Sani Aliyu is the Director-General, National Agency for the Control of AIDS (NACA). In this exclusive interview with PREMIUM TIMES’ Ayodamola Owoseye and Nike Adebowale, he speaks on why the largest survey of people living with HIV will be conducted from June in Nigeria and the reason why Nigeria still records high rate of Mother to Child HIV transmission of HIV.
PT – The world just celebrated World Tuberculosis Day to call attention to one of the deadest diseases affecting people living with HIV. What is your agency doing to prevent people with HIV from having Tuberculosis (TB) and providing treatment to those of them who already have TB?
Aliyu- You are quite right, HIV and TB are considered deadly twins and TB is the commonest cause of death in people living with HIV. And that is partly because of the prevalence of TB in our communities. Tuberculosis is so common, virtually most of us would have been exposed to tuberculosis at some point in our lives. What happens is that the disease becomes inactive in you and if your immune system drops, it becomes activated.
We at NACA have been working very closely with the federal ministry of health to design programmes that will reduce that frequency and incidence of TB in people living with HIV. For example, during the World TB Day, we engaged with the federal ministry of health, we were there, shoulder to shoulder with the minister, to show our solidarity.
Some years back, when there were issues with diagnosing TB, there is a new diagnostic tool which is based on PCR, which has been rolled out across a lot of sites in the country. NACA, actually worked with the Global Fund to deliver that and most of the machines that are currently used for Rapid Test in hospitals for TB were delivered through NACA.
There is also a very strong need that when people are diagnosed with HIV, an assessment is made as to whether they have been exposed to TB or not and if there is evidence that they have been exposed to TB and they have active Tuberculosis, then they need to be placed on full treatment. If there is evidence that they don’t have active TB, then they can go on to prophylaxis, which will prevent them from developing active TB. Our approach nowadays is across the board. The first thing is to make sure you do not have active TB because if you have active TB and we put you on prophylaxis, (the drug for prophylaxis is only one drug) you will end up developing resistance. But if you don’t have active TB, that Isoniazid which is the name of the drug, would stop it from activating from latent to active TB and it is only given for six months. So when people are placed on treatment for HIV, they will also be started on Isoniazid to prevent them from developing TB and it is now part of our national guideline across the board.
We are also doing a lot of works in the communities through other partners to make sure that people are aware of common symptoms of TB. So if you have cough that has lasted for more than two weeks, you have night sweat, losing weight, think of TB, because it is unlikely to be malaria. If you are having a cough that has been lasting for more than two weeks and losing weight, it is unlikely to be pneumonia, because if it is pneumonia for two weeks you will likely be in the hospital bed.
TB is a chronic illness, which takes a while before it actually brings a person down. You can continue to go to work for weeks, while you have TB and you are coughing before you realised you need to go the hospital. The awareness of the common symptoms of TB is important because if you know that you have TB, you will need to be put on treatment. Same way if diagnosed with TB, the next thing is to have an HIV test done. If you have HIV with TB, it is a different issue. We need to treat HIV as well to bring your immune system up so that as you are on treatment for the TB, the TB can be cured. If we give you treatment for TB without treating the HIV, work done is zero, because even if you are treated for TB, the first place the drug may not work very well. Secondly, the person might end up surviving from TB and dying from another opportunistic infection related to HIV.
There is a lot of work we have been doing and TB is really important. There are a lot more people with TB in the world than there is with HIV. It is estimated that there are up to 500 million people being exposed to TB in the world, while with HIV, about 30 million people living with the virus throughout the world. So you can see the difference. Out of every one person with HIV, we have 20 people who have been exposed to TB, so it’s a big problem.
PT- Do you have the statistics of people living with HIV and TB in Nigeria?