The Use of Antiretroviral Therapy for the Prevention of New HIV infection in Populations at High Risk for HIV Sero-conversion in Nigeria

John Idoko, Morenike O. Folayan

Abstract

The last few years have witnessed a renewed commitment to HIV prevention. The evidence to support the use of antiretroviral therapy (ART) for prevention of new HIV infection in the form of Pre-exposure prophylaxis (PrEP) among men who have sex with men, transgender, people who inject drugs, heterosexual men and women and HIV-1 serodiscordant couples, or treatment as prevention (TasP) for serodiscordant couples have also grown. The need to explore the possible use of ART for HIV prevention in Nigeria has become imperative in view of its high HIV burden and the current slow pace of effort to achieve the universal target of reducing its HIV incidence by 50%. While PrEP and TasP are welcome addendum to the existing HIV prevention armamentarium, it is still important to conduct a demonstration project to identify strategies that can facilitate access to PrEP and TasP taking cognizance of the peculiar local challenges with respect to ART and HIV prevention commodity access. The country has therefore drawn a roadmap for itself on how to introduce ART for use for HIV prevention as either PrEP or TasP. This paper discusses the three year national roadmap that would enable the country generated the needed scientific evidence as well as extensive community support for use of ART for HIV prevention in Nigeria. This process includes the conduct of modeling and formative studies, and the implementation of a 24 months demonstration project. The outcome of the demonstration project would inform plans for the scale up of pre-exposure prophylaxis (PrEP) access for population(s) at high risk for HIV infection in Nigeria. (Afr J Reprod Health 2014; 18[3]: 127-134)   

 

Keywords: Pre-exposure Prophylaxis, Nigeria, HIV, Prevention, Antiretroviral, Risk, treatment

 

Résumé Les dernières années ont été marquées par un engagement renouvelé à la prévention du VIH. La preuve à l'appui de l'utilisation de la thérapie antirétrovirale (TAR) pour la prévention des nouvelles infections du VIH dans la forme de la prophylaxie de la préexposition (PPrE) chez les hommes qui ont des rapports sexuels avec des hommes, les transgenres, les personnes qui s'injectent des drogues, les hommes hétérosexuels et les femmes et les couples séro- discordants VIH-1, ou le traitement comme la prévention (TcP) pour les couples séro-discordants ont également augmenté. La nécessité d'étudier l'utilisation possible de la TAR pour la prévention du VIH au Nigeria est devenu impératif en vue de son fardeau du VIH qui est élevée et la lenteur actuelle des efforts pour atteindre l'objectif universel de réduire l'incidence du VIH de 50%. Alors que la PPrE et le TcP sont des bonnes addenda pour l’arsenal de la prévention du  VIH existant, il est toujours important de mener un projet de démonstration pour identifier les stratégies susceptibles de faciliter l'accès à la PPrE et le TcP compte tenu de la  connaissance des enjeux locaux particuliers à l'égard de la TAR et l'accès à la prévention de la marchandise du VIH . Le pays a ainsi élaboré une carte routière pour lui-même sur la façon d'introduire la TAR pour une utilisation pour la prévention du VIH soit la PPrE ou le TcP. Ce document traite de la carte routière nationale de trois ans qui permettra au pays de générer les preuves scientifiques nécessaires ainsi qu'un vaste soutien de la communauté pour l'utilisation de la thérapie antirétrovirale pour la prévention du VIH au Nigeria. Ce processus comprend la conduite de la modélisation et des études de formation, et la mise en œuvre d'un projet de démonstration de 24 mois. Le résultat du projet de la démonstration influence des plans pour la mise à l'échelle de la prophylaxie de la pré-exposition (PPrE) à l'accès pour la population ou les populations à risque élevé d'infection du VIH au Nigeria. (Afr J Reprod Health 2014; 18[3]: 127-134)

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