Today is World AIDS Day. The human immunodeficiency virus (HIV) infection and acquired immune deficiency syndrome (AIDS) remain major public health challenges across the globe, including here in Nigeria. The day presents us with the opportunity to assess the government’s efforts to curtail the epidemic and consider how technology can help in the fight to eradicate the scourge.
It’s been 39 years since the disease was first discovered in the country and 24 years since the National Agency for the Control of AIDS (NACA) was established to coordinate the eradication efforts. Yet, we still struggle to muscle out the disease.
Current HIV/AIDS status
Director-General of NACA, Dr. Temitope Ilori, revealed last week that two (2) million Nigerians currently live with the disease. A 2023 report by the United Nations Joint Programme on HIV/AIDS (UNAIDS) revealed that about 160,000 children of 14 and below have HIV in Nigeria. The report also showed that 22,000 new infections are recorded yearly in the country and 15,000 deaths from AIDS. And, preventing mother-to-child transmission (PMTCT) and paediatric HIV coverage remains below 33%, far below the 95% UNAIDS target, according to Dr Ilori.
Missing the 95-95-95 UNAIDS target
While progress has been made in tackling the HIV/AIDS epidemic, the fact is that the country is still some way from achieving the 95-95-95 UNAIDS’ target by 2030. The 95-95-95 is a set of objectives enunciated by UNAIDS to eradicate the HIV/AIDS scourge by 2030. This means testing by people exposed to the disease such that 95% of people living with HIV will know their status, and those 95% receive antiretroviral therapy (ART) thereby helping the 95% suppress their viral load. The target is to achieve these 95% by 2030. However, at the rate of 22,000 new infections in the country annually, with low PMTCT (33%) coverage, Nigeria may struggle to achieve these targets. Dr Ilori admitted that “the country continues to face a significant challenge in preventing mother-to-child transmission of HIV.”
Challenges against 95-95-95 target
But why is Nigeria struggling to curtail the epidemic while smaller African countries with higher HIV/AIDS prevalence and limited financial support have managed to achieve the 95-95-95 goal? Zimbabwe, Rwanda, Eswatini, Tanzania, and Botswana have achieved the USAIDS’ goal. Botswana, for instance, which has one of the highest HIV/AIDS prevalence rates in the world, has managed to subdue the disease through the active involvement of the government, other key stakeholder groups, and a robust set of policies aimed at tackling the scourge from the roots. Some of the reasons for Nigeria’s challenges in the fight against HIV/AIDS are governments’ limited involvement in the fight and poor funding. A former director general of NACA revealed in 2021 that the country provides less than 20% of the funding to fight the disease and rely heavily on foreign donor agencies. The state governments also need to do more in the fight. To underscore a seeming lack of full commitment by the states, Dr Ilori revealed that NACA has only managed to inaugurate state committees to track the implementation of the HIV/AIDS strategy in three states, with plans to “go around the 36 states and FCT in due course.” Such a committee should have been jointly launched nationally and statewide for better coordination of the HIV/AIDS efforts. Also, NACA must develop a strategy to encourage private sector participation in the fight.
Using tech to fight HIV/AIDS
However, these shortcomings can be minimised or removed with the deployment of technology, especially artificial intelligence. We all know that early detection and diagnosis is critical to the treatment of any disease, including HIV/AIDS. AI can be deployed and optimised to identify high-risk centres where HIV/AIDS may break out across the country. This can be achieved using AI-powered algorithms to analyse the vast amount of data available to NACA or other relevant organisations in that space. Knowing such prone areas will enable sustained targeted preventative campaigns. It will also help NACA adequately manage the scarce resources at its disposal. For instance, if AI data analysis has shown that Area X is prone to an outbreak and Area Y or Z is a limited risk, NACA can mobilise more funds for targeted preventative campaigns in Area X and less in Area Y or Z. That way, it can optimise the resources it has.
AIso, by analyzing data such as healthcare access, demographics, education, pattern of behaviour, and lifestyle, AI can predict areas prone to future outbreaks of HIV/AIDS. Such vital information will enable NACA and other relevant bodies to take proactive steps to curtail the outbreak or its spread.
Through the deployment of virtual therapists and chatbots, people living with HIV/AIDS or people at risk of the disease can access personalised less intrusive support and advise on prevention or management of the disease. This also helps to remove the stigma and discrimination associated with having the disease. Rather than physical visits to or by therapists, an HIV/AIDS carrier has direct access 24/7 to a medical worker who guides him on steps to take and available options open to him. The virtual therapists will also be critical in accessing difficult-to-reach remote areas thereby reducing or eliminating the logistic nightmares that sometimes arise when trying to access remote rural areas.
AI can act as a monitor to ensure an individual living with the disease follows his treatment schedules. Not following the specified regimens could have disastrous consequences. So, an AI-powered app can send constant reminders to the patient on when to take medication and in what combinations. This will help to curtail the spread.
AI can equally help in the efficient allocation of resources by NACA and other healthcare agencies involved in the HIV/AIDS fight through the optimisation of employee scheduling and tool deployment and supply chain management. However, before AI is deployed, there must be a robust data security in place to protect patients’ privacy and sensitive medical information.
Learnings from other countries on technology use
South Africa
In South Africa a mobile app to help clinicians prescribe the correct antiretrovirals to people living with HIV/AIDS is in use.
Vietnam
In Hanoi and Ho Chi Minh City, Vietnam, mHealth is being deployed “to encourage HIV testing and care maintenance through gamification with mobile phones.”
Malawi
In Malawi, SMS messaging is utilised to remind the HIV community to attend HIV health management classes and support group initiatives.
United States
In Cook County, Chicago, US, an electronic health register (EHR) is in use that helps doctors and other health workers managing HIV patients to keep tabs on their patients in real time, enabling them to know when a patient has missed an appointment or is not filling prescriptions. The register also helps patients to access their healthcare givers on the go.
It is roughly six years to 2030 when nations are expected to have attained the 95-95-95 goal. While six years may seem a short time, Nigeria can still make significant progress in the fight against HIV/AIDS if it takes ownership of the efforts rather than leaving foreign organisations and entities to lead the fight, especially in the provision of funding, adopts a multi-stakeholder approach, which will include governments at all levels, the private sector, local communities, and foreign donor agencies and organisations, and most importantly, government must fashion a way to deploy technology for more effective outcomes.
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