Roundtable suggest strategies for scaling-up demand for treatment

September 4, 2006 :: Kingsley Obom-Egbulem, Journalists Against AIDS(JAAIDS)Nigeria

With less than four months to the end of 2006,the plan to place 250,000 people living with HIV on antiretroviral therapy (ART) in Nigeria remains a grandiose dream.
 
The Federal Government had, in 2005 promised to treat at least 250,000 PLWH by June 2006 and 350,000 by 2007. As at June this year, only about 75,000 are receiving ART in about 70 treatment centres in the country.

This figure according to a consolidated treatment report released in June 2006 includes figures from other care providers like the US President’s Emergency Plan for AIDS Relief;(PEPFAR), The Global HIV/AIDS Initiative in Nigeria (GHAIN), the MSF Clinic in Lagos.

With the June deadline already missed, some actors in the national AIDS treatment programme believe government’s inability to build capacity of primary and secondary health centers and incorporate them into the ART programme, low demand for VCT service and impact of stigma and discrimination may continue to stand in the way of genuine intention to increase access and demand for AIDS treatment in Nigeria.
 
“Scaling up access and demand for treatment is more than just making drugs available and giving it to those who need it. The implications of such scale up must be looked at from all perspectives”, said Dr.Ernest Ekong, PEPFAR National treatment Coordinator.

Ekong believe basic issues such as strengthening voluntary counseling and testing (VCT) programme and client referral mechanism are fundamental to any treatment programme.
He was speaking as lead discussant at a media roundtable organized by Journalists Against AIDS (JAAIDS) Nigeria in Lagos.The roundtable tried to address challenges confronting care providers in increasing demand for treatment.

Government’s efforts at scaling up access to treatment has led to the establishment of more treatment centers across the country with at least one centre in every state. But the number PLWH on treatment is still a far cry from the targeted 250,000.

“To increase demand for treatment we must get our VCT programme right and well structured, because it plays a very important role in any treatment programme”,
Ekong added.

Treatment scale up, according to Ekong must feed into a structured plan to increase access to and demand for VCT services since people have to know their HIV status before thinking about treatment.

Dr. Daniels George, Project Coordinator of the MSF AIDS Treatment programme at the Lagos General Hospital says ignorance has been the bane of most ART scale-up
efforts.

“In HIV/AIDS treatment, I find out that the major issue affecting scaling up is ignorance; people still have problems with simple issues such as whether HIV/AIDS really exist, those who know it exists don’t know what to do about HIV, those who know what to do don’t know where to go, those who know where to go are either afraid of being stigmatized or lack money to transport themselves”.

George said though VCT may address some issues, people still need basic education on what to do especially where to go to for VCT and other services. Aside the absence of a synergy between the VCT programme and those driving the ART scale-up in Nigeria, all the discussant at the roundtable believe that we need to spread treatment centres to include primary and secondary health centres.
 
“I really don’t think we can achieve much if only the tertiary health care centres- the centres of excellence are the ones involved in our efforts at scaling up access and demand for treatment .We need to incorporate the primary and secondary health care centres and this would reduce the number of people traveling from one state to the other to access ART ”,said Ekong.

This certainly would mean massive capacity building for such centres for which government may not be prepared at least for now.
But George has a recommendation, which sounds like a personal challenge to medical personnel at the primary and secondary health centres.

“I think the idea of having “special clinics” for HIV/AIDS and sending a few  “experts” there to work makes this issue of ART appear complex such that every body now wants to wait for someone to built their capacity, before they can attend to HIV and AIDS cases”.

George said that the issue of capacity building at the primary and secondary health centres would not be too serious if the doctor who attends to people with malaria and other common diseases is the same person attending to HIV cases. “All he needs to do is to learn more about one more disease (ie HIV/AIDS) and understands how three other drugs work on HIV, then he can refer issues such as monitoring;CD4 and viral load testing to the tertiary health centres”.

Even in the place of an ideal mechanism for scale-up, the impact of AIDS-related stigmatization continues to affect demand for treatment. Most of f the care providers agreed that stigma is adversely affecting demand for treatment a situation which has led to the movement of people from one centre to another, thus creating uneven distribution of clients.

“I know of a company that provides free treatment for its staff living with HIV but the staff would rather go to government centers and other private care providers to access treatment and they are swelling the number of PLWH at such centers while their own drugs are wasting away”, said Bose Olotu, South West Coordinator of the Treatment Action Movement (TAM).

Olotu said care providers and personnel at treatment centres must understand the inevitable role non-stigmatizing environment plays in increasing demand for treatment. “People will always resist any where they are being stigmatised even if treatment is free”. 

The need for a comprehensive treatment package as against the current “pills only” offer the government is making was reiterated.

Provision of drugs, regular laboratory monitoring, follow-up, adherence counseling, treatment literacy as well as psychosocial support are the component of a comprehensive treatment package.

Its not really clear how these package can be made available free to 250,000 PLWH by end of 2006.Even if the intention was to provide just free ARV to 250,000,
the target is still ambitious.

But Ekong still believes it is achievable "if every stakeholder in the treatment national programme plays its part as expected”.