Project: Service Expansion - CiSHAN Nigeria - Civil Society for HIV/AIDS in Nigeria

PROJECT:

Increasing the demand for HIV Testing in Nigeria

CiSHAN Project: Phase 1

Executive Summary/Introduction

The Nigerian AIDS Indicator and Impact Survey (2018) results showed that Nigeria was lagging behind in achieving the 1st 95 of the 95-95-95 target by 2020. The lockdown arising from COVID-19 had also significantly decreased access of community members – general, key and vulnerable population - to HIV testing. Prior to the lockdown, there had been challenges with thinking around how to address the gap with populations access to HIV testing and identifying the unreached HIV positive population. This require re-strategizing in ways that communities and community members can take the leadership to drive HIV testing.
The need to evolve community driven HIV testing strategies was further re-affirmed by the anecdotal field reports by CISHAN during the lockdown. CiSHAN had coordinated a national effort in partnership with Positive Action for Treatment Access (PATA), Association of Women Against AIDS in Nigeria (ASWHAN) and the Association of Positive Youth in Nigeria (APYIN) to work with identified community members/advocates in cohorts to deliver anti-retroviral drugs to PLHIV in need of it during the intensive phase of the lock down. CISHAN volunteers identified multiple individuals who asked for where to get tested: a gap that could be addressed through access to self-test kits.
As responsive Civil Society Organization, CISHAN has taken it as an organizational task to support the national government to reach the first 95. The project is focused on creating awareness and demand for HIV self-testing in Nigeria. Through its over 4000 members located in the 774 local government areas of Nigeria, CISHAN should facilitate access to HIV self-testing kits in both rural and hard to reach areas/populations. The campaign should lead to:

1. Increase in the number of Nigerians who have tested for HIV
2. Identification of the newly diagnosed HIV positive individuals
3. Increase in uptake of PrEP by persons at substantial risk of HIV infection

ACTIVITIES CONCLUDED

HIV Self-Test Advocacy

In 2019, CISHAN organized a 2-day training for its zonal and state leaders. These leaders conducted step down training for its members. This way, CISHAN was familiar with the publications, guidelines and marketing strategies required to promote access, uptake and linkages to care for individuals who use a HIV self-test kit for HIV screening. As an outcome of these training, CISHAN reached out to state SACA Executive Secretary asking for the state to invest in HIV self-testing as its domestic resource mobilization strategy. The National office also reached out to NACA to dedicate the 2019 World AIDS day to promote HIV self-testing to which the Director General of NACA consented too

The 1st National Community Dialogue

National Community Discussion on COVID-19 on HIV Self Testing was held with the Co-Chairs of the Expanded Theme Group: The Director General of the National Agency for the Control of AIDS (NACA) Dr Gambo Aliyu, and the UNAIDS Country Director for Nigeria Dr. Erasmus Morah. The meeting had over 600 registrants, and was attended by 169 participants representing CSOs, CBOs, IPs, the Academia, SACA, SACP, local and foreign partners. The panelists highlighted and identified with the urgent need for the country to invest in HIV self-testing as a strategic approach to reach the 1st 95 of the global 95-95-95 target by 2020 target. They also argued for the need to develop a national policy on HIV self-testing to facilitate government and partners’ investment in HIV self-testing. The role of the civil society in creating demand for HIVST across states, LGA and communities in Nigeria was also reiterated. CISHAN advocacy agenda from this dialogue was the need to work with NACA to develop the National policy and other policy instruments that will facilitate public access and uptake of HIV self-testing kits. The recordings for the session can be found at: https://www.facebook.com/CiSHANNIG/

The 2nd National Community Discussion

The second National Dialogue was with donors. The 1st panel session with Dr. Murphy Akpu Deputy Country Coordinator for PEPFAR, Dozie Ezechukwu GF/CCM Nigeria and Pamela Gado PEPFAR HTS Co-Chair as panelists. There were 148 participants in attendance drawn from all the development sector, government agencies, and manufacturers of diagnostic equipment’s within and outside Nigeria.
During the discussions, PEPFAR indicated that they will support the pilot of access of 200,000 persons to HIVST in Nigeria towards achieving the 1st 95. Global Fund also noted it had earmarked $2.9m matching funding for Nigeria in the 2021-2023 funding cycles; and activities to cover through this grant is HIV self-testing. Nigeria however has t to provide the matching funding to enable the country access the Global Fund allocation. A CSO advocacy agenda identified was the need to get the government to contribute its matching funding to GF before the end of 2020.
Concerns were also raised during the dialogue about the need for a confirmatory test following a positivity diagnosis with a HIVST, as this was a barrier to prompt access to treatment. The HIVST had a sensitivity that was not significantly different from that of the current first testing algorithm in the country. CSO can therefore work with the government on integration of HIVST into the national HIV testing algorithm. The recordings for the session can be found at: https://us02web.zoom.us/rec/share/y5RHIo_d-UFOaZX010PnUbN6GYH6eaa81igdqfNYnUhS54GyEcousYsgJVLO6YsP Password: 7j$^*19W

The 3rd National Community Discussion

The 3rd National Community Discussion. Speakers were Prof Ezechi of the Nigerian Institute of Medical Research, Dr. Solomon Odafe of the US Centers for Disease Control, and Dr. Layi Jayiola of UNITAID Funded STAR Project . They discussed their organizations’ projects on promoting access of special populations – adolescents and young women, men and key populations to HIVST. There were 107 participants drawn from all the sectors of the development space, government agencies at all levels including manufacturers of diagnostic equipment’s within and outside Nigeria.

Prof Oliver Ezechi was shared with all the participants their research project that was facilitating adolescents and young persons 15-24-years-old to testing and linkage to care. He identified that through 6 projects located in Southern Nigeria, 903 adolescents and young persons had taken up HIV self-tests, with interest in paying for the test kits at a cost ranging from N1000 – N1500. It was important to non-medicalize the access to HIVST and facilitates its integration into their social day-day activities. He ended his presentation with a practical demonstration of how to correctly use the HIVST kit. The other discussants also shared local and international program data that showed how HIVST helps increase the number of people who take a HIV test, and how linkage to care are managed. UNTAID will be launching its HIV self-testing program in Nigeria called START aimed to catalyze HIVST acceptance and scale up in Nigeria for the next 15 months. The recordings for the session can be found at:
https://us02web.zoom.us/rec/share/7uNJMJzsx3tOQc_Rx0red4pwHrbeT6a8gCdKqKFYzBpRBgKDt_LcL12OBK_6WVfU Password: 6t^1#55f

Key Achievements

Since embarking on the Community Panel Discussion, CISHAN has achieved the following:

1. Engendered renewed interest in and support for HIVST in Nigeria
2. Promoted dialogue between civil society, policy makers and partners on HIVST
3. Identified advocacy agenda for CISHAN and its members on how to support the government push its HIVST program.
4. Increased Civil Society awareness of their role in achieving the first 95 of the global 95-95-95 agenda.