APIN Prevention Program
The first case of HIV in Nigeria was reported in 1986. National prevalence surveys carried out subsequently showed that the HIV prevalence rate increased from 1.8% in 1991 to 5.4% in 2001 and dropped to 5.0% in 2003, 4.4.% in 2005 but increased slightly to 4.6% in 2008 and then declined to 4.1% in 2010. It is currently estimated that over 156 million Nigerians are currently free of HIV. Keeping the majority uninfected with the virus is the driving force behind design and implementation of APIN innovative prevention program.
APIN Prevention program is divided into two broad areas – Sexual Transmission prevention (STP) and Medical transmission prevention (MTP) of HIV.
Most of our prevention effort is channeled through STP since findings revealed that HIV is majorly transmitted through sexual means. Abstinence and be faithful, other prevention including condoms are elements of the sexual transmission prevention program area. However, Blood safety and injection Safety are the sub-units of medical transmission prevention program. This is basically targeted to the facilities and the activities that take place within the hospital environment.
In the first five years of implementation of PEPFAR program, the goal of the APIN prevention program is synonymous to the first Goal of the PEPFAR Program which was to achieve Primary Prevention of HIV through expanded HIV Counseling and Testing (HCT) and Prevention of Mother-to-Child-Transmission (PMTCT) Program. This include
- scale-up of HIV voluntary counseling and testing to maximize identification of HIV positive individuals for ART and Care;
- Outreach to most at risk populations (MARPS) or Key Population (KP);
- Collaborate with partner institutions and community based organizations in Nigeria to support existing prevention programs; and
- To improve the quality of HIV care and treatment services provided by health care workers in Nigeria through medical transmission prevention activities.
Key issues bordering on behavior change communication are tactically addressed through carefully selected mix of strategies in line with the national prevention plan. General and most-at-risk population are targeted for this intervention.
These issues and the associated demand generation strategies can be divided into five categories:
- Status discovery and patient recruitment through HIV Counseling and Testing (HCT);
- Community mobilization, advocacy and sensitization to prevent new infections of HIV through sexual and medical means;
- Integration of HCT services into other service delivery points within the health facilities to avoid missed opportunities;
- Targeting drivers of the epidemic and
- Training and capacity building for health care workers to minimize medical transmission of HIV among health care providers, hospital staffs and waste handlers.
HCT: A primary step in HIV prevention is for the population to know their HIV status. We achieve this through organized and qualitative HCT services within the health facilities, in the communities- in such locations as markets, churches and tertiary education institutions and among private and humanitarian services.
STP: APIN program moved from the previous and nationally accepted emphasis on one-off, large number driven prevention campaigns to the more coordinated, cost effective, behavior change communication driven interventions. This systemic Minimum Prevention Package Intervention (MPPI) is espoused in the National Prevention Plan. Activities were targeted at general population, students and MARPS.
Community based organizations, non-governmental organizations and faith-based organizations are engaged to implement HCT and STP prevention activities for wide range and cross-cutting coverage of the prevention services. This a bearing in mind the existing ethno-religious diversities in Nigerian society.
MTP: Medical transmission prevention of HIV infection on the other hand entails distribution of policy documents and guidelines for blood transfusion practice and safe injection practice to the hospitals. This is to encourage adherence to safe practices thereby reduce incidence of new infection. Several trainings and refresher courses in Blood Safety and Injection safety are consistently rolled out to promote safe blood transfusion – and safe injection practices within the hospitals. These are carried out in collaboration with line implementing partners, bespoke by the US government PEPFAR program to attain the objectives of the medical transmission prevention of HIV. Topics on universal precaution, reduced exposure to sharp and needle injuries, appropriate clinical use of blood, healthcare waste minimization and segregation; and post-exposure-prophylaxis procedures are part of the numerous themes articulated during these training sessions.
Reporting of the prevention intervention effort through the use of appropriate data capturing tools is also a key component of these services. Data captured are disaggregated appropriately by gender and age; the M & E unit of the APIN program ensures qualitative collection, collation and timely reporting of these prevention activities.
Divers categories of people have been imparted and reached with these prevention effort and numerous individuals are indebted to APIN either for the platform created for early HIV status discovery or through innovative prevention messages tactically crafted to effect positive behaviour change. Specific trainings for health care providers have given a sense of protection and recognition for their roles in the treatment, care and support of people living with- and people affected by the infection.