By Ojoma Akor
Dr. Helen Omuh is the Director of Prevention, Care, and Treatment at the Institute of Human Virology Nigeria (IHVN). In this interview, she speaks on the importance of continuous and strategic mentorship in sustaining progress in HIV treatment and outcomes, innovations in prevention and treatment regimens, and addressing HIV care challenges , among others.
Can you briefly explain how mentorship and continuous training enhances care for people living with HIV/AIDS
Mentorship and continuous training are essential because they build the knowledge base and capacity of healthcare providers—the people delivering services. This, in turn, benefits people living with HIV, as providers are better equipped to support them.
Mentorship serves as a hands-on, practical guide delivered at the point of service provision. It promotes better learning and retention, which directly translates into improved quality of care.
When healthcare providers deliver higher-quality services, clients are more likely to experience better outcomes. As a result, clients are retained in care instead of dropping out. If they do not find services satisfactory, they may leave and seek help elsewhere.
However, when the services are good, they return because they value the care provided. This also strengthens adherence to treatment guidance. Strong adherence improves health outcomes, as one of the primary goals of treatment is to achieve sustained viral suppression. Clients are more likely to reach and maintain viral suppression when healthcare providers are well-trained and consistently deliver quality services.
Hands-on mentoring allows for the expansion of services and improved access. By mentoring nurses, pharmacists, doctors, and volunteers, the workload is reduced from falling solely on one group.
When multiple providers deliver care, service time is shortened. This means that when clients visit a facility, they spend less time waiting and are more likely to return, which has the desired positive impact. Mentorship also strengthens the use of data. While providing services, data helps assess performance and guide improvements. For example, if I am providing care to a client and notice that some clients’ viral loads are not suppressed, I would want to understand why and follow up to work with them toward achieving suppression.
What is your advise to government and non-government stakeholders on sustainable strategies for the continuous training of clinicians and pharmacists?
Well, incidentally, we already have examples of sustainable strategies that are working in the country. It is up to our government to review what is currently in place and adopt them. For instance, in the HIV program we just discussed, mentorship has been key.
In the early days of the HIV response, we had what was called Preceptorship—essentially mentorship. Foreign experts would come to our facilities, observe our work, provide guidance and direction, and work alongside us. That was how we learned to mentor health facility workers ourselves. If the government adopts and sustains such strategies, it would go a long way. In fact, some of this is already happening.
Take Postgraduate Medical Training, for example—it’s built on mentorship. Trainees work with experienced professionals, observe them, learn hands-on, and receive guidance. They also hold review meetings to discuss the care they provided, identify mistakes or gaps, and get corrections. When unusual cases arise, they discuss them to find solutions. If a patient dies, they hold mortality meetings to review what went wrong and how to avoid similar mistakes, thereby reducing mortality.
These are well-established strategies that could be expanded beyond postgraduate training into HIV and other health programs. We also have the ECHO program, which is ongoing. It uses weekly virtual zoom meetings to train healthcare providers. It is currently funded by CDC and, I believe, the Global Fund. But the question remains: if CDC or the Global Fund ends their support, what happens next? Many facilities already have the necessary infrastructure, but will our government take full ownership to ensure the program continues and doesn’t fade away?
How can health workers in Nigeria keep up with new innovations for the prevention and treatment for HIV?
Definitely, that would mean regular updates. For example, as I mentioned earlier, the ECHO platform is a good forum for informing healthcare providers about recent updates and new treatments.
Dissemination usually happens in stages. Most times, when there is something new, the government holds a meeting, reviews the guidelines, and updates them accordingly. The updated guidelines are then shared with stakeholders. In the past, IPs (Implementing Partners) would receive soft copies and handle the printing and distribution to the facilities they supported. Currently, the government takes responsibility for printing and distributing the guidelines. They also convene stakeholder meetings to share new updates, after which organizations like IHVN meet with state teams and facilities to further disseminate the information.
We also have the development of IEC (Information, Education, and Communication) materials and job aids, which are produced and shared with healthcare providers and facilities that need them. In addition, beyond the ECHO platform, we as an IP also hold weekly meetings with all the states we work in—these serve as useful forums for dissemination. Conferences, such as the recent National AIDS, Sexually Transmitted Infections Control and Hepatitis Programme (NASCP) annual symposium, are also important opportunities to communicate new updates to both the public and healthcare providers; ensuring they are aware of changes and can incorporate them into their practice.
How has IHVN influenced guidelines and policies on HIV prevention and treatment, especially in areas such as Prevention of mother-to-child transmission (PMTCT) and comorbidities like tuberculosis and HIV?
Well, at IHVN, we have been working closely with the government by providing support, technical assistance, mentorship, and even participating in policy and national guideline reviews. We also contribute to the dissemination of these guidelines. With regard to PMTCT, IHVN was actively involved in the national mapping exercise carried out by the government. This exercise identified PMTCT service delivery points, not only in conventional health facilities but also in unconventional places such as traditional birth attendants and community birthing centers that many people prefer. The mapping provided a clear picture of where these services are available, which sites are supported, and which are not. IHVN supported the government throughout this process and played a role in ensuring the mapping was effectively carried out.
For the states where we provide support, our training and dissemination of updated information have contributed significantly to government efforts and national reporting. For example, in the National AIDS Impact and Indicator Survey (NAIIS), which guided program re-design, IHVN participated, especially in the laboratory components, through collaboration with the University of Maryland.
We view all these service provisions as part of our mandate because we are Nigerians living in Nigeria, and we care deeply about our people and their well-being. We are always willing and eager to support the government in improving health outcomes.
For instance, in the first states where IHVN worked: FCT, Katsina, Nasarawa, and Rivers, we contributed up to 40% of the state targets for pregnant women who were counseled, tested, and received their results. In addition, 45% of HIV-positive pregnant women were identified and placed on antiretroviral therapy (ART), and about 85% of early infant diagnoses were completed as of March 2025. These are key indicators our funders, such as CDC, expect us to track, to demonstrate our impact and how we are contributing to the government’s targets.
When it comes to challenges in the national HIV response, what do you think still needs to be prioritized to strengthen preventive measures and care?
Over time, we have seen HIV prevalence in Nigeria drop from an all-time high of 5.8% to the current 1.3%. We have also seen new HIV infections decline; the last report I reviewed recorded a little over 48,000 new cases. Yes, we need that number to go even lower. However, while national prevalence and new infections are reducing overall, we still have specific groups where the decline is less significant—or where transmission is still being driven.
These groups are the Key Populations (KPs): female sex workers, men who have sex with men, people who inject drugs, and transgender individuals. We also have priority populations, such as adolescent girls and young women. These groups face a higher prevalence of HIV compared to the national average. For example, prevalence among female sex workers is as high as 22%, while the national average is 1.3%. Among adolescent girls and young women, the risk is also significantly higher, which is why they are classified as a priority population.
The difference in prevalence among them compared to men of the same age group is significant, almost two to three times higher, if not up to four times. That is a serious concern.
Because of this, targeted interventions are being directed toward these groups. The key question is: how can we find them to ensure that those identified are placed on treatment and achieve viral suppression, thereby reducing transmission? One of the innovations being used is hotspot mapping. For example, in the TB program, artificial intelligence (AI) is applied to identify areas where positive cases are being detected. This allows case-finding efforts to be concentrated in those areas, increasing the chances of identifying more positives.
Additionally, index testing or family index testing is used. When a person tests positive, we trace their sexual contacts, and for women, especially their children and close social networks, so that more positives can be identified early. These are some of the innovations being used to address the challenges of reaching and supporting these key populations.
Can you tell us more about best practices and innovations being used for HIV in IHVN-supported facilities?
Well, for now, let me give an example with TB infection. Remember, HIV and TB are closely linked, so people living with HIV face a much higher risk of developing TB compared to the HIV-negative population.
There is now a mobile portable X-ray device. Among people with HIV, TB often presents differently, especially when their immune status is weakened. Sometimes they may not produce sputum, or they may not even have a cough, yet still show symptoms suggestive of TB.
Traditionally, TB diagnosis has relied on sputum microscopy, and now we also use LF-LAMP tests. But for patients unable to produce sputum, X-rays become very important. The challenge, however, is that X-rays are expensive and not always available. In some communities, even if clients are referred for X-rays, they may not be able to afford transport costs or may not have any nearby facilities with X-ray equipment.
To address this, we now use a mobile device called the PDX machine (Portable Digital X-ray). It has been rolled out to support communities without easy access to X-ray services, enabling timely diagnosis of TB among people living with HIV. The newer versions of the machine also come with artificial intelligence (AI) integration, which records the locations of clients.
This allows us to identify areas with high numbers of positive cases and target screening efforts in those communities, which has been very helpful. This innovation has already strengthened the national TB program, the Global Fund TB program, and now PEPFAR is rolling it out to states. I believe almost every state has received one. This way, we can identify people living with HIV who also have TB in a timely manner and ensure they are started on treatment early for better outcomes.
Can you tell us more about Lenacapavir—what promises or benefits does it hold for Nigeria’s HIV population?
More recently, in 2025, Lenacapavir (LPEP) was introduced. It is an injection that can be taken just once every six months. The country is still in the planning phase for this and hopes to roll it out by 2026. That is the current situation regarding PrEP in Nigeria.
Definitely, there will be eagerness to take it. People would prefer an injection once every six months over a monthly injection or daily pill intake, except perhaps for those who are particularly afraid of injections. Lenacapavir will make life easier, offering a more convenient option for people to protect themselves from acquiring HIV.
In the light of recent funding cuts, how can government and communities take greater ownership of the HIV response to ensure sustainability?
The truth of the matter is that government should be ready to fund anything related to HIV. Yes, to some extent, capacities have been built for government officials, and this is still ongoing. But the major drawback remains resources. When resources are not available, even with built capacities, how will implementation take place? We need resources for drugs, for all required testing, and for healthcare workers as well—since we’ve also had challenges with their recruitment and retention. If the government is willing to ensure consistent funding for HIV services, and integrate these services into the regular health system, it would go a long way in ensuring sustainability.
What is your advice to Nigeria on HIV prevention, and for people already living with HIV?
Well, from the beginning of the HIV program, we had the ABC strategy, isn’t it? Now it has even expanded to ABCD. If we can adhere to those principles, it will go a long way in preventing the spread of HIV. In addition, for those who are positive, they also need to adhere to ABCD.
ABCD stands for Abstinence, Being faithful, Condom use, and Detection. Early detection is especially important because when HIV is identified on time, treatment and management can begin promptly. This helps individuals achieve viral suppression, which greatly reduces the risk of transmission. Condom use, on the other hand, must be both correct and consistent to be effective. By adhering to these four principles, people can significantly reduce the risk of acquiring or transmitting HIV.
