NIGERIA AND THE HIV BURDEN

Isaac Imole argues that other non-communicable diseases should be part of the standard treatment plan for people living with HIV

Last week I was at an event that brought together academics, program managers, policymakers and national and global health experts to review data and trends in public health issues…the area of HIV and non-communicable diseases to be exact.

Now, here are some interesting statistics to lay the foundation for this piece. According to the Centre for Disease Control (CDC), Nigeria has the fourth highest HIV burden in the world, reporting over 1.9 million people living with the condition and over 190,000 new infections every year. Out of the number, over one million are presently on life-saving anti-retroviral treatment.

HIV (human immunodeficiency virus) as we know is a virus that attacks the body’s immune system. If HIV is not treated, it can lead to AIDS (acquired immunodeficiency syndrome). There is currently no effective cure. Once people get HIV, they have it for life.

But with proper medical care, HIV can be controlled. People with HIV who get effective treatment can live long, healthy lives and protect their partners.

Over the years, the successes recorded in identifying people living with HIV by partners and getting them on ARTs has meant that People Living with HIV (PLHIV) are now living longer and growing well into old age.

According to the World Health Organisation, 11.2 million Nigerians are living with Diabetes Mellitus. One out of every 17 adults in Nigeria is living with the disease. Again, the WHO estimates that about 31/2% of Nigerians are presently living with hypertension. The prevalence of both conditions increases significantly among people aged 45 and above.

Other common chronic NCDs which become more prevalent with age are cancers, cardiovascular and respiratory diseases, as well as renal diseases. Collectively, the WHO estimates that these are responsible for over 74% of deaths worldwide.

The ART-aided longevity of PLHIV has brought about a new scenario where the co-existence of HIV and one or more other non-communicable diseases such as hypertension and diabetes are becoming more common. Each of these conditions brings its unique challenges in the lives of those living with them and for PLWAs, having to contend with any of them is certainly going to be much tougher than for the average person on the street. For now, these conditions are being treated in silos. We all have people around us managing one or more of this NCDs and we know the toll they take. Imagine having to deal with those alongside HIV.

But what if there is a better, more pragmatic, more integrated way. Let’s face it: aside from privacy concerns, understanding the medical history of a patient is critical to determining the right medication and treatment regimen for them. Managing co-morbidities of HIV and another NCD will be better handled in an integrated manner because it allows a 360-degree view of all the factors at play and optimal utilization of resources for the ultimate benefit of PLHIV.

This basically was the crux of discussions by healthcare professionals, partners, and administrators last week when they converged under the auspices of the first Annual APIN Public Health Initiatives’ one-day symposium on ‘Integrating NCDs and HIV to ensure Long and Quality lives for People Living with HIV (PLHIV)’.

The Chief Executive Officer of APIN, Dr Prosper Okonkwo had opined that the rapid decline in mortality among PLHIV is one of the major benefits of expanding access to antiretroviral medication and that it was estimated that by 2030, 73 per cent of HIV-infected individuals will be over 50 years of age and 78 per cent of individuals living with HIV will have cardiovascular diseases.

Given such a scenario, the need for an intentional national response is quite apparent. Integrating comorbidities should become part of the standard treatment plan for PLHIV.

Interestingly, many NCDs that we grapple with today are a function of lifestyle choices influenced by economic development and urban living as pointed out by Dr Jerry Gwamna of the United States Center for Disease Control (US CDC) at the symposium.

Are we now becoming victims of economic growth in our societies? The fact that many countries are reporting increases in life expectancy due to advances in medicine and increased healthcare coverage among younger populations sets up the scenario for a higher population of older people with attendant risks of age-related diseases listed earlier and the possibilities of the existence of the double burden of infectious diseases and NCDs.

But his argument is strongly in support of the integrated approach. After all, it will discourage competition for the limited resources available for tackling health problems. Resources (manpower, funds, programs and medication) can be optimized where all efforts are harnessed and channeled in an integrated framework.

This approach also helps expand coverage of health care for PLHIV and NCDs and would help Nigeria get closer to the attainment of Sustainable Development Goals (SDGs) and Universal Health Coverage (UHC).

To do these successfully, meaningful stakeholder collaboration and partnership will need to be birthed and driven actively. Ideas, no matter how relevant and well-conceived, must be given life through the instrumentality of people, systems and institutions.  Dr. Salma Anas-Kolo, Special Adviser to the President on Health spoke to this during the symposium, advocating for a conscious design and roll out of such an integration initiative as well as the need for a comprehensive service delivery approach to ensure that there is a link between the primary health care level, the secondary level of care and the tertiary level of care, knitting all into one delivery approach.

Good enough the board chair of APIN Dr Ayodeji Odutolu also acknowledged this when he said APIN would have failed as thought and program leaders if the knowledge leaders they do not use it to better society.

I agree with both on this. In Nigeria, we are not slow to generate brilliant ideas. Talk shops are never in short supply. The missing link most times is action. Who will bell the cat? Who will bell this cat? APIN as leaders in the public health space in Nigeria has done well to initiate a very pertinent conversation. Translating it through policies, frameworks, and programs into actual changes in the status quo to achieve the desired effect is where the true work is.

 Imole, a public commentator, writes from Abuja