Why rate of deaths from HIV is falling, by minister

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Minister of Health Prof Isaac Adewole has attributed the reduction in the number of Nigerians dying from HIV-related diseases to increased awareness of their HIV status and use of drugs.

Adewole spoke at a Joint Stakeholders Summit on Drug Resistance Monitoring, Early Infant Diagnosis and Viral Load in Lagos.

The event was organised by the National HIV/AIDS Control Programme (NASCP).

Adewole said: “More people are getting to know their status and accessing HIV treatment and care; as a result, HIV-related deaths are being averted. However, there is still programmatic challenge, such as therapy adherence and retention in care with attending issues, such as HIV drug resistance, be it pre-ART or acquired among the different population groups.”

On drug resistance, the minister, who was represented by Dr Sunday Aboje, the National Coordinator, National AIDs/STIs Control Programme, said since its inceptions the national HIV response programme, has witnessed significant improvement through commitment of the various stakeholders. “Studies have shown that the surveillance and early identification of these issues which necessitates prompt intervention is required to prevent the untold effect of HIV drug resistance,” he said.

The minister said there were still challenges in the management of HIV, despite the commitment of the government and donor partners to achieving global targets.

According to him, only about 8.9 per cent of infants born to HIV positive women were being tested. “This is due to difficulty with tracking babies of HIV positive mothers delivered outside public health facilities. So also are poor Dried Blood Spots (testing of infant blood samples), viral load testing sample logistic systems and weak mentorship and supportive supervision at the health facility levels, among others,” Adewole said.

The minister said a well-coordinated programme which involved all major implementers would help solve the problems.

“Surmounting these challenges would require improving the implementation of the programme that will ultimately serve as good practice for other countries,” he noted.

Consultant Haematologist, Prof. Sulaiman Akanmu said regular monitoring of drug resistance mutations in the form of studies by institutions would help influence policies. He said: “The studies about drug resistance are important and any institution offering anti-retroviral therapy must expect that resistance will naturally evolve. We must anticipate it and put measures in place to ensure that we are able to contain it.”

Akanmu said the research was important is because before a medic could treat a patient in some countries, he must put him on an anti-retroviral therapy and drug resistance testing to determine the type of drugs to adminster to him.

“That is not feasible in our clime. We really need to give it a public approach system in the sense that we will have to find out what is the common form of resistance that occurs in our patients. We use the report of the resistance testing study to inform policy on what we should consider as first line drug, second line drug and how we should manage what we call third line regimen. That is the reason why you must be able to do drug resistance testing,” he said.

Senior Virologist, Institute of Human Virology, Nigeria, Dr Nicaise Ndembi, said there was the need to design surveys to provide evidence-driven interventions.

Ndembi, however, said the country lacked the data which showed the problem of resistance. “Basically, the concept is that if you have more exposure to anti-retroviral therapy, the virus will select resistant mutations. Thus, the reason we should worry as a nation is because the more we have people being placed on treatment, the more we have cases of more resistance. We need more research studies to know the magnitude of the problem,” he said.

Consultant in Public Health, Prof. Phyllis Kanki identified high cost of laboratory test, lack of patience to attend to or give treatment to patients as some challenges facing HIV treatment.

“All the laboratory tests have a certain cost, no waiving, the other challenge is even though the therapy works pretty well it is still life long treatment. So, you have to exercise huge patience and the healthcare system is not ready to support a patient for many years. Finally, is the patients’ compliance. Patients may have issues with taking the drugs, they may want to stop and that can be a problem for them,” she added.

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