APIN – AIDS Prevention Initiative Nigeria

The Harvard School of Public Health (HSPH), in partnership with Nigerian governmental and non-governmental agencies and universities in Nigeria, initiated the AIDS Prevention Initiative Nigeria (APIN) supported by the Bill and Melinda Gates Foundation in late 2000. Education, training and capacity building were the original foundations of the program and critical to its sustainability. Through sponsored projects, APIN implemented prevention strategies that were tailored to target states. APIN supported over 30 projects in the target states of Lagos, Oyo, Plateau, Borno, and the Federal Capital Territory.  These projects addressed the program objectives of promoting AIDS awareness, second-generation HIV and STD surveillance, intervention in high-risk populations, prevention of mother to child transmission and ARV treatment to adult and pediatric populations.  APIN sought to develop evidence based prevention programs for each target state with the recognition that epidemiologic heterogeneity might influence program design. This represented a new model for HIV prevention/intervention program design and implementation – driven by targeted assessment and surveillance methods the programs were specifically tailored to the capacities of our Nigerian partners.   The collaborative design and implementation process developed the capacity and sustainability of the programs and provided the necessary foundation for scale-up particularly in association with significant access to treatment and care programs.

Accomplishments:

Developed capacity and implemented second-generation surveillance systems included HIV and sexually transmitted infection (STI) surveillance and monitoring of risk behaviours.  This included NGOs working in community outreach with 8 new VCT sites or clinics established. These systems helped develop evidence-based interventions including ART.  Several publications have resulted from these projects.

The APIN prevention of mother to child transmission (PMTCT) scale-up program is the most significant progress in PMTCT services in the country.  In less than one year, four sites were scaled-up to over 20 satellite centers in Jos and Oyo states.  This was implemented with significant training and infrastructure building and now been integrated and supported by the PEPFAR program with screening of over 274,000 pregnant women to date in 36 sites.

Six of seven HIV reference laboratories at university teaching hospital or research institutes were developed with APIN support.  All laboratories have facilities for HIV serology, automated CD4 flow technology, viral loads, PCR diagnosis, hematology and clinical chemistries.  Three of these laboratories have sequencing capability for HIV drug resistance and TB drug resistance work.

Instituted HIV training programs for 1) antiretroviral therapy (ART) management and 2) laboratory tests for the diagnosis and monitoring of HIV infection.  This training curriculum is now available for use by various stakeholders in Nigeria.  Training is provided for all 36 states in a biannual basis at two associated APIN sites.

A complete compilation of APIN’s work and research studies in epidemiology, prevention interventions and economic impact are provided in our book entitled, “AIDS in Nigeria, A Nation on the Threshold”.   A second book, “A Line Drawn in the Sand” documents the response of four African countries to the AIDS treatment crisis.

Kanki, P., Adeyi, O., Idoko, J., Odutolu, O., AIDS In Nigeria: A Nation on the Threshold  (Harvard Center for Population and Development Studies, Cambridge, MA  2006).

Kanki, P., Marlink, R.G. A Line Drawn in the Sand: Responses to the AIDS Treatment Crisis in Africa (Harvard Center for Population and Development Studies. Cambridge, MA  2009).

Impact:   

  • APIN’s operational research and scale-up of PMTCT programs informed the development of the revised National PMTCT guidelines (2006) based on evidence from our drug resistance studies, efficacy of single-dose nevirapine and antenatal care uptake across the country.
  • APIN’s operational research and scale-up of ART programs demonstrated early evidence of the efficacy of generic based ART in the National Nigerian ART program and informed the principles of adherence and drug resistance monitoring policies, now incorporated in the National Nigerian ART guidelines.
  • APIN supported the development of National ART training modules for Nigeria, which have now been rolled out to training for doctors, nurses, pharmacists, counselors and lab workers in all 36 states of the Federation. In the first year of operation, this provided indirect support of 12,000 patients placed on ART therapy.
  • The capacity building and training for state of the art HIV laboratories helped establish central reference centers in the country that now support ART treatment and care for over 30,000 patients annually.