HIV: Nigeria needs national PrEP roadmap to ensure equitable access

Sample blood collection tube with HIV test label on HIV infection screening test form.

Durueke Florita, Executive Director of the New HIV Vaccine and Microbicides Advocacy Society (NHVMAS), has many years’ experience in the field of HIV/AIDS, particularly biomedical HIV prevention. In this interview, she speaks on why Nigeria should invest in vaccine research, the status of the use of microbicides and Pre-exposure Prophylaxis (PrEP) as well as HIV prevention research.

What is PrEP and how accessible is it to people at high risk of infection in the country?

Oral Pre-exposure Prophylaxis (PrEP) is the use of antiretroviral drugs to prevent HIV infection. PrEP is taken by HIV negative persons to prevent replication of virus and infection. PrEP requires daily adherence to Tenofovir based regimens like Truvada.

By WHO guidelines, PrEP should be accessible to people at substantial risk of HIV infection – these include people who engage in sex work, people in sero-discordant relationship, sexually active adolescents and people who inject drugs.

In Nigeria, efforts are being made to provide PrEP to those who need it but we are not there yet. There is limited access to PrEP in our HIV prevention programme. PrEP is accessed in programme specific for key populations. There is need for a national roadmap for PrEP roll out in Nigeria that will ensure equitable access to all those who need it.

Those who use drugs and homosexuals complain of non-inclusion in the National Agency for the Control of AIDS (NACA) demonstration study on PrEP, which served 600 sero-discordant couple (where one partner is positive and the other is not). What is your take on this?

It is not possible for all population of interest to be included in a research study, the MSM and drug users are not necessarily left out in the study, rather the demonstration study was designed to work with sero-discordant couples. What is imperative now is the fact that such study should translate to PrEP access to sero-discordant couples as well as other populations at substantial risk of HIV infection like MSM, drug users, FSW and sexually active adolescents. This is not where we are yet.

How well is the uptake of microbicides in Nigeria?

Microbicides are substances that can be applied in the vagina and/or rectum to reduce the risk of HIV infection via sexual exposure. As at today, we do not have any approved/licensed microbicides for use in HIV prevention.

However, there are promising results from the Dapivirine vaginal ring study that showed about 31% reduction in HIV infection in clinical trial and when used in an open label study, the efficacy was about 54%. Advocates are hoping the vaginal ring will move to licensure and that will give women power to prevent HIV infection.

What is significant for Nigeria is to be at alert on the progress of Dapivirine ring licensure and also position itself for implementation science of the vaginal ring.

There are many researches on vaccines, which is a key biomedical prevention tool against HIV infection. How do you think that will help?

Vaccines are very important tools in the control of infectious diseases. We need an effective HIV vaccine to end the epidemic. We do not have one yet but researchers are working at developing HIV vaccines. HIV vaccines will be very useful for both HIV negative persons and people living with HIV.

A preventive HIV vaccine will be taken by HIV negative people and it would teach the immune system how to create protective immune response that will prevent the virus from establishing infection.

Similarly, a therapeutic vaccine would be taken by PLHIV and these would build immune strength and reduce the risk of getting sick; and ideally their reliance on antiretroviral treatment.

There is need for support and investment in vaccine research. Nigeria will need to invest in vaccine research; ensuring that the Nigeria HIV strain is considered in vaccine research and development so we will not be left behind.

Can you briefly tell us about the state of HIV prevention research in Nigeria?

Funding, lack of infrastructure, accountability and transparency remain a challenge in driving HIV prevention research in Nigeria. The investment in HIV prevention research is very poor, more so our HIV response is donor driven. Advocates through the HIV Prevention Coalition are pushing for the allocation of 25% of the HIV budget to prevention services at the states and national level.

With so many rape cases, what’s your advice to the victims to prevent themselves from contracting HIV?

Rape survivors can contract HIV if the perpetrators are HIV positive hence the need to take protective action against HIV for all rape survivors. Within 72 hours of rape, the survivor should be provided with Post Exposure Prophylaxis (PEP) to prevent HIV infection. This will require taking antiretroviral drugs for four weeks to prevent the establishment of HIV infection. PEP can be accessed in any of the HIV treatment centres in Nigeria.

Can you briefly tell us about new HIV Vaccine and Microbicies Advocacy Society (NHVMAS)?

NHVMAS is a non-governmental organisation working to see to the creation of a conducive environment that supports HIV prevention related research in Nigeria.

It has been engaged over the last 17 years in HIV prevention research and development advocacy, promoting research literacy for vulnerable populations, and working with key populations, advocates, journalists and civil society organisation.

In the most recent times, NHVMAS rolled out its HIV prevention Advocacy Academy that annually engages with 10 young advocates, 10 journalists, and 10 social media influencers to promote research literacy with the public and advocate for increased investment in HIV research and the roll out of proven HIV prevention tools.

This initiative is very critical to ensure ‘Leaving No One Behind’ in the global campaign to end the AIDS epidemic by 2030.

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