PEPFAR has greatly expanded access to HIV testing, treatment, and care in Nigeria, enabling millions to know their status and receive lifesaving medication. It has also strengthened healthcare systems, reduced mother-to-child transmission, and enhanced community support for people living with HIV. In this interview, IHVN’s Program Lead, Dr. Oche Yusuf, speaks with Health and Science Africa on the organization’s ongoing efforts to prevent a resurgence of HIV-related deaths and stigma.
By Ojoma Akor
Briefly tell us how the PEPFAR program has helped improve access to testing, prevention, and treatment services for HIV in Nigeria?
PEPFAR is a key funder of the HIV program in Nigeria. Before PEPFAR came into the country, most medical wards—especially in secondary and tertiary health facilities that catered to patients—did not have access to antiretroviral medications (ARVs) because they were not readily available.
With PEPFAR’s support, we have been able to move medications to communities and health facilities, and place patients on ARVs. This has significantly improved accessibility. When the program began, Implementing Partners (IPs) with the capacity to carry out this work were identified. Some were selected and have continued to implement activities under PEPFAR; others were changed or added in the course of implementation.
So, how does this work? These partners continually engage with the government, build the capacity of healthcare workers, employ staff, and recruit ad hoc staff when necessary. This is because achieving wide program reach requires having personnel with the requisite experience and expertise to implement the program effectively.
The program also identified different sub-populations such as adults, adolescents, pregnant women, children, and people at higher risk for HIV—such as commercial sex workers, men who have sex with men, and people who inject drugs. The rate of transmission among these sub-populations is higher.
Our goal is to prevent new infections. PEPFAR has made provisions for HIV testing services not only in health facilities but also within communities. Some community-based testing activities are targeted at specific populations—particularly the sub-populations mentioned earlier. By targeting these groups, we can use daily data to conduct geo-mapping and identify where new infections are emerging. This allows us to reach those communities, ensure that individuals are tested, and link those who test positive to ARV treatment.
The good thing about the PEPFAR program is that HIV services are offered free of charge. You don’t pay any money—testing and medications are completely free. All the support you receive is free, except in cases where complications develop and patients need to be referred to higher-level facilities for additional medical attention.
The provision of HIV services under PEPFAR began in tertiary facilities and was later scaled up to secondary and primary health facilities. This expansion has made access to services much easier. When we were scaling up, we started implementation in tertiary institutions, then extended to secondary and finally to primary health institutions. Most facilities now implement a comprehensive program, meaning that if you visit a primary healthcare center, you can receive the same quality of care provided in a tertiary health institution—except in cases of complications, which require referral.
What we are now beginning to see is that because clients start antiretroviral therapy (ART) early, complications are less likely to occur. Many patients do very well on their medications and achieve viral suppression.
It’s important to note that accessibility was not always this easy. It was through PEPFAR’s support that we were able to reach this level. We faced many challenges in making services readily accessible, but the program has significantly improved the situation.
How would you describe PEPFAR’s intervention in helping Nigeria achieve epidemic control for HIV?
When we talk about epidemic control, we’re not just referring to achieving the 95-95-95 targets. The ultimate goal is to improve the quality of life for people living with HIV and reduce both HIV-related mortality and new infections. Once the number of new infections becomes lower than HIV-related deaths, we can confidently say that we are approaching epidemic control.
The government is working very closely with PEPFAR, which has been at the forefront of this effort. PEPFAR has built the capacity of healthcare personnel, strengthened policy development, and introduced interventions to help achieve the 95-95-95 goals. Currently, when you look at the 95-95-95 targets—HIV testing, treatment, and viral suppression—you’ll find that for the first 95 (testing), we have achieved close to 95%. For the second 95 (treatment), we have also achieved around 95%. For the third 95 (viral suppression), data validation is ongoing, but the rate is estimated to be between 86% and 90%.
Once individuals are tested, they are immediately initiated on treatment. The linkage rate for most of the clients we see is nearly 100%, while the retention rate is about 98%. Globally, viral suppression among pediatric and adolescent populations remains a challenge, with rates ranging between 75% and 88% in most countries, including Nigeria. This is largely due to the difficulty some adolescents face in adhering to their medications.
For the pediatric sub-population, medication and dosage vary based on age and weight. If the prescribed dosage—determined by a trained healthcare worker—is not properly followed, the child may not receive the correct amount of medication, which affects viral suppression. In many countries, viral suppression among children ranges from 75% to 88%. However, Nigeria has made remarkable progress, and viral suppression rates are now approaching 90%.
We are moving steadily toward epidemic control, but more work still needs to be done to significantly reduce new infections and mortality. It’s important to note that deaths are not caused by HIV itself; rather, when the immune system is weakened, it creates opportunities for infections that ultimately lead to death.
Can you also tell us about the prevention of mother-to-child transmission (PMTCT) when it comes to these interventions in Nigeria?
Globally, PMTCT is a very important intervention. If you recall, when we discussed HIV prevalence in Nigeria, the figures were initially obtained from pregnant women attending antenatal clinics. For PEPFAR, this sub-population is one of the most important because it involves both the mother and the baby. Over 7.8 million children have been prevented from acquiring HIV. If that had not happened, imagine having 7.8 million children living with HIV—it would have been a disaster for the country. But because of that singular intervention, we now have much better outcomes.
The progress achieved so far is due to several focused activities aimed at ensuring that pregnant women get tested. The previous model required all pregnant women to visit health facilities for testing. However, the reality is that many Nigerian women do not attend health facilities for antenatal care. So, how do we reach them?
We adopted community-based programs, which meant moving beyond health facilities into communities to test every pregnant woman where she lives. Despite that, there were still missed opportunities, so we introduced additional models—such as the congregational approach—implemented in collaboration with faith-based organizations, given their influence and reach within communities. Women respond positively to these faith-based structures, and as a result, the uptake of HIV testing and PMTCT services among pregnant mothers has increased significantly.
Another approach was to leverage existing government resources and programs. One of the most important of these is the Maternal, Newborn and Child Health (MNCH) Week, which is conducted in some states once or twice a year, depending on the availability of resources.
Implementing Partners, including IHVN, have supported these efforts to reach more women in communities and close gaps in testing and missed opportunities. Leveraging the MNCH Week provides a comprehensive platform to reach women, children, and newborns in the community. During these activities, beneficiaries receive not only HIV testing and referral services but also screening and support for hepatitis, malaria, blood pressure, haemoglobin levels, urinalysis, growth monitoring, blood group testing, deworming, nutrition counseling, and other essential health services.
When pregnant women are tested, those who test positive are immediately linked to comprehensive care and assigned a mentor mother, also known as a peer champion. A mentor mother is someone who has previously received HIV services, successfully delivered an HIV-negative baby, and is willing to support other HIV-positive pregnant women to achieve the same outcome.
These mentor mothers facilitate HIV drug administration, adherence, and other program interventions. They also engage with communities and interface with various stakeholders to address issues related to discrimination, adherence, and social support. While the mentor mother does not disclose the positive woman’s HIV status, she supports her through every stage of the PMTCT cascade, including the viral load test at 32 weeks. The result of that test determines the appropriate care and services for the baby.
The medications provided under the PMTCT program serve both treatment and prevention purposes, with the ultimate goal of ensuring that the baby remains HIV-negative. Each baby’s level of risk is carefully assessed based on the mother’s HIV status and her adherence to antiretroviral therapy (ART). A baby is classified as high-risk if the mother is not on ART, was newly diagnosed with HIV at 32 weeks of pregnancy or later, is not adherent to her prescribed medications, or if her HIV status is discovered only during labor or the breastfeeding period.
This level of risk determines the type of prophylaxis given to the baby. For high-risk babies, two medications—Nevirapine and Zidovudine—are administered for 12 weeks. For low-risk babies, Nevirapine is given for 6 weeks. In addition, cotrimoxazole is administered at six weeks to protect the baby from opportunistic infections. Healthcare workers and peer mentors are trained to ensure that women go through every stage of the PMTCT cascade. By the time the mother completes the process, we expect the baby to be HIV-negative.
If you visit a facility and review pregnant women who have gone through the PMTCT cascade and achieved viral suppression, you’ll find that nearly all their babies—about 99%—are HIV-negative. The remaining 1% of HIV-positive babies are typically those whose mothers did not go through the program. In some cases, a baby’s HIV status is only discovered when the child is brought to the facility due to illness.
So, specifically, can you tell us about some of the PEPFAR projects that IHVN has implemented and their impact, or the number of beneficiaries in the implementation states?
When you look at the impact, there’s a significant contribution from PEPFAR and, more specifically, from IHVN. Currently, IHVN supports about 238,000 clients who are receiving HIV medications across 380 health facilities in Nigeria. These facilities include primary, secondary, and tertiary health institutions.
We have also collaborated with the Government of Nigeria to upgrade the country’s health infrastructure—an investment that proved valuable during outbreaks such as Ebola and COVID-19. One of the most important projects implemented on behalf of CDC and PEPFAR is the National Reference Laboratory in Gaduwa, Abuja. IHVN equipped the facility, built human capacity, and provided technical support. During the COVID-19 pandemic, most of the laboratory tests conducted nationwide were handled there. This facility now serves not only the HIV response but also testing for other infectious diseases.
Other key facilities include the BSL-3 laboratory at the National TB and Leprosy Training Center in Zaria. We have also provided equipment and support to institutions such as the Nigerian Institute of Medical Research (NIMR), Ahmadu Bello University Teaching Hospital (ABUTH), Rivers State University Teaching Hospital, and the University of Port Harcourt Teaching Hospital.
In addition, we have trained over 260,000 healthcare workers across the country. This has strengthened the capacity of government personnel and key stakeholders, especially at a time when their experience and expertise are critical to sustaining program achievements. In terms of infrastructure, numerous facilities have been upgraded—some lacked adequate space for patients, while others had no functional laboratories. Today, these facilities have been strengthened to deliver comprehensive HIV services.
Currently, IHVN supports over 238,000 clients on antiretroviral therapy (ARVs), with a retention rate of over 99% and an interruption rate of less than 1%, one of the best in the country. Our viral suppression rate stands at about 96%. IHVN remains committed to achieving epidemic control and continues to work diligently toward that goal.
How has the USAID funding freeze earlier in the year affected the implementation of HIV programs, whether in Nigeria or within IHVN specifically?
The PEPFAR program is structured in such a way that there is no interruption in service delivery. The funding freeze did not affect the supply of drugs, testing, or other services that clients are supposed to receive. Initially, there was concern that people might not get their medications, but fortunately, the drugs remained available and services continued without disruption.
As an expert in this area, what advice would you give to Nigerians regarding HIV testing, prevention, and treatment?
All HIV-related services—testing, treatment, and prevention—are completely free. As an individual, getting tested helps you know your status, equips you with valuable information, and empowers you to take informed steps regarding your health. Before testing, clients receive counselling on how to prevent HIV infection.
For those who test positive, treatment is readily available and should begin immediately. Starting treatment right away improves quality of life and helps achieve viral suppression. For married individuals, being virally suppressed also prevents transmission of the virus to their partners. The program also supports Pre-Exposure Prophylaxis (PrEP). For instance, the HIV-negative pregnant wife of an HIV-positive man can receive PrEP medication. If she is HIV-positive, she will receive antiretroviral therapy (ARVs) for free.
Similarly, Post-Exposure Prophylaxis (PEP) is available for individuals who may have been exposed to HIV—for example, healthcare workers who experience a needle-stick injury, clients who have unprotected sex with a partner known to be positive or of unknown status, victims of rape, or anyone exposed through incidents like a blood splash into the eyes. PEP services are also free.
The PrEP services I mentioned earlier are available for pregnant and breastfeeding mothers. In addition, the Government of Nigeria is introducing a new drug called Lenacapavir, an injectable PrEP medication given twice a year to HIV-negative individuals for prevention. However, taking this medication does not grant license for risky behavior—there are also behavioral change interventions that go hand-in-hand with these preventive measures. The prevention package under the program is comprehensive, holistic, and free.
I’m interested in knowing more about the PrEP program in Nigeria under PEPFAR. How readily available is it across the country, especially for MSM, for instance?
The PrEP program was initially available across the country under both the Global Fund and PEPFAR-supported programs. However, PEPFAR now supports PrEP specifically for HIV-negative pregnant and breastfeeding mothers. That’s why I mentioned earlier that the Government of Nigeria plans to introduce Lenacapavir for that purpose. I’m confident that within the next two months, more information will be circulated, and everyone who qualifies will be able to access it—free of charge.
I’m glad to hear that Nigeria will also be introducing Lenacapavir. But what about other new innovations? We’ve seen several biomedical prevention tools in use across other countries. Apart from this, are there other innovations being factored into HIV programs in Nigeria or at IHVN?
At IHVN, we have the International Research Center of Excellence (IRCE), which partners with several organizations on research and innovation. We are working closely with laboratories to explore the development of locally produced test kits—not just Rapid Diagnostic Kits (RDKs), but also Polymerase Chain Reaction (PCR)-based kits that can be used for early diagnosis in children.
It’s a gradual process, but we are optimistic that, over time, new innovations will emerge. Other ongoing efforts include local manufacturing of antiretroviral drugs (ARVs). IHVN and Nigeria are also at the forefront of research toward developing an HIV vaccine.
In summary, can you describe how IHVN has helped shape or contributed to the HIV response in Nigeria?
Our contribution has been significant. From the first, second, and third 95 targets—and even before then—we have been working with the Government of Nigeria to identify and support community-based organizations, as well as government agencies at both the local and state levels, to collaborate and mitigate the HIV epidemic. We have also participated in training staff from government agencies, community-based organizations, faith-based organizations, and other implementing partners. The total number trained, as I mentioned earlier, exceeds 260,000 individuals.
Through PEPFAR funding, many hospitals have been equipped with essential infrastructure and tools. For example, the National Reference Laboratory, Ahmadu Bello University Teaching Hospital, the National Tuberculosis and Leprosy Training Centre in Zaria, and the Rivers State University Teaching Hospital are among the facilities that have benefited. These facilities now support not only HIV programs but also other diagnostic services, such as for Hepatitis B and viral load testing.
We have also enhanced laboratory processes—for instance, through the institutionalization of proficiency testing for HIV and other programs. Proficiency testing involves external quality assessment, where laboratories analyze unknown samples from an outside source to objectively compare their performance and accuracy with other laboratories.
IHVN has supported both quality assurance (QA) and quality control (QC) processes. QC identifies and addresses faults, while QA ensures that procedures are implemented according to established standards. Together, proficiency testing, QA, and QC have strengthened the capacity and technical skills of laboratory personnel. Additionally, IHVN is assisting the Medical Laboratory Science Council of Nigeria in calibrating laboratory equipment across facilities nationwide.
For the HIV program, we currently have over 238,000 individuals on treatment, with a viral suppression rate of about 96% and a retention rate of approximately 99%. Achieving this level of success requires a great deal of commitment, expertise, and resources. Now, looking at facilities, we have achieved service integration; there are no longer separate facilities where HIV programs run in isolation from other health programs. We are integrating services so that clients who come for HIV care are not seen separately.
We are also working with state governments to build their capacity in managing HIV, malaria, tuberculosis, hepatitis B, and other programs. These programs should be government-driven and not donor-dependent. States should be able to mobilize resources locally and fund their programs effectively.
We are facilitating increased enrolment of people living with HIV (PLHIV) in the Social Health Insurance Scheme. Some states are already implementing this. For instance, the FCT recently enrolled about 2,000 HIV-positive individuals free of charge because the government covered the cost. Similarly, Rivers State has also enrolled PLHIV in its health insurance scheme. We are not just implementing programs; we are also advocating on behalf of clients and PEPFAR to ensure that the responsibilities assigned to the government are carried out—and carried out effectively.
Thanks for the timely advice in your response, especially regarding funding. So finally, how do you think the media, private sector, and others can help support HIV program implementation and response in the country?
If you remember, when we had serious issues with stigma and discrimination, it was the media that helped. Some people were not employed simply because they were HIV positive. Advocacy is important, but we also need the media to convey information to government agencies, relevant stakeholders, and the private sector.
Even at the community level, when people face discrimination, it is the media that helps share the message that HIV is not a death sentence. The media also played a vital role in encouraging people, including pregnant women, to get tested. Drugs are free in healthcare facilities, and if you take your medications consistently, your viral load will be suppressed. I don’t think we can highlight any achievement without acknowledging the role of the media.
The private sector is also supporting the program. Some organizations provide free medications as part of the PEPFAR program. They do not charge for HIV services, demonstrating their commitment to achieving set goals. You can see public-private partnerships at work, showing how both the government and private sector are backing this initiative.
Stakeholders such as government agencies, community leaders, and community-based organizations are also key. You cannot implement this program in isolation. Collaboration is essential to make progress, given the influence these groups have within their communities. If you try to implement the program alone, you will not achieve the desired results. Their capacity is being strengthened so that, when PEPFAR eventually transitions out of the program, they will be able to work closely with the government to sustain implementation.
Part of IHVN’s responsibility is to build and strengthen the capacity of these stakeholders. Stakeholders include not only government officials but also community-based organizations, faith-based organizations, community leaders, women leaders, and market leaders. The majority of these stakeholders are influencers—especially at the community level—who play a critical role in mobilizing people and fostering positive community responses.
