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NIGERIA. COUNTRY PRESENTATION. By: Drs. Uzono Levi G and Adegboyega Adewumi. 4 th September 2004. REMINDER – The main issues. Which ARVs are available in your Country Do you have treatment guidelines What information is available to -Health professionals -The Public

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nigeria

NIGERIA

COUNTRY PRESENTATION

By: Drs. Uzono Levi G and

Adegboyega Adewumi

4th September 2004

reminder the main issues
REMINDER – The main issues
  • Which ARVs are available in your Country
  • Do you have treatment guidelines
  • What information is available to

-Health professionals

-The Public

  • Is there any safety Monitoring in your Country
presentation outline
Presentation Outline
  • About Nigeria
  • Epidemiology of HIV/AIDS
  • The National ART Programme
  • The main Issues
  • Conclusion
important statistics
Nigeria located in Western Africa, bordering the Gulf of Guinea, between Benin and CameroonImportant Statistics
  • Population: 123.9m (1999)
  • Life Expectancy at Birth (LEB): 52years
  • Urban: Rural Ratio: 50:50 (approx)
  • Adult Literacy Level: 55.6%
  • External Debt: US$ 31.6 billion
  • Poverty Level: 65% live below Poverty level
  • HIV Prevalence: 5.0% (end of 2003)
  • Estimated HIV Burden: 3.47million (2001)
  • Estimated AIDS Burden: 1.2million (2001)
epidemiology of hiv aids
Epidemiology of HIV/AIDS
  • Since 1986 when the first AIDS case was detected in Nigeria, the epidemic has rapidly grown.
  • The adult HIV prevalence has increased from 1.8% in 1991 to 4.5% in 1996 to 5.8% in 2001 and finally 5.0% at the end of 2003.
  • Estimates using the 2001 HIV seroprevalence sentinel survey of women attending ante-natal clinics indicate that the more than 3.5 million Nigerians were infected with the virus in 2002.
the national art programme
The National ART Programme
  • In 2001 the Federal Government of Nigeria adopted a policy to provide antiretroviral treatment to people living with HIV/AIDS in the country.
  • By the middle of 2004, approximately 13,500 people were receiving ARV treatment from these centres and many more were on waiting lists.
  • Implementation of the program began in 2002 with 25 centres selected to provide ART in various parts of the country.
slide7
HIV Prevalence per State end of 2003 and States with ARV Centers

Sokoto State

4.5%

*Sokoto

*Katsina

Yobe State

*Birnin Kebbi

Katsina State

Jigawa State

Borno State

*Gusau

3.3%

*Kano

2.0%

3.2%

Zamfara State

2.5%

Kano State

3.3%

Kebbi State

*Dutse

*Damaturu

*Maiduguri

4.1%

2.5%

Bauchi State

Gombe State

4.3%

Niger State

*Kaduna

6.8%

Kaduna State

*Bauchi

*Gombe

Adamawa State

Kwara State

7.0%

*Jos

*Minna

6.0%

7.6%

2.7%

6.3%

*Jalingo

FCT

**

Plateau State

< 5%

NasarawaState

*Yola

Oyo State

*Ilorin

8.4%

**

6.5%

3.9%

*Lokoja

*Lafia

Taraba State

5 - 7%

*Ibadan

*Osogbo

Ekiti State

5.7%

2.0%

1.2%

Kogi State

*Ado Ekiti

Osun State

*Makurdi

6.0%

*Abeokuta

9.3%

*Akure

1.5%

Edo State

Benue State

7 -12% +

2.2%

Ogun State

Ondo State

4.9%

*Ikeja

4.3%

3.3%

Enugu State

4.7%

*Benin City

7.2%

Anambra State

Lagos State

*

*Asaba

*Enugu

ARV Centers

*Awka

Ebonyi State

3.1%

5.0%

IAbia State

12%

Imo State

Cross River State

Delta State

3.7%

Lagos Has 3 ARV Centers

*Owerri

*Yenagoa

Rivers State

7.2%

*Calabar

*

4.0%

Bayelsa State

6.6%

*Uyo

*Port Harcourt

Akwa Ibom State

Abuja Has 7 ARV Centers

**

MO-ARVS NASCP – FMOH 15th June 2004

treatment needs
Treatment Needs

The epidemic has extended beyond the commonly classified high-risk groups to the general population.

As at the end of 2001, at least three and a half million people are living with HIV/AIDS, which is expected to rise to well over four million in 2008.

Cumulative deaths by 2008 are predicted to be between 3.6 to 4.2 million.

Out of this, between 300,000 to 700,000 people are in urgent need of treatment.

slide10
Currently registered/listed in Nigeria either as single products or in fixed dose combinations we have

6 Nucleoside Reverse Transcriptase Inhibitors (NRTIs),

  • 2 Non Nucleoside Reverse Transcriptase Inhibitors (NNRTIs) and

5 Protease Inhibitors (PIs)

slide11
ARVs currently Registered with National Agency for Food and Drug Administration and Control (NAFDAC)
do you have treatment guidelines
?Do You have Treatment Guidelines

Yes!

GUIDELINES FOR THE USE OF ANTIRETROVIRAL (ARV) DRUGS IN NIGERIA

FEDRAL MINISTRY OF HEALTH

ABUJA, NIGERIA

JULY 2001

Draft

GUIDELINES FOR THE USE OF ANTIRETROVIRAL (ARV) DRUGS IN NIGERIA

FEDERAL MINITRY OF HEALTHABUJA – NIGERIA

AUGUST 2004

contents
Contents
  • 1.0 Introduction .
  • 2.0 Virology and Pathogenesis of HIV
  • 3.0 Diagnoses of HIV infection and AIDS
  • 4.0 Antiretroviral therapy (ART)
  • i. Classes of ARV Drugs - Available ARV drugs
  • ii. Criteria for initiation of therapy
  • iii. Recommended and alternative regimen of ART
  • iv. Adverse drug reactions and Interactions
  • v. When to switch ART
  • vi. When to stop ART
  • 5.0 Follow-up and Monitoring patients on ART
  • 6.0 Key issues in ART
      • i. Adherence
      • ii. Immune Reconstitution Syndrome
      • iii. Treatment experienced patients
      • Indications for Referral
  • 7.0 Prevention of Mother to Child Transmission
  • 8.0 Post Exposure Prophylaxis and Universal Safety Precautions
  • 9.0 Management of TB and Other Opportunistic Infections
  • 10.0 Supportive management
  • i.Nutrition
  • ii. Psychosocial Support
  • iii. Palliative Care
treatment protocol
Treatment Protocol

Recommended and alternative regimens for adults and children

  • First line regimen for adultsd4T / 3TC / NVP
  • Alternative first line drugs for special category of adults:
      • ü Pregnant women or women of childbearing age
  • ZDV / 3TC / NVP
      • ü Adults with tuberculosis co-infection (that require Rifampicin containing regimen for TB treatment)
  • d4T / 3TC / EFV

First line regimen for childrend4T / 3TC / NVP

Alternative first line drugs for special category of children: Children with tuberculosis co-infection (that require Rifampicin containing regimen for TB treatment)

d4T / 3TC / EFV (not recommended for children below 3 years)

is there any safety monitoring in your country
?Is there any Safety Monitoring in your Country
  • What we have is post marketing surveillance, which is the responsibility of NAFDAC
  • Address the issues of counterfeit drugs and other regulatory products through
  • -Public Enlightenment Campaigns
  • -monitoring of Good Manufacturing Practices, -beefing up surveillance at the ports
  • -Mopping-up fake / counterfeit drugs and other regulated products
the future
The Future

?

The launching of Pharmacovigilance on the 9th of September will initiate drug safety monitoring with special emphasis on ADRs

conclusion pharmacovigilance in nigeria
Conclusion -Pharmacovigilance in Nigeria

We are compiling Sample reports to get fully registered with the Uppsala Monitoring Center

Draft Guidelines for Pharmacovigilance has been developed

Draft case reporting forms have been developed

On the 9th of September the official launching will take place

slide19
Ke a leboga

Thank You

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