Rapid Scale-up of an Antiretroviral Therapy Program Before and During the COVID-19 Pandemic — Nine States, Nigeria, March 31, 2019–September 30, 2020

Dirlikov, Emilio; Jahun, Ibrahim; Odafe, Solomon; Ogbanufe, Obinna; Onyenuobi, Chibuzor; Ifunanya, Mgbakor; Efuntoye, Timothy; Tingir, Nguhemen; Ene, Uzoma; Fagbemi, Ayodele; Meribe, Chidozie; Bassey, Orji; Ayo, Adeola; Fagbamigbe, Omodele Johnson; Amafah, Joy; Bamidele, Moyosola; Alagi, Matthias; Oladipo, Ademola; Dalhatu, Ibrahim; Okoye, McPaul; Onotu, Dennis; Gwamna, Jerry; Abrams, William; Conner, Deborah A.; Nwaohiri, Anuli; Carpenter, Deborah; Ijeoma, Ugonna C.; Shah, Sarita; Tison, Laura; Shah, Minesh; Chun, Helen M.; Williams-Sherlock, Michelle; Boyd, Andrew T.; Bachanas, Pamela; Ikpeazu, Akudo; Aliyu, Gambo; Ellerbrock, Tedd V.; Swaminathan, Mahesh; FitzGibbon, Kathleen; Giambrone, Mark; Abutu, Andrew; Fellows, Ian E.; Murie, Lisa A.; Miller, David A.; Nnadozie, Obinna; Shiraishi, Ray W.; Thorsen, Viva Combs; Adebayo, O; Dakum, Patrick; Mensah, Charles; Mishara, Fadimatu; Kinmilola, Olupitan Olayemi; Pillatar, Benjamin J.; Okolo, Chukwuemeka; Verinumbe, Tarfa; Sambo, Yakubu; Yillong, Fidelis; Abe, Oluwaseun; Achor, Olaitan; Bashir, Musa; Bature, Stephen; Madina, Emily; Oyedelun, Bolanle; Bassey, Fabian; Effiong, Amana; Francis, Alimigbe; Magbadelo, Dorcas T.; Okolie, Charles E.; Oko, John Okpanachi; Olayiwola, Olanrewaju; Onu, Eugene; Onwuchekwa, Chukwudi; Obaje, Mikhail; Okwonkwo, Prosper; Usha, Thomas; Ejimkaraonye, Evans; Achebe, Chiagozie; Adebajo, Sylvia; Alonge, Johnson; Asiozi, Moses; Attah, Nelson; Musei, Nnabundo; Onyekachi, Prosper; Stafford, Kristen A.

doi:10.15585/mmwr.mm7012a3

Cited by 18 publications

(26 citation statements)

References 3 publications

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“…The ART Surge in Nigeria, perhaps because of its general flexibility of approach to increasing access to HIV services, serves as an example of how HIV services, including community outreach, testing and counseling, and linkage and retention to ART, can be not only maintained but expanded during COVID-19. Within the ART Surge approach, the use of geographically localized incident command structures and consortia with partners allowed rapid development and dissemination of ART service delivery adaptations [ 4 , 8 ]. When COVID-19 arrived in Nigeria, the staff operating in these structures were able to use this same framework to develop COVID-19 mitigation strategies, incorporate input of technical expertise, and facilitate widespread program implementation of COVID-19-specific adaptations quickly and early in the pandemic.…”

Section: Discussionmentioning

confidence: 99%

“…From the start of the ART Surge, a key HIV case-finding strategy was conducting targeted community-based testing. [ 4 , 8 ] In the COVID-19 context, to maintain HIV case-finding while health facility-based services were more limited, health staff intensified their focus on increasing the proportion of testing done in the community setting. Specifically, dedicated HIV testing and outreach teams entered communities to conduct HIV education, screening, counseling, and testing.…”

Section: Methodsmentioning

confidence: 99%

“…As part of ART Surge monitoring and evaluation, both health facilities and community-based HIV service teams reported weekly numbers of newly-diagnosed PLHIV initiating ART in an Excel-based dashboard described elsewhere [ 4 , 8 ]. Upon implementation of the four key adapted strategies, these teams included data on the corresponding HIV program process variables within the dashboard, including the number of PLHIV initiating ART with an ART “starter pack” of 90 daily doses and the number of PLHIV established in care who received on-time ART refills.…”

Section: Methodsmentioning

confidence: 99%

“…In April 2019, the US President’s Emergency Plan for AIDS Relief (PEPFAR), which supports the Government of Nigeria in providing HIV services, including technical assistance and direct funding of implementing partners, launched the ART Surge, intended to rapidly increase the proportion of PLHIV identified and linked to treatment, in line with the UNAIDS 90-90-90 HIV targets for epidemic control [ 3 ]. As part of the ART Surge, the US Centers for Disease Control and Prevention Nigeria country office (CDC Nigeria), supported by PEPFAR, set a goal to identify, initiate, and retain on ART nearly 340,000 additional PLHIV, focusing efforts in nine states (Benue, Delta, Enugu, Federal Capital Territory, Gombe, Imo, Lagos, Nasarawa, and Rivers) [ 4 ].…”

Section: Introductionmentioning

confidence: 99%

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

et al. 2021

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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.

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Section: Discussionmentioning

confidence: 99%

Section: Methodsmentioning

confidence: 99%

Section: Methodsmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

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

et al. 2021

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“…With epidemiologic data provided by NAIIS, in April 2019, Nigeria reshaped programming to control the epidemic more precisely, scaling up ART programs to provide services to an additional 500,000 PLHIV within 18 months. 4 , 5 At the time, resources for case-finding had been reserved for exclusive use within healthcare facilities and among key populations. Because of low number of positive individuals identified, community testing methods had been discontinued.…”

Section: Introductionmentioning

confidence: 99%

Ensuring Optimal Community HIV Testing Services in Nigeria Using an Enhanced Community Case-Finding Package (ECCP), October 2019–March 2020: Acceleration to HIV Epidemic Control

Jahun¹,

Dirlikov²,

Odafe³

et al. 2021

HIV

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Purpose The 2018 Nigeria HIV/AIDS Indicator and Impact Survey (NAIIS) showed Nigeria’s progress toward the UNAIDS 90-90-90 targets: 47% of HIV-positive individuals knew their status; of these, 96% were receiving antiretroviral therapy (ART); and of these, 81% were virally suppressed. To improve identification of HIV-positive individuals, Nigeria developed an Enhanced Community Case-Finding Package (ECCP). We describe ECCP implementation in nine states and assess its effect. Methods ECCP included four core strategies (small area estimation [SAE] of people living with HIV [PLHIV], map of HIV-positive patients by residence, HIV risk-screening tool [HRST], and index testing [IT]) and four supportive strategies (alternative healthcare outlets, performance-based incentives for field testers, Project Extension for Community Healthcare Outcomes, and interactive dashboards). ECCP was deployed in nine of 10 states prioritized for ART scale-up. Weekly program data (October 2019–March 2020) were tracked and analyzed. Results Of the total 774 LGAs in Nigeria, using SAE, 103 (13.3%) high-burden LGAs were identified, in which 2605 (28.0%) out of 9,294 hotspots were prioritized by mapping newly identified PLHIV by residential addresses. Over 22 weeks, among 882,449 individuals screened using HRST, 723,993 (82.0%) were eligible and tested for HIV (state range, 43.7–90.4%), out of which 20,616 were positive. Through IT, an additional 3,724 PLHIV were identified. In total, 24,340 PLHIV were identified and 97.4% were linked to life-saving antiretroviral therapy. The number of newly identified PLHIV increased 17-fold over 22 weeks (week 1: 89; week 22: 1,632). Overall mean HIV positivity rate by state was 3.3% (range, 1.8–6.4%). Conclusion Using ECCP in nine states in Nigeria increased the number of PLHIV in the community who knew their status, allowing them to access life-saving care and decreasing the risk of HIV transmission.

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