Andrea Smesny

Adherence to antiretroviral therapy in Nigeria: an overview of research studies and implications for policy and practice

Both Human Immunodeficiency Virus (HIV) infection and AIDS remain major public health crises in Nigeria, a country which harbors more people living with HIV/AIDS than any country in the world, with the exception of South Africa and India. In response to the HIV pandemic, global and international health initiatives have targeted several countries, including Nigeria, for the expansion of antiretroviral therapy (ART) programs for the increasing number of affected patients. The success of these expanded ART initiatives depends on the treated individual’s continual adherence to antiretroviral (ARV) drugs. Thirteen peer-reviewed studies concerning adherence to ART in Nigeria were reviewed with very few pediatric and adolescent studies being found. Methodologies of adherence measurement were analyzed and reasons for nonadherence were identified in the geopolitical zones in the federal republic of Nigeria. The results of the literature review indicate that adherence to ART is mixed (both high and low adherence) with patient self-recall identified as the common method of assessment. The most common reasons identified for patient nonadherence include the cost of therapy (even when the drugs are heavily subsidized), medication side effects, nonavailability of ARV drugs, and the stigma of taking the drugs. This manuscript highlights the policy and practice implications from these studies and provides recommendations for future ART program management.

Routine HIV testing in health care settings: the deterrent factors to maximal implementation in sub-Saharan Africa.

The sub-Saharan region of Africa is the most severely affected HIV/AIDS region in the world. The population of this region accounts for 67% of all people living with HIV/AIDS and 72% of all AIDS-related deaths. As international collaboration makes access to HIV treatment more widely available in this region the need to increase the population’s awareness of its serostatus becomes greater. The incorporation of provider-initiated HIV testing and counseling (routine HIV testing model) as part of a routine medical care would not only increase the population’s serostatus awareness but also lead to a better understanding of HIV prevention and treatment and ultimately, increased utilization of available HIV/AIDS prevention programs on a much larger scale. This mini-review summarizes some important regional, sociocultural, economic, legal, and ethical issues that may be deterrent factors to maximal implementation and integration of provider initiated HIV testing and counseling as part of routine medical care in the sub-Saharan African region.

A training need for rural primary care in Nigeria.

The major causes of maternal death in Nigeria are avoidable and preventable. Many of these deaths occur in the rural health facilities and hospitals which are severely lacking in skilled birth attendants. Of the many strategies that have been developed to reduce avoidable maternal death significantly, increasing the availability of skilled human resources is crucial. The shortage of obstetric specialists, especially in the rural and peripheral health facilities in rural Nigeria where more than 60% of the population resides, has been a major contributing factor to the low number of skilled birth attendants. The increased availability of skilled human resources ensures that all aspects of obstetrics, such as antenatal care, postnatal care and other life-saving interventions, including emergency surgery, is available for women during labour and in the immediate postpartum period. In this paper, we propose a short obstetric-training programme for generalist medical officers to increase the number of skilled birth attendants in both rural and peripheral health facilities in Nigeria. These general practice/family practitioners (GP/FPs) and hospital medical officers (MO), will have designated career structures within the primary and secondary healthcare systems, while the consultant obstetrician and sub-specialists, trained with long postgraduate programmes will function at the urban ‘specialists’ and in teaching hospitals.