NIGERIA: HIV TESTING ISSUES FOR SURVEILLANCE

1. NIGERIA: HIV TESTING ISSUES FOR SURVEILLANCE

3. HISTORY OF HIV SURVEILLANCE IN NIGERIA: - HIV was first reported in Nigeria in 1986. - Between 1986 and 1990 there was no organized surveillance of the growing epidemic. - Prevalence values were based on reports by individual investigators. - �Up to 1995/96 there was no central training for survey participants. - �First HIV sero-prevalence survey was carried out in 1991 in selected towns covering 9 out of 30 States of Federation.

4. continuation� - Individuals were given responsibility to organize and supervise survey in their states. Survey employed Wellcozyme and Genelavia kits. - There was no formal training, no centralized supervision and no Q.C. - - Second national survey took place in 17 States in 1993/94, employing Genelavia and Test � Pack reagents. - �As in 1991 this survey was neither properly planned nor supervised. - In 1995/96 21 States out of the 30 then in existence were covered in the survey.

5. continuation� -�The FMOH planned the survey with State AIDS Programme Co-ordinators (SACP�S) without any input from the laboratory . - Genelavia and Test Pack Kits were used in the survey. - 1999 survey was planned with consultants from WHO, DFID, UNICEF and UNAIDS. - Laboratory quality assurance, centralized TOT and state level training and minimal data entry quality control were introduced. Supervision was carried out at federal and state levels. All above newly introduced activities were expected to raise the standard of the 1999 survey. Unfortunately the survey suffered a set-back by late arrival of consumables and other materials.

6. continuation� -Furthermore, as a result of non-involvement of �Laboratory personnel at planning stage wrong tubes, pipette tips and some other materials were procured. - Late release of funds and late disbursement at various stages of survey were additional problems. -�Overall, 1999 survey was a great improvement on previous ones. -� The approaches introduced in 1999 were further developed for use in 2001 and 2003 surveys.

7. continuation� -�The 1999 survey raised awareness on the sensitivity of the conduct of a national sentinel sero-prevalance survey. These are - need for careful planning - adequate training - strict adherence to survey protocol. -�Effort was made to build on the gains of the 1999 survey in the planning, training and execution of the next two surveys� 2001 and 2003. -�Problems encountered overtime are grouped under: Planning, logistics, funding, training and supervision.

9. Survey Flowchart

11. Quality Control Retesting Supervision of QC retesting was done by the National Technical Working Group with technical support from CDC. All samples transported to QC Center by laboratory personnel. From every site retesting was run on: 100% positives 10% negatives >5% discordance all negatives tested from the state) All laboratory results were entered into database by laboratorians.

12. Planning Inadequate and late start for planning. Solution: - Planning starts early, stakeholders to show early commitment to avoid short falls and funding gaps.

13. Logistics -�Procurement of wrong consumables. -�Insufficient supply of consumables and reagents. -�Inadequate cold storage facilities. �Inadequate provision of power back-up. -�Cold chain maintenance.

14. Solution: - All consumables, reagents and other materials to be on ground before commencement of survey . -�Laboratory personnel should always be involved in planning. - Samples of consumables and other materials should be kept and used to make purchases. -Problems of inadequate storage facilities have yet to be completely resolved. - Appropriate training has improved cold chain maintenance

15. Funding Funding issues have remained recurrent decimal Inadequate funding for survey and late release of funds

16. SOLUTION:- All funds for survey should be on ground before commencement of survey.

17. Training: This is one of the most important components preparatory to any survey: Inadequate Training often arises from engaging too many people at a time and insufficient time for practical training Wrong personnel trained for laboratory work. e. g - Laboratory scientists unable to use vacutainers. Poor adherence to SOP resulting in poor concordance.

18. Solution: Training should be decentralized but this will mean extra funding to cover additional facilitators and logistics. ToT should be stregthened, with emphasis on information disemination. Only laboratory personnel performing HIV testing should be trained. SOP�s should be boldly written and prominently pasted for easy reference. Right consumables and materials for survey should be used in training the participants.

19. Problems Observed During Supervisory Visits Poor record keeping (Inconsistent reporting between sites) Inconsistent labeling and coding of specimen bottles Improper sample handling at sites Maintenance of confidentiality Bad arrangement of stored samples Lack of surveillance understanding at site level loss of information during transfer Inadequate means of transportation for supervisors

20. Solution:- Two levels of supervision were introduced: Central and Zonal Included individuals from various organizations (national and international, eg CDC, APIN, WHO) Continuous supervision ensured through out the survey period. Several feed back meetings with all supervisors Adequate supervision has minimized most of the problems listed above.

21. National Technical Working Group Made up of 6 experts in HIV/AIDS testing from different organizations and diverse parts of the country. Participated in following: Protocol development Compiled lab supply list Development of training modules Supervision of training Supervisory visits QC retesting