Objective:To estimate the impact and cost-effectiveness of treatment as prevention (TasP), pre-exposure prophylaxis (PrEP) and condom promotion for serodiscordant couples in Nigeria.Design:Mathematical and cost modelling.Methods:A deterministic model of HIV-1 transmission within a cohort of serodiscordant couples and to/from external partners was parameterized using data from Nigeria and other African settings. The impact and cost-effectiveness were estimated for condom promotion, PrEP and/or TasP, compared with a baseline where antiretroviral therapy (ART) was offered according to 2010 national guidelines (CD4+ <350 cells/μl) to all HIV-positive partners. The impact was additionally compared with a baseline of current ART coverage (35% of those with CD4+ <350 cells/μl). Full costs (in US $2012) of programme introduction and implementation were estimated from a provider perspective.Results:Substantial benefits came from scaling up ART to all HIV-positive partners according to 2010 national guidelines, with additional smaller benefits of providing TasP, PrEP or condom promotion. Compared with a baseline of offering ART to all HIV-positive partners at the 2010 national guidelines, condom promotion was the most cost-effective strategy [US $1206/disability-adjusted-life-year (DALY)], the next most cost-effective intervention was to additionally give TasP to HIV-positive partners (incremental cost-effectiveness ratio US $1607/DALY), followed by additionally giving PrEP to HIV-negative partners until their HIV-positive partners initiate ART (US $7870/DALY). When impact was measured in terms of infections averted, PrEP with condom promotion prevented double the number of infections as condom promotion alone.Conclusions:The first priority intervention for serodiscordant couples in Nigeria should be scaled up ART access for HIV-positive partners. Subsequent incremental benefits are greatest with condom promotion and TasP, followed by PrEP.

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BackgroundNigeria has the second highest number of new HIV infections annually. Therefore, it is important to explore new strategies for preventing new infections. The introduction of pre-exposure prophylaxis (PrEP) for use by persons at high risk of HIV infection has new potential in preventing new HIV infections. The aim of this study is to explore the public opinion, community interest, and perceptions about the use and access to PrEP in Nigeria.MethodsThis formative study used a mixed method approach to collect data on public opinions and perceptions on appropriate target groups for PrEP access, community interest, perceptions about the use of PrEP as an HIV-prevention tool, how best to communicate with participants about PrEP, concerns about PrEP use by serodiscordant couples, and suggestions for the design and implementation of a PrEP demonstration project. Telephone and in-depth interviews were conducted, and focus group discussions and consultative meetings were held with critical stakeholders engaged in HIV-prevention, treatment, care, and support programmes in Nigeria. An online survey was also conducted.ResultsHIV serodiscordant couples were identified as the appropriate target group for PrEP use. Most respondents felt that PrEP use by key affected populations would help reduce the HIV incidence. Stigma was identified as a major concern and a potential barrier for the acceptance and use of PrEP by HIV serodiscordant couples. Electronic and print media were identified as important means for massive public education to prevent stigma and create awareness about PrEP. In a male dominated society such as Nigeria, HIV-negative male partners in serodiscordant relationships may resist enrolment in PrEP programmes. This may be complicated by the fact that the identified index partner in most serodiscordant relationships in Nigeria is an HIV-positive woman, who is often diagnosed during pregnancy.ConclusionsPrEP uptake and use by HIV serodiscordant couples in Nigeria may face notable but surmountable challenges. Much depends on the appropriateness of actions taken by multiple players. Motivation of HIV-negative male partners to use PrEP and establishment of effective public education programmes in addressing stigma are essential.

Background: Considering HIV pandemic among uniform service personnel (UPS), a lot of HIV intervention programmes designed to mitigate the spread have not been very successful thus the introduction of the HIV minimum prevention package intervention (MPPI). This paper therefore presents the achievements of HIV prevention programme among UPS in Kogi State, Nigeria including its implications for programming. Methods: This project was implemented among uniform service personnel who are in army, police, custom and prison in Kogi State. A total of 2676 was an estimated sample size for this intervention and MPPI was used for implementation of project activities. Data were entered on DHIS2 platform and later exported and analyzed using Microsoft Excel. Results: Out of the total number of 67 community dialogues/advocacies carried out during the project period, 56.7% were done in 2014 and a total of 187 participants participated with a participating rate of 62.0% and 38.0% in 2014 and 2015 respectively. The total number of condoms distributed during the entire project was 7,387 and 3038 peers were registered during the project. A total of 82.6% and 71.6% were reached with HIV counselling and testing and MPPI respectively while the prevalence of HIV was 5.3%. Conclusions: This intervention successfully scaled-up demand creation for condoms and HIV counselling and testing among uniform service personnel. More engagement at all levels to engender political commitment and ownership of the HIV response with a view of ensuring sustainability through increased funding should therefore be encouraged.

Background: Kogi State recognizes the necessity of meeting the needs of orphans and vulnerable children (OVC) with compassionate care as a result broad range vulnerabilities faced by these children and their families. This paper therefore presents achievements and implications of care and support programme among OVC in Kogi State, Nigeria Methods: Five civil society organizations were engaged by Kogi State Agency for the Control of AIDS under HIV/AIDS fund (HAF) II project to provide care and support services for OVC. A total of 3700 OVC were reached with this intervention and selection of participants was done using purposive sampling. Data collected using data collection and reporting tools were entered on DHIS2 platform and later exported into and analyzed using Microsoft Excel. Results: Out of the total of 3700 OVC enrolled in this project, 114 (3.1%) were lost to follow up, 138 (3.7%) voluntary withdrawn from the project and 295 (8.0%) died. The number of household heads provided with economic support was 760. Among these, 60.9% were supported in 2015. A total of 192 children were also provided with economy strengthening services, 3367 were provided with educational access. In 2015 alone, a total of 1920 representing 51.9% of the total population were provided with nutritional support, 808 children were provided with protection services while 116 were provided shelter. Conclusion: Programming for children orphaned and made vulnerable by HIV/AIDS will contribute to the achievement of an AIDS-free generation by responding to the social (including economic) and emotional consequences of the disease on children, their families, and communities that support them. Scale-up of this intervention is therefore recommended.