INTERVIEW: HIV 2030 target may be derailed if COVID-19 persists — NACA DG

PT: Could you explain the risk COVID-19 poses to people living with HIV? Are they at higher risk of contracting the virus?

Aliyu: There is no evidence till date that People Living with HIV (PLWHIV), who are on regular effective antiretroviral treatment are at higher risk than other people whether of contracting the virus or of developing severe consequences when they contract COVID-19.

We know individuals aged 65 and above are at higher risk of contracting COVID-19 than a younger individual. And when they get the disease, they are also at higher risk of developing severe consequences.

The data has shown 80 per cent of severe cases that include deaths are age 65 years or older. Data also have shown that 80 per cent of COVID-19 is harboured by people who are aged 40 years and below. So, in terms of infection risk, individuals who are 49 years and below are at higher risk of getting COVID-19.

If you are to look at these two categories, PLWHIV falls in both categories. However, we haven’t seen those who have HIV being at higher risk amongst those below the age of 40, and we also haven’t seen corresponding risk of individuals age 65 and above that have HIV, developing severe consequences more than their counterparts.

One thing to note here is most of these data that we base our conclusions on came from places where they have a better count of people with the disease and almost everyone who has the disease is on effective treatment.

In our environment, we have a scenario we are very fearful about. We have lots of people within our community who don’t know they have HIV, who have never tested to know their HIV status or are aware of their HIV status but have refused to take the free medications given or who have started taking this medication but fall out of the radar and we don’t see them again.

For this category, we do not have enough data to show that they are also having the same risk pattern as those that are on effective treatment with respect to COVID-19.

So, we are calling on these categories to get tested and know their HIV status today. Call our centre on 6222 and somebody will guide you on how to get tested. And if you know your status, and it is positive, call the same number and you will be guided on how to get enrolled on effective treatment, which is free.

PT: There are reports that antiretrovirals for HIV may be used in treating COVID-19. What is your take on this?

Aliyu: Globally, second line antiretroviral drug, Kaletra, is being used for COVID-19 but there is no evidence till date that it has any effectiveness in that. So, there have not been demonstrable benefits of using HIV drugs in treating COVID-19.

PT: The world is fighting a pandemic which no one knows how long it will be around for. Are shortages of antiretrovirals expected?

Aliyu: This is one of the global fears. UNAIDs recently did a modelling forecast to say in 2018, about 480,000 people died in sub-Saharan Africa from HIV. With COVID-19 dislocating supply chain, with COVID-19 affecting Antiretrovirals manufacturing, with COVID-19 affecting kits manufacturing because of lockdown in countries where these plants are located and with COVID-19 competing with HIV in terms of health care personnel time, in terms of services being provided to patients, there may be an increase of almost 100 per cent fall of mortality and morbidity in the HIV community.

Meaning, in the next one year, if care is not taken and HIV services are not back effectively, we may witness increased mortality that may go beyond the 480,000 to about 960,000 and above.

This will be because of the effect of COVID-19 on HIV service provision and management in Sub Saharan Africa. And, that is why the question of dislocation in terms of the supply chain – the question of disruption of treatment because the drugs are not there in time – the stock we have are exhausted and we are waiting in the queue for our next line of manufacturing to get the drug manufactured and move the drug from the country to Nigeria.

Our projection is – if COVID-19 continues to impact and force lockdowns on activities globally, including HIV commodities, manufacturing and HIV supply chain, we may likely witness what UNAIDs is projecting.

PT: With the dislocation of the supply chain in mind, what is NACA doing to ensure People Living With HIV still have access to care?

Aliyu: We have been calling on PLWHIV in Nigeria to ensure they have a minimum of one-month refill stock with them before the lockdown. They should, at every time, be adequately equipped with enough quantities of drugs that will last them for one month. The reason is the lockdown could extend. All clients that have heeded to our advice and show up at our facility were given drugs that will last for three months. This is what we call (a) multi-months dispenser.

Instead of having drugs dispensed for one month, they had it for three months. We know some people before the lockdown probably had the refill for one month, so these – especially with what we have observed earlier, transportation issues and facilities (being) shut down in some places and outpatients clinics not holding – these pose a serious threat.

What we did in Abuja, when we realised that access to medication was becoming difficult for people who are yet to get their refill, we took the medication to them. And for the last two months, this is what our implementing partners – together with the network of PLWHIV – have been doing in Abuja, and it has been paying off.

PT: To what extent are you adopting the strategy in the fight of HIV to fight COVID-19?

Aliyu: COVID-19 and HIV share some things in common. They are two diseases that are viral in nature and secondly, individuals are stigmatised.

We have been in the field for the past 15 years fighting stigma and discrimination against PLWHIV and AIDs and we have one of the best team – if not in the world, but in Sub Saharan Africa – that is well equipped, well trained in terms of getting down to the community level to fight stigma and discrimination and facilitate community ownership.

The success that NACA (has) had in the last 15 years in getting to bring (the) HIV epidemic to a greater extent under our monitoring and to see that we have control over the numbers that are coming is because these guys have been doing wonderful jobs at the community level.

People no longer fear to discuss HIV, people no longer fear demanding for HIV services, people now feel free to test themselves when getting married to know their status. People now feel a sense of responsibility when their wives are pregnant to ensure they go for antenatal visits and HIV tests are provided to them.

We are tremendously grateful to these young men and women out there in the community fighting stigma and discrimination and getting people to feel at ease with PLWHIV and to help them rather than to keep them away from services.

It is one thing that we can bring on board to help community ownership with respect to COVID-19 at the community level – to get people to believe that COVID-19 exists, to get people to own the COVID-19 response at community level, to get people to help individuals who test COVID-19 positive, instead of running away from them. They should help them to make sure they have access to services and make them know there is nothing bad in having COVID-19 or being isolated.

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PT: Do you think the pandemic has disrupted the HIV 2030 target and other goals set for the elimination of the disease?

Aliyu: I don’t think it has but it is on the way. If we continue to be on lockdown, if we continue to stay away from services, if we continue to stay away from getting to the community and identifying new cases of HIV and putting them on treatment, certainly, it will elongate the period we will need to get HIV under control.

We have one decade now to have HIV under control globally, which is a good time for us and which we hope that with the impact of COVID-19, we will start to get back to normal.