By Paul Okah
“Oral daily PrEP is available in Nigeria at the moment, while the injectable is yet to come into the country. PrEP should be taken daily for 7 days or as long as possible; provided the person has risk of exposure to the virus”
What Dr George Ikaraoha, Pre-Exposure Prophylaxis, PrEP Advisor with JHPIEGO Nigeria, an International non – profit organization is talking about is one of the innovative prevention approaches in use now in the country to avoid the spread of HIV. According to him, PrEP is one of the very effective sustainable approaches for the prevention of HIV and assurance to a healthy life especially among young persons.
Speaking at a journalist training organised by Internews Europe for health correspondents in Abuja recently on HIV PrEP and Self Testing, he said a major benefit of the approach is that it is an intervention before exposure to the infection by HIV negative persons.
According to him PrEP fits into their lifestyle and preferences. Right now, in the country, he says PrEP services are available in hospitals. “However, you will get PrEP … in hospitals provided you meet the requirements,” he said.
“Available information from continuous research in the country indicate that young persons, boys and girls constitute the largest single percentage of the nation’s population and so the largest working population, this population therefore needs to be provided with acceptable prevention mechanisms to help them remain HIV negative”
First, he said the requesting person must test HIV negative. The person must also have no known exposure to HIV in the past 72 hours. Very importantly, he said “a clinician must confirm that the person has no suspicion of acute HIV infection (AHI)” in addition the person must “have no allergies or contraindications to medicines in PrEP” among others
This includes the person must be “be willing to use PrEP as described and test for HIV infection periodically” and must be “at substantial risk of infection”
Being at substantial risk to HIV infection or AHI according to him is calculated on a person’s history of risk in a circle of 6 months prior.
“The client is sexually active in a high HIV prevalence population (either in the general population or a key population group) and reports any one of the following in the past 6 months; vaginal or anal intercourse without condoms with more than one partner, sex partner with one or more HIV risk, history of an STI (based on lab test, syndromic STI treatment, or self-report) and history of use of PEP” Ikaraoha explained.
The screening criteria also includes the client reporting a no history of sharing of injection material and/or equipment with another person in the past 6 months as well as
the client reporting not having a sexual partner in the past 6 months who is HIV positive and who has not been on effective HIV treatment.
The other HIV prevention approach which sounds like PrEP is called PEP or Post Exposure Prophilaxis. It means short term use of ARV to prevent onset of HIV after potential exposure to the infection via occupational or non-occupational activity for instance sexual intercourse.
While PrEP is started before potential exposure, PEP is taken after exposure.
Ikaraoha also says PEP is taken for 28 days only while PrEP requires ongoing use as long as HIV risk exists.
He says a major common factor in the two approaches is that they are both effective if used correctly and consistently But “PrEP is needed during periods of substantial HIV risk. Individuals taking PrEP receive regular risk assessment” while discontinuing PrEP is appropriate when there is no more exposure to the risk of the infection.
Other Priority populations who may require PrEP according to Ikaraoha are clients of Sex Workers, Adolescent girls and young women (AGYW), migrant workers/Fisher folk and negative partners of serodiscordant couples.
Ikaraoha says in situations of rape, PEP have come in very useful. “There is a three-day window period after a rape incident, so survivors are given PEP up to 28 days” to ensure victims are not infected with the virus.
A man who has worked with HIV positives in the last 10 years admits the benefits of PrEP and PEP but says the onset of the Covid – 19 pandemics in the country has imposed additional hurdles for people who need them, especially in access to service.
Vitalis Offor is a HIV counsellor and caregiver with Institute of Human Virology Nigeria, IHVN, stationed at the National hospital Abuja. He says “we are still evolving new ideas on how to deal with the challenges of Covid – 19 on HIV services” because “it has affected access to services and the quality of services available”
Offor says PrEP and PEP are routine services that should be available at short notice, “but because of Covid – 19 most health workers are more afraid to provide HIV care and treatment and those who need services are even afraid to come to the hospital to access services because of fear of Covid – 19 screening”
According to Offor “many HIV positives find it very difficult to come to hospital now, they are afraid they will be screened for Covid – 19. You agree that many people are still afraid or don’t want to do the screening, so they rather opt to stay away”
As a result, he says the leadership of the support group at the hospital has had to increase its outreach activities and introduce the use of the social media more forcefully than it used to do, to communicate and munt sensitization activities on Covid – 19 to reduce its fear among their members.
Dr Philip Nwajiobi – Princewill is a consultant clinical microbiologist also at the National hospital Abuja. He agrees that Covid – 19 has imposed additional hurdles on HIV care and treatment at the hospital, “the hospital is not an island onto itself, so like other health institutions and services we are also dealing with the twin demands of providing care and services while at the same time ensuring our workers and clients are not infected with either of the two infections in our environment”
“This is our new reality and we are coping steadily with the new challenges” he added.
