President Muhammadu Buhari with NACA stakeholders in Abuja

His Excellency, Muhammadu Buhari, President of the Federal Republic of Nigeria, formally unveiled the findings of the Nigeria HIV/AIDS Indicator and Impact Survey (NAIIS) at a special event in the Presidential Villa, marking the start of disseminating NAIIS results.

The Government of Nigeria, with the support of The U.S. President’s Emergency Plan for AIDS Relief (PEPFAR), The Global Fund to Fight AIDS, Tuberculosis and Malaria (Global Fund) and other development partners with technical assistance from the US Centers for Disease Control and Prevention (CDC), conducted NAIIS, one of the largest population-based HIV/AIDS household survey in the world. NAIIS directly measured HIV prevalence and viral load suppression, allowing Nigeria to focus on providing services to the areas with the greatest need to control the HIV epidemic.

Speaking in Abuja at the event, the President welcomed the news that Nigeria had fewer people living with HIV than previously estimated and launched the Revised National HIV and AIDS Strategic Framework 2019-2021, which will form the future response to the country’s epidemic.

HIV prevalence, defined as the percentage of PLHIV in the population of Nigeria,among adults age 15-49 years was 1.4% (1.9% among females and 0.9% among males). HIV prevalence among children age 0-14 years was 0.2%. HIV prevalence was highest among females age 35-39 years at 3.3% and the highest prevalence among males age 50-54 years at 2.3%. The HIV prevalence gender disparity between females and males was greatest among younger adults, with females age 20-24 years having 4 times the prevalence of males in the same age group. The new prevalence gives an estimate that there are 1.9 million people age 0-64 years living with HIV in Nigeria. This new estimate is more accurate than those previously conducted, as they are based on an expanded surveillance system and a revised and enhanced methodology.
Viral load suppression (VLS),defined as having less than 1,000 HIV RNA copies per ml of plasma, shows the positive effect of anti retroviral treatment. Achieving VLS maximizes the health benefits to PLHIV, minimizes the risk of HIV transmission, and is necessary to halt the epidemic.

At the national level, viral suppression among people living with HIV aged 15 to 49 years old with access to treatment stands at 42.3% (45.3% among women, and 34.5% among men). VLSwas 44.5%(46.2% among females and 40.9% among males) for age 15-64 years. VLS among PLHIV was highest among males age 55-64 years at 55.0% and the highest VLS among females age 45-54 years at 54.3%. The VLS gender disparity between females and males was greatest among those age 25-34 years, with females in this age range being2 times more likely to achieve VLS, compared to males in the same age group.

Halting the epidemic includes stopping transmission of HIV from mothers to children during pregnancy, labor and delivery, and breastfeeding. Transmission to from mother to child can be halted by making sure that mothers have access to antenatal care during their pregnancy, are tested to know their HIV status, and receive antiretroviral drugs (ARVs) if they are HIV-positive. NAIIS data show that among women who gave birth since January 1, 2015, 76.5% self-reported attending at least one antenatal care visit for their last pregnancy and 40.0% self-reported knowing their HIV status during pregnancy. Among women who self-reported knowing their HIV status, 1.4% self-reported testing HIV-positive before or during pregnancy. Among the known HIV-positive women, 82.6% self-reported receiving antiretroviral drugs during their pregnancy.

“The Nigeria HIV/AIDS Indicator and Impact Survey findings provide Nigeria with an accurate national HIV prevalence measure of 1.4%.NAIIS also showed we are able to effectively provide antiretroviral treatment.Everyone infected with HIV needs to get treatment so they can achieve viral suppression, especially pregnant women. We must ensure pregnant women have access to ANC services and are tested during every pregnancy. We know we can support HIV-positive mothers, hence ensuring the next generation is free from HIV,” Professor Isaac F.Adewole, Nigeria’s Honourable Minister of Health.

“It is important that all people living with HIV get into treatment and achieve viral suppression. To halt the epidemic, we need to act now. As a government working with our partners, we have what it takes to support persons who are HIV-positive, to provide treatment, to protect their families and to help people live long and healthy lives,”Dr. Sani Aliyu, Director General, National Agency for the Control of AIDS (NACA).

NAIIS was a national household-based survey that assessed the prevalence of HIV and related health indicators. Data collection was succesfully donein a compressed time, July through December 2018, to ensure the data were available to plan for the provision of HIV treatment and prevention services in 2019. Data were collected from household members ages 0-64 years old. Confidential HIV counseling and testing services were provided to people who participated in the survey. All participants that were found to be HIV positive were linked to a health facility to help them access HIV services. NAIIS data includes national, zonal, and state information on HIV control activities in Nigeria.

“I commend the Nigerian government and all its partners for conducting this ambitious survey which provides us with a much better understanding of the country’s AIDS epidemic. While it is fantastic news that there are fewer people living with HIV in Nigeria than previously thought, we must not let down our guard. Let us use the results of this survey to better focus our delivery of HIV prevention, treatment and care services to people in greatest need and ensure that Nigeria gets on track to end the AIDS epidemic by 2030,” Michel Sidibé, Executive Director of UNAIDS and Under-Secretary-General of the United Nations

“The Nigeria HIV/AIDS Indicator and Impact Survey represents an extraordinary example of what can be achieved by working together. The US Government (USG), through the President’s Emergency Plan for AIDS Relief (PEPFAR), looks forward to continuing to work with the Government of Nigeria, implementing partners, and civil society to support the HIV response. Importantly, USG looks forward to increased Government of Nigeria ownership and investment in the HIV response to ensure sustainability,” David J. Young, Charge d’affaires, US Embassy, Nigeria

“The Nigeria HIV/AIDS Indicator and Impact Survey results provide Nigeria and partners with accurate data, including HIV prevalence, viral load suppression, and the impact of preventing mother-to-child transmission services. CDC is proud to partner with the Federal Ministry of Health, the National Agency for the Control of AIDS, and others to complete the household survey. The encouraging results presented today, along with ongoing monitoring and evaluation data will help the Government of Nigeria to intensify efforts in the fight against HIV/AIDS to achieve epidemic control. CDC will continue to work alongside our Nigerian brothers and sisters in this fight,” says Mahesh Swaminathan, Country Director, CDC Nigeria.

Nigeria has shown steady progress on increasing access to treatment for people living with HIV, with the adoption of a test and treat programme in 2016 further accelerating referrals to treatment for people who test positive for the virus. From 2010 to 2017, the country has almost tripled the number of people living with HIV having access to antiretroviral therapy, up from 360 000 in 2010 to over 1 million people in 2018. However, the new estimates released today indicate that almost half of people living with HIV still do not have access to treatment.

Between 2012 and 2014, there was a significant expansion in the country’s HIV response. The number of sites providing treatment doubled, prevention of mother-to-child sites increased 8-fold and HIV counselling and testing sites increased four-fold. A total of 6.7 million adults were counselled and tested for HIV in 2014, a 65% increase from the previous year.

The NAIIS survey reached about 250,000 respondents in nearly 100,000 households and was successfully completed in record time, despite geographical, infrastructural, logistical and security challenges in the country at the time when the survey was conducted. It was implemented by the NAIIS Consortium led by University of Maryland Baltimore (UMB), other members are African Field Epidemiology Network (AFENET), ICF, and University of Washington.Supervision was provided by the NAIIS Technical Committee.