Sustainability of HIV/AIDS Treatment in Nigeria Through Domestic Production of Antiretroviral Therapy
Creators: name: Ganama, Maria
Publisher: name: The University of North Carolina at Chapel Hill University Libraries
Year: 2019

description: Nigeria currently has the second largest HIV epidemic globally with about 3.2 million persons of all ages living with the virus by the end of 2017 (UNAIDS, 2018). HIV is now regarded as a chronic treatable condition which can be managed throughout a person's lifetime with antiretroviral therapy (ART) (CDC, 2018). Effective antiretroviral medications currently exist for the management of HIV across the globe and since 2002  access to ART has been available in Nigeria. Almost all ART options available in the country are provided by international donors.The current World Health Organization (WHO) guidelines recommend a ‘test and treat approach’, meaning that once diagnosed, irrespective of CD4+ count, ART is initiated. Nigeria has implemented the test and treat guideline, however, by the end of 2017, of the 3.2 million people living with HIV/AIDS in Nigeria, only about 1,066, 223 were on ART (UNAIDS, 2018).Globally, trends have shown that donor funds for the care of HIV in developing countries has declined. There has also been uncertainties of continued support from major funding sources such as the U.S. President’s Emergency Plan for AIDS Relief (PEPFAR).  A large proportion of HIV treatment cost in Nigeria is covered by 2 main organizations – PEPFAR and the Global Fund to Fight AIDS, TB, and Malaria. In 2016, Nigeria contributed only about 1% of all funds available for ART (NSF, 2018). Analysis of Nigeria’s National Strategic Framework for HIV and AIDS for 2017 – 2021 shows a budgetary funding gap of 37% ($USD 900 million) over the next 3 years (2019 – 2021).It is against this background that Nigeria has to find a means of continued access to ART should donor funding discontinue or diminish. Any proposed solution has to be cost-effective to enable the country to maintain the gains achieved in the fight against HIV over the past several years. The focus of this paper is thus the proposed domestic production of ART as a means to sustain HIV treatment in Nigeria. Studies have shown that domestic production of ART would be advantageous as it would help bring down cost, increase access to treatment and overall brings beneficial economic gains to a country (Pinheiro et al. 2014). Nigeria’s pharmaceutical manufacturing industry runs at less than 50% of its total capacity (Wambebe, 2011). The potential to begin producing antiretroviral drugs domestically currently exists, however, increased governmental support and improved policies that encourage local production need to be in place for this to occur.This paper first gives a background on the response to HIV in Nigeria demonstrating the evolution of this response. The paper then examines challenges with the current funding schemes. Finally, the paper assesses the Nigerian pharmaceutical industry using a SWOT (Strengths, Weaknesses, Opportunities, and Threats) analysis to establish the feasibility of domestic ART production, and briefly reviews laws guiding domestic production of ART globally. The paper concludes by making policy recommendations that may facilitate the domestic production of ART within the country based on the SWOT analysis.