terms of geographical distribution, the estimated number of people with HIV is highest in the Southsouth zone of the country, followed by the Northcentral and lowest in the Northeast. Results also reveal that HIV prevalence among adult population (15-49) is 1.4 per cent and 1.5 per cent for 15-64.
While reminding the public that HIV/AIDS still remains a significant problem, particularly on the continent, Adewole explained that it requires high-level political commitment, vision and leadership, quality epidemiologic data and strategic interventions to defeat the disease.
“As you may be aware, the first case of AIDS in Nigeria was reported in 1986. Since then, the epidemic has grown steadily from 1.8 per cent in 1991 to 3.8 per cent in 1993, 4.5 per cent in 1995, 5.4 per cent in 1999 and peaked at 5.8 per cent in 2001. The prevalence began a gradual reduction from 5.8 per cent to five per cent in 2003, this decline continued to 4.4 per cent in 2005, 4.6 per cent in 2008 and 4.1 per cent in 2010.  By 2014 the HIV prevalence rate was 3.0 per cent.
“I promise that the (NAIIS) findings would be used to improve health care planning and the coordination of HIV/AIDS control activities in the country. I implore everyone to study the findings, understand them and use them for effective and efficient planning at the national and sub-national levels,” he said.
But Buhari cautioned that it was not yet time to sing the victory song, as there was still a lot of work to be done. The President tasked NACA and relevant institutions to work closely with state governments, especially where there is high HIV prevalence, to reduce the epidemic drastically. Pledging his administration’s continued commitment to healthcare, he promised that more people living with HIV will be put on free anti-retroviral treatment.
“However, we cannot celebrate yet as we are more committed to ensuring that more people are placed on treatment. Now that we have the data, I urge us all to work together to ensure that we deliver ahead of 2030,” he said.
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