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Nigeria's ARV programme picks up some speed ...Pilot centres to expand client capacity, as second phase commences

By Olayide Akanni

LAST January, officials at the national AIDS/STDs control programme unit of the federal ministry of health in Abuja quietly began disbursing stocks of antiretroviral (ARV) drugs to 25 health institutions across the country.

It was a decidedly slow start to a long-drawn planning process to execute what is generally touted as Africa’s largest antiretroviral treatment programme. In April 2001, when the federal government announced its decision to invest N500 million annually in purchase of the life-saving antiretrovirals (drugs used to treat HIV/AIDS, which stop the virus from replicating), it was hailed as a positive confirmation of government’s commitment to combating HIV-related stigma and promoting care for Nigerians living with HIV.

After a series of postponements, the programme finally rolled on last January 1, with clinical trials of the drug combination Lamivudine, Nevirapine and Stavudine in 25 designated centres across the country (see list of sites below). But the programme was not without hiccups. Many people living with HIV/AIDS (PLWHA) complained of lack of information about the treatment sites and programme details.

By end of March, three months into the programme, many of the sites had not yet filled up their quota of 25 patients, an incredible situation considering that at least three million Nigerians are HIV-positive. Moreover, there were several questions begging for answers: Were these drugs completely free or merely subsidized? How much were patients to pay for accompanying laboratory investigations? Would the programme be accessible only to openly HIV-positive people who had openly declared their status?
Last May, Dr. Salma Anas Kolo, head of the care and support unit at the health ministry’s AIDS programme told Access Alert that the programme had overcome most of the teething problems. “All the centres had fulfilled their 25-patient and many of those centres had begun to expand their capacity to expand capacity to administer treatment to more PLWHAS under the second phase”, she told our correspondent.
In the first phase of the treatment programme, the 25 centres were expected to run free clinical trials for a minimum of 25 clients per centre (a total of 625 clients). Under the second phase however, each centre is expected to expand its capacity in order to provide treatment and care for between 200-250 clients who would be paying N1, 000 to receive treatment on a monthly basis.

Although according to Kolo, the expansion is geared towards meeting government’s target of treating 10,000 adults and 5000 children in the first year, it remains to be seen how they could achieve this. Even with the expansion in the number of patients, only 6250 patients (assuming each of the 25 sites meets its 250-patient quota) will be able to benefit, a far cry from the targeted15,000.

Giving further information on the expanded programme, Dr. James Edo, also of the health ministry’s care and support unit told our correspondent that not all the 25 sites would roll over to phase two immediately.

“We have just finished monitoring the clinical trials which most centres have completed. A few of these centres are yet to conclude the trials because health workers in these facilities were on strike. However, those who have completed the clinical trials are now expanding their patient uptake capacity to cater for between 200-250 clients in readiness for the second phase”, he said.

Edo explained that the aim of the clinical trials, which lasted three months and constituted phase one of the treatment programme, was to give the medical practitioners and health care workers an idea of how clients would respond to treatment.

“The clinical trials were restricted to only 25 people per centre”, he explained further. “Any PLWHA could go to any of these centres, undergo the necessary laboratory tests and commence antiretroviral therapy once the results of the clinical investigations show that they meet the criteria specified in the ARV treatment protocol, which all the centres adhere to.
“The drugs for the second phase of the treatment programme have already been distributed to the various centres and those who have been able to expand the patient capacity would soon begin administering the drugs to patients”, he added.

A press statement issued on June 3 2002 by Dr. Shehu Suleiman, permanent secretary at the federal ministry of health, gave further explanation. According to him, in the scond phase of the programme, “patients are expected to bear the costs of routine laboratory tests.”

The statement also announced that a treatment programme targeting prevention of mother-to-child transmission (MTCT) of HIV would be launched on June 14. Six hospitals will serve as treatment sites for the MTCT programme. These are the National Hospital, Abuja as well as the university teaching hospitals in Lagos, Port Harcourt, Enugu, Zaria and Maiduguri.
*Culled from May/June edition of Access Alert, a bi-monthly publication of Journalists Against AIDS (JAAIDS) Nigeria, produced with support from The Ford Foundation.