Nigeria is the third-largest U.S. President’s Emergency Plan for AIDS Relief (PEPFAR) program and has received over $4 billion since 2004. CDC-Nigeria works in close collaboration with Nigeria’s Federal Ministry of Health (FMOH) to support sustainable, country-owned HIV prevention, treatment, and care programs and to strengthen the country’s laboratory, disease surveillance, and program monitoring and evaluation systems.
With partners in Nigeria, CDC works to
- Scale-up testing for and treatment of HIV-positive individuals in high burden LGAs in Nigeria
- Develop tailored prevention efforts for high-risk populations
- Support interventions to prevent mother-to-child transmission of HIV
- Transition HIV/AIDS treatment programs to Nigerian government for long-term sustainability
CDC-Nigeria has provided
- Laboratory support for diagnosis and monitoring of HIV-positive patients, affected family members, and orphans and vulnerable children
- Technical and logistics assistance to harmonize laboratory systems and practices
- Technical and financial support for national antenatal care, TB, and HIV drug resistance surveillance surveys
Specifically, CDC-Nigeria is working to address the impact of HIV/AIDS through:
HIV Epidemiology and Strategic Information
CDC-Nigeria is responding to challenges in maintaining high-quality surveillance systems and strengthening the public health disease response to outbreaks in Nigeria. To achieve high impact, CDC-Nigeria supports GoN to conduct routine HIV/AIDS prevalence survey through sentinel antenatal clinic attendees and provides technical assistance to other general and high-risk population studies. CDC-Nigeria collects accurate health data and uses the data to plan, implement, and evaluate programs. A high-quality epidemiological surveillance system allows Nigeria to tailor programs to the local epidemic and direct resources to the areas with the highest need. CDC’s top priorities are to ensure high data quality and create quality surveillance systems throughout the country. In this regard CDC-Nigeria’s epidemiology program has been the bedrock of PEPFAR programs, providing monitoring, evaluation, and strategic information services that include regular site monitoring and supervisory visits; managing facility-level monthly program reports and conducting facility-level data quality validation and assessments; general population, Sentinel and target group surveys.
Specifically, CDC-Nigeria’s Epidemiology-Strategic Information program provides technical and logistics support and training to Nigeria to conduct significant ongoing surveillance programs, surveys, and individual studies. These include HIV incidence study, National antiretroviral therapy impact and outcome evaluations, Prevention of Mother-to-child Transmission (PMTCT) impact evaluation study. It also provides State level AIDS indicator survey and Drug resistance monitoring surveys
Since 2006, CDC-Nigeria has provided funding and technical assistance to the Government of Nigeria and implementing partners for coordinated TB/HIV efforts in Nigeria. The CDC-Nigeria TB/HIV program works to strengthen TB/HIV collaboration within the Federal Ministry of Health, State Ministries, and PEPFAR-supported TB/HIV partners and support the use of new technologies such as GeneXpert for timely TB diagnosis for people living with HIV. Using the 3 ‘Is’ approach; CDC-Nigeria supports Intensified case finding–Regular TB screening for people with HIV and people with high HIV risk. It also carries out Isoniazid preventive therapy–Treatment to prevent latent TB infections from developing into active TB and the TB Infection control–Detect TB infections, prevent airborne transmission, and treat those with TB infections in line with TB BASICS (Building and Strengthening TB Infection Control Strategies) model. Also, core to the TBHIV program is the scale-up of ART services for HIV-infected TB patients, treatments of their TB as well as the strengthening of TB/HIV monitoring and evaluation systems.
Orphan and Vulnerable Children
CDC-Nigeria programs for children orphaned and made vulnerable by HIV/AIDS contributes to the achievement of an AIDS-free generation by responding to the social (including economic) and emotional consequences of the disease on children, their families, and communities that support them. CDC-Nigeria collaborates with relevant government ministries, departments and agencies (especially the Federal and State Ministries of Women Affairs and Social Development), Implementing partners and other stakeholders to deliver OVC program services.
CDC-Nigeria Implementing Partners work with health facilities, community-based organizations (CBOs), civil society organizations (CSOs), faith-based organizations (FBOs), etc. to provide community and facility child-focused, family-centered interventions/OVC services to beneficiaries. Service package includes health and nutrition, education, psychosocial support, household economic strengthening, child and legal protection, adolescent girls and young women program, etc.
HIV Treatment, Care and Support program
CDC-Nigeria supports Government of Nigeria to scale up comprehensive HIV treatment, care and support program which is patient-centered and focuses on quality services. The program aims to reduce HIV burden and mortality by increasing access to ART for HIV-infected individuals inclusive of children hence contributing to an AIDS-free generation where no Nigerian child dies on account of HIV infection. Since 2004, Care and support for adults and pediatrics living with HIV/AIDS has evolved from the provision of palliative care and management of myriads of opportunistic infection to the current client tailored needs. This approach is centered on positive health, dignity and prevention services in the health facility and community, adequate adherence preparation before the commencement of ART and laboratory monitoring of patients on ART using viral load testing. CDC has been working to coordinate HIV treatment, care and support efforts in Nigeria and to strengthen the Government of Nigeria’s ownership of HIV treatment services.
CDC’s technical support will continue to be essential in helping the Government of Nigeria expands HIV treatment services in ways that will significantly reduce unmet needs. The treatment program intends to accomplish this by doing the ‘right things’ that is implementing the right package of care that will improve the quality of life and reduce morbidity and mortality. Additionally, CDC’s program Implementation is focused in the ‘right places,’ that is scaling up of treatment services in the most HIV-burdened local government areas in Nigeria, and by leveraging locally available resources to achieve synergy, and improving overall efficiency through the implementation of concepts that strengthens the health systems in Nigeria. Also, to supporting expanded access and quality of ART services, CDC is work with IP and Government of Nigeria to develop programs that will demonstrate sustained control of the HIV epidemic and long-term sustainability.
HIV Testing and Counselling
CDC-Nigeria also works with local groups who go to the homes of clients who test positive for HIV. The groups provide home-based HTC so family members also can connect to nearby hospitals or clinics for services. This approach is focused on populations with highest HIV risk, including prison inmates, people in alcohol/drug rehabilitation centers, sex workers, families of people diagnosed with HIV, and pregnant women and their children.
Prevention of Mother-to-Child Transmission (PMTCT)
CDC-Nigeria Prevention of Mother-to-Child Transmission (PMTCT) program has led the effort to strengthen Nigeria’s health system so that all women have access to testing, lifelong ART, care, and support. The HIV testing of all pregnant women and provision of lifelong antiretroviral therapy (ART) for those found to be HIV positive is very effective in preventing the transmission of HIV from mother to child. The PMTCT program supports health facilities in thirty-two selected priority local governments across eight supported states in Nigeria to pilot option B+ in line with the latest WHO guidelines.
CDC-Nigeria works on many fronts to assure that PMTCT activities are effective, cost efficient, and sustainable in all their supported states and facilities. The efficiency is achieved through partnerships with States and local indigenous organizations who can provide PMTCT services and collaborate with public and private health facilities to scale up PMTCT in areas with the highest HIV burden. CDC also works with GoN and other stakeholders in the field of policy and capacity building and development to strengthen the provision of PMTCT services in health facilities.
Preventing Sexual Transmission of HIV
In Nigeria, 80% of new HIV infections is acquired through unprotected sex (National Strategic Plan; 2010 – 2015). Since 2007, CDC-Nigeria’s Sexual Transmissions Program (STP) has been working to reduce sexual transmission of HIV, especially in subpopulations with the highest risk of exposure. Since CDC-Nigeria launched STP in 2007, the program has played a significant role in the steady decline in national HIV prevalence. By building the capacity of local implementing partners and CBOs to raise community awareness, and develop skills on HIV prevention and safer sex. The STP program is helping to build a stronger health care infrastructure in Nigeria. In addition to influencing the general population, CDC-Nigeria’s partners have been able to design and implement programs for Key Populations not previously reached.
Gender Equity and Response to Gender-Based Violence
Gender norms, inequalities, and violence increase women’s/girls and men’s/boys vulnerability to HIV due to multiple socio-cultural factors, including limited the ability to negotiate safer sex. It also encourages engaging in transactional sex, high sexual risk behaviors, and curtailed ability to test, disclose and access HIV treatment because of real or perceived fear of violence and abandonment. CDC-Nigeria, through its implementing partners, works to promote gender equity and equality in its HIV program by engaging women and girls, men and boys to address norms and behaviors that contribute to the HIV epidemic. Due to the intersections between gender-based violence (GBV) and HIV, CDC-Nigeria also recognizes the intersections between gender-based violence and HIV and is providing comprehensive health services to survivors of GBV and providing referral linkages for non-clinical services.
Laboratory Services Program
The medical laboratory is the backbone of our public health programs and interventions. We partner with the Government of Nigeria through the Laboratory services program, to support the provision of integrated and quality assured public health laboratory services for the diagnosis, staging, treatment monitoring, and laboratory-based surveillance of HIV/AIDS, Tuberculosis, and other related diseases. Our principal areas of strategic focus are Laboratory Service provisions, Laboratory Quality Improvement, and laboratory capacity building and systems strengthening.
Through our PEPFAR program, Implementing Partners CDC/Nigeria is supporting laboratory services for HIV and related diseases in over 213 public and private laboratories across the six geopolitical zones of Nigeria, with an astute focus on achieving the PEPFAR Nigeria 90-90-90 targets as a strategy towards attaining an AIDS-Free Generation. CDC is leading the coordination of a USG inter-agency (USAID, DOD, and CDC) efforts in the provision of viral load, early infant diagnosis, CD4 count, TB GeneXpert tests across the 36 states of the Nigeria and the FCT, through a network of about 500 PEPFAR supported laboratories.
As part of our Systems Strengthening and continuous quality improvement efforts, CDC/Nigeria is supporting and providing the needed technical assistance for the implementation of a Proficiency Testing Program in Nigeria, through the National External Quality Assurance Laboratory (NEQAL), established through CDC funding support. Through this lab, CDC is also supporting the Post-market validation of all procured HIV Rapid test kits to ensure their reliability before they are deployed for use in HIV testing sites.
We are currently leading the efforts of institutionalizing Quality Management Systems (QMS) implementation in all PEPFAR supported laboratories in Nigeria using the Strengthening Laboratory Quality Management Towards Accreditation (SLMTA) program as an implementation strategy in this direction. Through this efforts, a significant number of laboratories have achieved varying degrees of Stars levels in recognition of their quality improvement efforts.
CDC has worked in collaboration with Stakeholders’ to develop a National Medical Laboratory Strategic Plan for 2015 – 2020, and we are supporting the implementation of this strategic plan, in partnership with other donors and development partners in Nigeria. CDC is also collaborating with the Clinton Health Access Initiatives in the implementation of a National Laboratory Information Management System (LIMS) in supported molecular and clinical laboratories.