AIDS2008_THPE0840_Oloriegbe IY, Adirieje UA (Nigeria)
1
AIDS2008 Presentation no. THPE0840
by:
Oloriegbe IY, Adirieje UA
Health Reform Foundation of Nigeria
[HERFON], Abujahttp://www.herfon.org/docs/AIDS2008poster_THPE0840_Oloriegbe_IY_Adirieje_UA_HERFON_Nigeria.ppt
AIDS2008_THPE0840_Oloriegbe IY, Adirieje UA (Nigeria)
2
TITLE
Quality of life of women on Nigeria’s antiretroviral therapy (ART) programme
AIDS2008_THPE0840_Oloriegbe IY, Adirieje UA (Nigeria)
3
INTRODUCTION
Nigeria developed a 5-year ART scale-up plan to provide treatment and improve the quality of life of one million PLWHAs especially women by 2009. The provision of ART is the most pragmatic approach to improving the quality of life of PLWHAs. Midway into the scale-up, it became necessary to assess its impact on the quality of life of beneficiaries.
AIDS2008_THPE0840_Oloriegbe IY, Adirieje UA (Nigeria)
4
METHODS
This study was conducted during year 2007, using a combination of qualitative and quantitative methods (questionnaires, interviews, focus group discussions, round table meetings, on-the-spot observations and secondary data); as part of a larger study of the impact, challenges and long-term implication of the ART programme in Nigeria. It covered 14 ART sites and 5 selected HIV Counselling and Testing (HCT) centres in the country’s six geopolitical zones and Federal Capital Territory (FCT). PLWHAs were asked if they fill that their quality of life improved with ART.
Gender Distribution of PLHA on ART
AIDS2008_THPE0840_Oloriegbe IY, Adirieje UA (Nigeria)
5
Figure 10: Gender Distribution of PLHAs on Antiretroviral Therapy
39%61%
Males Females
ART Centres in Nigeria & HIV Burden
AIDS2008_THPE0840_Oloriegbe IY, Adirieje UA (Nigeria)
6
Adamawa
Abia
Oyo
Ogun
Lagos
Osun
Ekiti
Ondo
Kwara
Edo
Delta
BayelsaRivers
Akwa Ibom
CrossRiverImo
An
amb
ra
Enugu
Ebonyi
Kogi
Benue
Nasarawa
Niger
Plateau
Taraba
GombeBauchi
Y obe
Borno
Kaduna
Kebbi
Zamfara
Sokoto
Katsina
Kano
Jigawa
FCT
Emergency Plan Focus States
2.1 – 4.0%
KEY
6.1 – 8.0%
>8.0%
1.0 – 2.0%
4.1 – 6.0%
Figure 1: ART Centres Across Nigeria / Burden of HIV in the States
ART Sites
Overview of Tuberculosis Related Services
ART and TB services Available in facilities
Score (%)
TB Adherence 17 89.5Access to X-Ray 16 84.8TB doses missed 6 31.8Hand hygiene 16 84.8TB HCT/ART serve 15 79.5TB health history taken 14 74.2Latent TB Prophylaxis 7 37.1Medication to 1st line TB toxicity 12 65.6Post treatment smear positive 15 79.5TB privacy/confidentiality 15 79.5TB patient weighed 9 47.7TB referrals 14 74.2TB side effect management 14 74.2TB smear available 15 79.5TB SOPs 13 68.9TB staff courteous 15 79.5TB treatment medication 15 79.5Treatment of active TB 16 84.8
AIDS2008_THPE0840_Oloriegbe IY, Adirieje UA (Nigeria)
7
Deaths & Losses to follow up among PLHAs on ART
AIDS2008_THPE0840_Oloriegbe IY, Adirieje UA (Nigeria)
8
Figure 14: Deaths and Losses to
Follow up Among PLHAs on ART
Transfers Deaths1st line
Deaths2nd line
Defaulters
Cost of Antenatal and Delivery Services
AIDS2008_THPE0840_Oloriegbe IY, Adirieje UA (Nigeria)
9
AIDS2008_THPE0840_Oloriegbe IY, Adirieje UA (Nigeria)
10
DATA/RESULTS
144 PLWHAs on ART (all literate) were studied - 89 females and 55 males, which agrees with the 3:2 ratio of women to men seen in other sites in Sub-Saharan Africa. All reported improvement in quality of life while on ART. About 50% do not have enough money to eat, a place to stay in especially when they travel long distances to access the ARTs, or money for transportation to access ART. 45.2% total deaths and 22.7% defaults to ART adherence were recorded, with 2 in 5 (40%) individuals dying while on first line regimen – higher than 10–15% seen in other parts of Africa.
ARTs and regimens used
AIDS2008_THPE0840_Oloriegbe IY, Adirieje UA (Nigeria)
11
Availability of ART Monitoring Tests
AIDS2008_THPE0840_Oloriegbe IY, Adirieje UA (Nigeria)
12
Figure 7: Availability of ART Monitoring Tests
100
100
25
71.4
15.8
81.8
85.7
55.7
78.6
0
42.9
100
100
75
25
30
25
36.4
0
53.8
0
0
14.3
Rapid HIV testing
*Double Rapid
*D/Rapid/Tie breaker
Sputum microscopy
**TB culture
Full blood count
Hepatitis B
Hepatitis C
Serum chemistry
Resistance testing
Viral Load
CD4+ Count
Ca
teg
ory
of
lab
. te
sts
HCT Centres
ARTS Sites
Availability and Turn-around Time for Lab Results
Availablein
Facilities
ART Sites HCT Centres
TAT(hrs./wks)
Avail.(%)
TAT(hrs.)
Rapid HIV test 19 0.45 100 0.45Western Blot 12 6 NA NA*Double Rapid 18 1 75 24*Double Rapid+ Tie breaker
17 24 25 24
Full blood count 16 24 25 72Hepatitis B 16 24 44.4 24Hepatitis C 10 48 0 24Pregnancy Test 15 1 -
Assessed for ART Sites only (n=14)Sputum microscopy 11 72 30 24Serum chemistry 11 72 53.8 84CD4+ Count 13 24-48 NA NATB culture 4 2 wks NA NAViral load 6 2 - 12 wks NA NADiagnostic PCR 5 2 - 4 wks NA NAResistance Testing 0 NA NA NAAIDS2008_THPE0840_Oloriegbe
IY, Adirieje UA (Nigeria)13
Legend: * Used as confirmatory tests;
TAT: Turn-around Time
Overview Pharmacy Services Indicators Score (%)ARVs (adult/Paediatric) 92.9Three months stock in the store 71.4ARVs expired in the last 6 months 53.8ARV stock out in the last 6 months 7.7Pharmacy orderly 60.0Clean Pharmacy 33.3Pharmacy counselling room available 62.5Drug withdrawal management 80.1Space for Pharmacy dispensing area 87.5Pharmacy stores 86.7Security maintained 92.9OI drugs available 87.5Palliative drugs available 81.5Antibiotics, Antiseptics, Antifungal --3 months stock 85.7Drugs procured from recognized and trusted suppliers
93.8
HIV, ART-related publications 75.0Functional AC/fans 100Temperature Control report maintained 47.3Fridge/Freezer 64.3Equipment maintained regularly 92.9Comply with government regulations 92.9Pharmacy forms available 100.0Drug adherence counselling 71.4SOPs, Wall charts 71.4Staff adhere to SOPs 71.4
AIDS2008_THPE0840_Oloriegbe IY, Adirieje UA (Nigeria)
14
Multidisciplinary Staff @ ART & HCT Facilities
AIDS2008_THPE0840_Oloriegbe IY, Adirieje UA (Nigeria)
15
Figure 8: Multidisciplinary Staff at ART and HCT Facilities
100
100
100
100
93.3
25
100
66.7
46.7
66.7
25
25
25
25
25
6.7
75
75
75
50
Prescribing clinician
Nurse
Counselors
Records clerk
Pharmacist
Lab. Specialist
Lab. Scientists
Volunteers
Nutritionist
Job aides Sta
ff Cate
gory
Adult/Paed. ART HCT Centre
Staff capacity & Training in Facilities
AIDS2008_THPE0840_Oloriegbe IY, Adirieje UA (Nigeria)
16
14121515
157
148139
158148
158128
1581313
1511148
159
1515148
126146
117
Specialist Physician
Doctors (MBBS)
Nurses/Midwives
CHOs
CHWs
Lab. Scientists
Lab. technician
Pharmacist
Pharm. Assist.
Counselors
Program Mgrs.
Data Mgrs.
Social Workers
Med. Rec. Officers
Nutritionists
Clerical/Se. Staff
Cleaners
Drivers
Volunteer staff
Figure 9: Staff capacity and Training in ART
No in Facility No Trained
AIDS2008_THPE0840_Oloriegbe IY, Adirieje UA (Nigeria)
17
CONCLUSIONS
ART improved the quality of life among women PLWHAs by decreasing AIDS-related morbidity and mortality, making them live longer; and enabling them to return to their jobs and families, as well as engaged in new socioeconomic endeavours.
AIDS2008_THPE0840_Oloriegbe IY, Adirieje UA (Nigeria)
18
ACKNOWLEDGEMENTS
• Heads and staff of institutions/facilities in the various states and FCT where this study was conducted
• NACA, NASCP, USAID, FHI/GHAIN Project and NEPWAN
• State/local government action committees on AIDS (SACA/LACA)
• HERFON members across the country• DFID
AIDS2008_THPE0840_Oloriegbe IY, Adirieje UA (Nigeria)
19
REFERENCES1. Federal Ministry of Health, Nigeria, in collaboration with PHRplus and WHO. 2003. “Instrument for Assessment of
ARV/PMTCT Centers in Nigeria, January 2002 to October 2003
2. WHO, Progress in scaling up access to HIV treatment in low and middle income countries, June 2006, 16th August 2006
3. Social development and poverty in Nigeria, Chapter 3 in Measuring poverty in Nigeria', Sofo, C.A. Ali-Akpajiak and Toni Pyke 2003, Oxfam Working. Paper www.oxfam.org.uk/what_we_do/where_we_work/nigeria/ resources.htm
4. WHO, Towards Universal Access: Scaling up priority HIV/AIDS interventions in the health sector, 17th April 2007
5. WHO, Progress in scaling up access to HIV treatment in low and middle income countries, June 2006, 16th August 2006
6. 'FHI 'GHAINS' new funds for HIV/AIDS, TB services in Nigeria', Family Health International,204, www.fhi.org/en/HIVAIDS/country /Nigeria/nigernews.htm
7. Nigeria may lose N11.2956 World Bank Grant' ThisDay, June 28, 2004 www. naijapost.com/news/publish/article_980.shtml
8. Mocroft A. et al. Changes in the cause of death among HIV positive subjects across Europe: results from the EuroSIDA study. AIDS, 2002,16(12):1663–1671.
9. Kombe, Gilbert, David Galaty, and Chizoba nwagbara. Scaling up Antiretroviral treatment in the public sector in Nigeria: A comprehensive analysis of resource requirements. Bethesda MD: The partners for Health Reformplus Project, Abt Associates Inc. February 2004
10. Federal Ministry of Health, Nigeria, in collaboration with PHRplus and WHO. 2003. “Instrument for Assessment of ARV/PMTCT Centers in Nigeria, January 2002 to October 2003
11. Njoku MO, Sirisena ND, Idoko JA, Jelpe D. CD4+ T-lymphocyte counts in patients with human immunodeficiency virus type 1(HIV-1) and healthy population in Jos, Nigeria Nigeria Postgradute Medical Journal 2003, 10(3): 135-9