How we achieved 0.5% in mother-to-child-transmission - NIMR boss
Prof. Innocent Ujah is the Director General of the Nigerian Institute for Medical Research, NIMR, Yaba, Lagos. In this Interview with IJEOMA UKAZU, he debunks the allegation that People Living With HIV/AIDS, PLWHs, are now paying for their drugs likewise receiving treatment. Ujah explained why PLWHs now pay minimal service charge. Excerpt:
What is the mandate of Nigerian Institute of Medical Research?
The Nigerian Institute of Medical Research, NIMR, has a mandate to carry out research for national development. We are to research into diseases of public health importance - communicable and non -communicable. In addition, we are to disseminate our research findings and carry it to the public and this is done through scientific publications and policy brief for government and creating awareness to the public.
The institute has established the relevance of research in policy and clinical care because we have one of the largest centres for HIV/AIDS treatment care and prevention in Nigeria, apart from the one in Jos University Teaching Hospital, JUTH, Plateau State.
We have about 24,000 cumulative numbers, but Jos has more and we collaborate in research. JUTH has a very large volume for mother-to-child-transmission, MTCT, of HIV infection from pregnant women and we also do follow ups. What it means is that if a pregnant woman was not followed up with anti-retroviral drugs, ARV, and monitored, if she has a baby in the womb, 30 percent chances are that the baby may be positive for HIV but because of the quality of service we provide here, we are reporting about 0.5 percent of mother-to-child-transmission of HIV after delivery.
We also have institutionalized our annual conferences as never been before. We had the sixth in the series since I came here and we disseminate our research findings during our scientific conferences which attracted researchers from within and outside Nigeria. It actually puts the institute on the world map and has enabled us attend international meetings. NIMR’s E-library building is ongoing, it is expected that it would have been completed in 2015 but we believe that this year 2016 we should be able to complete it. We are hoping that our laboratory for Tuberculosis, TB, would be improved upon so that we could go ahead and do our research on Ebola Virus Disease, EVD, and other similar viruses that are dangerous to man.
To what extent has the institute been able to manage resistance to anti-retroviral drugs?
A lot of progress has been made regarding anti-retroviral in the treatment of HIV. You recall that when HIV came there was no drug to treat it, now we have some drugs. What these viruses do is that they change their coat after a while just like antibiotics, therefore the drugs may not be effective and these also bothers on the adherence of the patient to the drugs.
Some patients don’t take their drugs and that causes some resistance. But fortunately we have facilities to monitor and record resistance. Those that fail to a first-line drug are moved to second-line drug. The third-line drugs are very expensive. So what we try to do is look at the changes with regards to patient and HIV so that we use this to get the necessary information and make suggestions on how to improve and reduce the cases of resistance to anti-retroviral drugs.
Recently, People Living With HIV/AIDS alleged that there’s a federal government directive for them to pay for their drugs as donor agencies are withdrawing funding and they are being discriminated against. How true is this directive?
There is no federal government directive to say that the people should start paying. What happened is that we had to be creative since the donor agencies are withdrawing. We cannot close down the clinic and let the people living with HIV go away and we also have project staff in the clinic that are not NIMR staff that we could not dismiss.
I had to write a memo to then Minister of Health, Prof. Onyebuchi Chukwu, that the funding agencies are withdrawing and we still have cases of HIV. Suggestions were made to reabsorb the staff and keep the clinic going.
Secondly, because we needed support from the U.S President’s Emergency Plan for AIDS Relief, PEPFAR, and other agencies, we need to keep the services going. We run generator 24 hours, we monitor the regularity of the attendance with our computer system and monitor the drug intake. We decided to have what we call service charge; a minimal charge. I must state very clearly that no person living with HIV is paying for drugs for HIV. It is still free.
What is a challenge now is follow-up test that we need to do, we need to do their haematological profile and also ensure that CD4 also called T. cells, which is a type of white blood cells that protect the body from infection to evaluate the immune system, are okay. We have to monitor this and because the PEPFAR programme has withdrawn those services, we had to substitute and have to maintain the quality care that they used to have when the programme was in place. That has kept us going and I must say that in the last one year, we have done very well and all that called for minimal service charge.
The TSA has also created some bottle necks for us. Just like you rightly said that the banks are creating problems for them for payment. We are now redesigning the strategy and discussions are ongoing with the bank to come to NIMR with their staff to collect the minimal service charge from People Living with HIV, PLWHs, or they pay through the Point of Service, POS, so to avoid going to the banks. We believe that from this year those things would change.
I am undergoing a study regarding some of the challenges among the PLWHs so as to reorganize the clinical system and the means of payment and to let the Federal government know the challenges. By this year NIMR will have a bank that will receive their payment because we cannot do anything without the TSA in place.
Most of these PLWHs cannot afford these drugs as a result are withdrawing from the treatment. What should the federal government do to maintain their treatments?
We are discussing with National Agency for the Control of AIDs, NACA, on the funding challenges. The funding must be improved. It is true that many of these people are less-privileged but that is why the charges are quite affordable. The reason is that if you look at it we have so many diseases; HIV, TB and treatment is also free but what about cancers, nobody pays for that. The patients pay for treatment for cancer, diabetes, hypertension, hepatitis.
We must be grateful to government for taking up the responsibility of ensuring that those who are positive with HIV are being treated to some extent free of charge. When HIV first came to Nigeria first one month drug was N50, 000 eventually it was reduced in partnership with federal government to say that it is free test. Now at the moment, drugs are been supplied free of charge and its very expensive and these other tests they are not regular. If they have good reasons to evaluate you then you do the test. Something has to give, we think that those living with HIV/AIDS should try and see how they can support themselves and government would improve the finances and training. The programme is capital intensive. The PLWHs pay for test not the drugs; drugs are free but the minimal service charge is for us to keep the service going.
The cancer centre that was commissioned last year, when is it going to take off and what will be the areas of focus?
The cancer research centre has already taken off. As soon as we carry out research, the findings would be made known to the public, just as we will provide briefs to the government through the Federal Ministry of Health and it will help shape the magnitude of the problem. We will develop a policy issue regarding specific modalities of treatment and train more people. The truth of the matter is that apart from equipment we need training and it should be regular as it is practiced in Europe and America.
The problem Nigeria has is funding and research is not being taken seriously. Funding for health is about 5 or 6 percent and that really cannot do anything considering Nigeria’s population. Look at National Institute of Health of America, NIA, they have billions and they even give grants to developing countries like Nigeria. The Centre for Disease Control, CDC, form that we are using is from NIA and Medical Research Council, MRC, in the United Kingdom and they vote a lot of money for research.
We believe that our government should vote substantial amount of money to health sector. And as for the outcome, health is capital intensive, health research is even more capital intensive, the equipment are not cheap.
Former President, Goodluck Jonathan before he left, signed into law the National Health Act. What is the place of medical research in that Act?
As a matter of fact that health Act has captured very strategically health research. So in terms of its role, it has the whole section of research committees. What we are looking for is the implementation. We will also ensure that the Act is monitored thoroughly.