1. ART SERVICES SCALE UP IN NIGERIA SUCCESSES CHALLENGES and WAY FORWARD TEAM NIGERIA

2. BACKGROUND Location: West Africa Size: 923,768 sq km Population: 149 million – Birth rate - 37/1000; Death rate 16/1000 – Life expectancy ( F=48, M=47yrs) – Population growth 2% HIV Prevalence – ANC 2008 - 4.6% – NARH 2010 - 3.6% Mostly HIV1 subtype A, G and A-G The first two cases of HIV identified in 1985 Over 800, 000 PLWHA require ARVs Risk factors include – Prostitution – High prevalence of STIs – Intl trafficking of women – Polygamy – Poverty No of PLWH- 2.95 million (male- 1.23, female- 1.72 million) Annual HIV + Birth- 56,681 Cumulative AIDS Death- 2.99 million (male- 1.38, female- 1.61) Annual AIDS Death- 280,000 (male- 123,000, female- 157,000) No requiring ART- 833,000 (Adult- 740,000, Children- 92,000) New infection- 380,000 (Adult- 323,000, Children- 57,000) Total AIDS orphaned- 2.23 million

3. National HIV Prevalence Trend 1991 – 2008

4. ART SCALE UP ART started in tertiary hospitals in 2002 Initial numbers ( Adult = 10,000; Children = 5,000) Funding ( PEPFAR, GFATM, DFID, GoN) Rapid scale up from 13 sites to 393 sites Infrastructural upgrade Capacity building for HCWs Laboratory back up Robust M&E system Standardized ARV & other Commodity LMIS – Forecasting – Inventory management – Pool procurement (Donors, GoN, Private) – Warehousing (Central, Regional) & Distribution (Axios, Chan MP) – Reporting – Combine Request Requisition & Issue (Form) Logistics Total # on treatment (SAPR10) – Adult = 289,953 – Children = 18,283 Majority of patients on 1 st line regime (97%) Decentralizing ART to PHCs 2004 2010 Scale up

5. SITE DISTRIBUTION BY OWNERSHIP AS AT 2009 (UNGASS 2010) SITE DISTRIBUTION BY LEVEL OF CARE (UNGASS 2010)

6. STRENGTHS Political will and substantial donor support Updated national guidelines, SOPs and job aids Locally developed IEC materials Updated national training curriculum Good M&E structure A national scale up plan A dynamic Technical Working Groups ATM task team Good logistics system LESSONS LEARNT Effective political commitment is essential Primary prevention is utmost Collaborations with stakeholders especially NGOs, CBOs, donor agencies, multilateral and bilateral govt agencies Strengthening linkages with all HIV/AIDS interventions Implementation of routine HIV testing and rapid HIV testing Community ownership through community capacity building Dynamic IEC strategy needed to motivate community Need to conduct operational research in issues emerging in the HIV/AIDS HIV related mentoring is helpful in solidifying skills

7. CHALLENGES Donor driven procurement of commodities Vertical disease programming Weak health systems, inadequate HRH Low coverage of ART despite increased sites Sub-optimal quality of service in many facilities Weak health information management systems, Need to develop M&E systems that meet multiple needs Identifying trends & Using Data Sets for secondary analysis Commodity stock-outs WAY FORWARD Primary Prevention Advocacy and sensitization Continue to build systems for improved access and capacity strengthening in all ramifications Competing for funding to support operational research Maintain the highest level of good business practice and high quality care and treatment Continue to receive technical assistance from donor agencies Involvement of other stakeholders including FBOs and private health care providers Effective monitoring and evaluation Health system strengthening (logistics and supplies) Political commitment Community mobilization for participation and action (use of stand alone HCT centers in communities to increase number of women in reproductive age group for testing).

8. Thank you Merci