THE HIV Treatment Surge in Nigeria Doubles the Number of People on Treatment in Two Years

Nigeria, the most populous country in Africa, is home to the fourth largest HIV epidemic in the world and one of the highest rates of new infections in sub-Saharan Africa.

For decades, the country was unable to effectively find those living with HIV and get them started on treatment. As a result, year after year, they were unable to meet the UNAIDS’external icon goals for HIV epidemic control.

That all changed in 2018, when the country leadership, with support from CDC and the U.S. President’s Emergency Plan for AIDS Relief (PEPFAR), launched national, household survey that confirmed less than half of the 1.9 million people living with HIV in Nigeria were receiving lifesaving HIV treatment.

The survey revealed something more. It identified, more precisely, where these individuals were residing.

Armed with these data, the team in CDC-Nigeria set out to implement an ambitious approach that would employ the skills, resources, and commitment of a broad range of partners – from the Ministry of Health to the agency’s implementation partners, to state and local community leaders — to dramatically scale up HIV treatment and put Nigeria on the path to epidemic control.

The Surge

Beginning in April 2019, CDC and partners launched an aggressive HIV anti-retroviral therapy (ART) Surge to efficiently increase HIV testing and dramatically expand access to lifesaving treatment for people living with HIV in the nine Nigerian states with the largest numbers of individuals with HIV not on treatment.

An innovative, strategic operational platform, known as CIRAS (Comprehensive, Integrated, Resilient ART System), was designed for the Nigeria ART Surge and launched in the targeted states of Benue, Delta, Enugu, Gombe, Imo, Lagos, Nasarawa, and Rivers, as well as the Federal Capital Territory.

As part of this intensive push, CDC and partners established incident command structures in each of the states. Each command structure was, in turn, led by an operations chief who was responsible for overseeing HIV service delivery efforts in that area. This included working closely with community leaders, capturing key data, identifying challenges and brainstorming solutions to expand and enhance efforts to get lifesaving treatment to those who needed it most.

On a weekly basis, these and other CDC experts collected the site-level data on HIV testing and treatment and analyzed them via a shared, collaborative dashboard. These data were then used to continually adapt and improve HIV testing and treatment efforts within these hard-hit communities.

“These operational shifts were the turning point in our efforts,” remembers Dr. Solomon Odafe, Deputy Director for Programs for CDC-Nigeria. “We now knew where the disease burden was, and we could attack it. We created accountability by placing individual people responsible for success in each state. We leveraged technology to capture real-time information and we were able to take our full arsenal of tools into these communities and effectively arrest the epidemic,” he said.

In each state, the Ministry of Health, CDC and its implementing partners worked with community leaders to launch a combination of proven HIV interventionsexternal icon – layering them in such a way to bring about the greatest impact.

The results were immediate and impressive. A A recent analysis published in CDC’s Morbidity and Mortality Weekly Report (MMWR) showed that, even in the midst of the COVID-19 pandemic, the first 18-months of the Nigeria HIV treatment Surge resulted in an eight-fold increase in the weekly number of newly identified people with HIV who started treatment in the nine focal states. The total number of people diagnosed with HIV who are now receiving treatment in those nine states also skyrocketed – a stunning 65 percent increase (208,202) in a year and a half.

CDC leaders in Nigeria and Atlanta would go on to share lessons from the nine initial states with partners working in nine additional Nigerian states. As a result, the Nigeria HIV treatment Surge increased the number of people living with HIV in these 18 states from 454,000 in 2019 to 903,000 in 2021 – in essence doubling the number of people with HIV on treatment in just two years.

Dr. Ibrahim Jahun served as CDC-Nigeria’s Incident Commander of the Surge during its first 18 months of implementation.

“When I look back at my time helping to lead this effort, I think about the innovations and the way we worked synergistically to create impact,” he said. “But more than anything I think about the hundreds of thousands of lives that have been saved, all of those men, women and children who now have a future and how much closer we are to ending HIV in Nigeria.”

Jahun attributes the program’s success to its use of local, real-time data to help CDC and local experts refine and adjust their efforts on the ground for the greatest impact.

“At one point,” he explains, “the data highlighted that not enough people were being tested in several areas. By having access to that information in real time and being able to rapidly pivot and increase testing, we were able to almost double the number of tests and the number of positive case findings in those areas.”