1. NIGERIA COUNTRY PRESENTATION By: Drs. Uzono Levi G and
Adegboyega Adewumi
4th September 2004

2. REMINDER – The main issues
Which ARVs are available in your Country
Do you have treatment guidelines
What information is available to
-Health professionals
-The Public
Is there any safety Monitoring in your Country

3. Presentation Outline About Nigeria Epidemiology of HIV/AIDS
The National ART Programme
The main Issues
Conclusion

4. Nigeria located in Western Africa, bordering the Gulf of Guinea, between Benin and Cameroon
Important Statistics
Population: m (1999)
Life Expectancy at Birth (LEB): 52years
Urban: Rural Ratio: :50 (approx)
Adult Literacy Level: %
External Debt: US$ 31.6 billion
Poverty Level: 65% live below Poverty level
HIV Prevalence: % (end of 2003)
Estimated HIV Burden: 3.47million (2001)
Estimated AIDS Burden: 1.2million (2001)

5. Epidemiology of HIV/AIDS
Since 1986 when the first AIDS case was detected in Nigeria, the epidemic has rapidly grown.
The adult HIV prevalence has increased from 1.8% in 1991 to 4.5% in 1996 to 5.8% in 2001 and finally 5.0% at the end of 2003.
Estimates using the 2001 HIV seroprevalence sentinel survey of women attending ante-natal clinics indicate that the more than 3.5 million Nigerians were infected with the virus in 2002.

6. The National ART Programme
In 2001 the Federal Government of Nigeria adopted a policy to provide antiretroviral treatment to people living with HIV/AIDS in the country.
Implementation of the program began in 2002 with 25 centres selected to provide ART in various parts of the country.
By the middle of 2004, approximately 13,500 people were receiving ARV treatment from these centres and many more were on waiting lists.

7. HIV Prevalence per State end of 2003 and States with ARV Centers
Sokoto State
4.5%
*Sokoto
*Katsina
*Birnin Kebbi
Yobe State
Katsina State
Jigawa State
Borno State
*Gusau
*Kano
2.0%
3.3%
3.2%
Zamfara State
2.5%
Kano State
3.3%
Kebbi State
*Dutse
*Damaturu
*Maiduguri
4.1%
2.5%
Bauchi State
Gombe State
4.3%
Niger State
*Kaduna
6.8%
Kaduna State
*Bauchi
*Gombe
Adamawa State
Kwara State
7.0%
*Jos
*Minna
6.0%
2.7%
6.3%
*Jalingo
7.6%
FCT **
Plateau State
< 5%
NasarawaState
*Yola
Oyo State
*Ilorin
8.4% **
6.5%
3.9%
*Lokoja
*Lafia
Taraba State
5 - 7%
This map shows a visual picture of the states/regions that had the highest cases of HIV positive persons among the PTB patients. The most seriously affected states are Benue (35.1%), Plateau at (30.4%), Kaduna (31.3%) and Borno (27.1%).
*Ibadan
*Osogbo
Ekiti State
5.7%
1.2%
2.0%
Kogi State
Osun State
*Ado Ekiti
*Makurdi
6.0%
*Abeokuta
9.3%
1.5%
*Akure
2.2%
Edo State
Benue State
7 -12% +
Ogun State
Ondo State
4.9%
4.7%
*Ikeja
4.3%
3.3%
Enugu State
*Benin City
7.2%
Lagos State *
*Asaba
Anambra State
*Enugu
ARV Centers
*Awka
3.1%
Ebonyi State
5.0%
IAbia State
12%
Imo State
Cross River State
Delta State
3.7%
Lagos Has 3 ARV Centers
*Owerri
*Yenagoa
4.0%
Rivers State
7.2%
*Calabar *
Bayelsa State
6.6%
*Uyo
*Port Harcourt
Akwa Ibom State
Abuja Has 7 ARV Centers **
MO-ARVS NASCP – FMOH 15th June 2004

8. Treatment Needs
The epidemic has extended beyond the commonly classified high-risk groups to the general population.
As at the end of 2001, at least three and a half million people are living with HIV/AIDS, which is expected to rise to well over four million in 2008.
Cumulative deaths by 2008 are predicted to be between 3.6 to 4.2 million.
Out of this, between 300,000 to 700,000 people are in urgent need of treatment.

9. ?Which ARVs are available in your Country

10. Currently registered/listed in Nigeria either as single products or in fixed dose combinations we have
6 Nucleoside Reverse Transcriptase Inhibitors (NRTIs),
2 Non Nucleoside Reverse Transcriptase Inhibitors (NNRTIs) and
5 Protease Inhibitors (PIs)

11. ARVs currently Registered with National Agency for Food and Drug Administration and Control (NAFDAC)

12. ?Do You have Treatment Guidelines
Yes!
GUIDELINES FOR THE USE OF ANTIRETROVIRAL (ARV) DRUGS IN NIGERIA
FEDRAL MINISTRY OF HEALTH
ABUJA, NIGERIA
JULY 2001
Draft
GUIDELINES FOR THE USE OF ANTIRETROVIRAL (ARV) DRUGS IN NIGERIA
FEDERAL MINITRY OF HEALTHABUJA – NIGERIA
AUGUST 2004

13. Contents 1.0 Introduction . 2.0 Virology and Pathogenesis of HIV
3.0 Diagnoses of HIV infection and AIDS
4.0 Antiretroviral therapy (ART)
i. Classes of ARV Drugs - Available ARV drugs
ii. Criteria for initiation of therapy
iii. Recommended and alternative regimen of ART
iv. Adverse drug reactions and Interactions
v. When to switch ART
vi. When to stop ART
5.0 Follow-up and Monitoring patients on ART
6.0 Key issues in ART
i. Adherence
ii. Immune Reconstitution Syndrome
iii. Treatment experienced patients
Indications for Referral
Prevention of Mother to Child Transmission
Post Exposure Prophylaxis and Universal Safety Precautions
9.0 Management of TB and Other Opportunistic Infections
10.0 Supportive management
i.Nutrition
ii. Psychosocial Support
iii. Palliative Care

14. Treatment Protocol
Recommended and alternative regimens for adults and children
First line regimen for adults d4T / 3TC / NVP
Alternative first line drugs for special category of adults:
ü Pregnant women or women of childbearing age
ZDV / 3TC / NVP
ü Adults with tuberculosis co-infection (that require Rifampicin containing regimen for TB treatment)
d4T / 3TC / EFV
First line regimen for children d4T / 3TC / NVP
Alternative first line drugs for special category of children: Children with tuberculosis co-infection (that require Rifampicin containing regimen for TB treatment)
d4T / 3TC / EFV (not recommended for children below 3 years)

15. ?What information is available to -Health Professionals -The Public

16. ?Is there any Safety Monitoring in your Country
What we have is post marketing surveillance, which is the responsibility of NAFDAC
Address the issues of counterfeit drugs and other regulatory products through
-Public Enlightenment Campaigns
-monitoring of Good Manufacturing Practices, -beefing up surveillance at the ports
-Mopping-up fake / counterfeit drugs and other regulated products

17. The Future ?
The launching of Pharmacovigilance on the 9th of September will initiate drug safety monitoring with special emphasis on ADRs

18. Conclusion -Pharmacovigilance in Nigeria
We are compiling Sample reports to get fully registered with the Uppsala Monitoring Center
Draft Guidelines for Pharmacovigilance has been developed
Draft case reporting forms have been developed
On the 9th of September the official launching will take place

19. Ke a leboga
Thank You