National Agency for the Control of AIDS,

For those who know John Idoko, a professor of medicine, his appointment to head the National Agency for the Control of AIDS, NACA, did not come as a surprise. Idoko’s antecedent at the University of Jos Teaching Hospital, where he ran the largest HIV/AIDS programme, singled him out for the job. The programme aimed at helping those who suffer from the scourge of the disease was very successful having catered for about 15,000 patients. He has since taken that same fight to NACA where he is already winning the battle against the virus. He speaks to Maureen Chigbo, general editor, Chris Ajaero, assistant general editor, and Ishaya Ibrahim, reporter/researcher, on the battle against the virus, the hope for a vaccine against the ailment and the impact of the recent endorsement of condom use by the Pope. Excerpts: Normal 0 false false false EN-US X-NONE X-NONE For those who know John Idoko, a professor of medicine, his appointment to head the National Agency for the Control of AIDS, NACA, did not come as a surprise. Idoko’s antecedent at the University of Jos Teaching Hospital, where he ran the largest HIV/AIDS programme, singled him out for the job. The programme aimed at helping those who suffer from the scourge of the disease was very successful having catered for about 15,000 patients. He has since taken that same fight to NACA where he is already winning the battle against the virus. He speaks to Maureen Chigbo, general editor, Chris Ajaero, assistant general editor, and Ishaya Ibrahim, reporter/researcher, on the battle against the virus, the hope for a vaccine against the ailment and the impact of the recent endorsement of condom use by the Pope. Excerpts: Newswatch: You have been in NACA for more than a year now. We would like you to give us an overview of what you met on ground and how you have improved it and where you want to take NACA to. Idoko: I am like 20 months old at NACA. I came in on the 2nd of April, 2009. When I came in, basically, NACA was in a transition mood. You know that when NACA was formed, it was a committee. It was National Action Committee on AIDS. There was an act of the National Assembly in 2007 that transformed it from a committee to an agency. The difference between a committee and, an agency is that when you become an agency you become a legal instrument of government and, therefore, you are supposed to be budgeted for and become part of all the responsibilities of government. In essence, the structure of actually putting that in place started just before I came. It was pretty difficult because this was a committee that had staff from different places. Some of them were from government, some came from the World Bank, some came from Department for International Development, DFID. You can imagine, you kind of fuse people from several places making them into what a government structure is. One of the difficulties we faced was how to place somebody who had never worked in government. Funding had always been a problem. That was the scenario when I took over. The excitement that took me to this job is very simple. Before I got to Abuja, I used to run the largest HIV programme in the country. This was at the teaching hospital in Jos. We were running a programme where we had a very organised structure. We had a teaching hospital where we had 15,000 patients out of which over 12,000 were collecting antiretroviral drugs. That is the biggest clinic in the country and the biggest in Africa, but we decentralised our programme in this way. From a teaching hospital, we went down to 14 general hospitals or secondary health centres, eight of which are public, one private and the rest were ours. Under these, they were linked to three primary health centres or comprehensive primary health centres. These comprehensive primary health centres were all linked to at least five big communities. We call it a cluster system in such a way that you have a hospital and around a hospital, there are linkages. Why do we need it like that? In what we do, there is referral upwards and a referral downwards. For example, if you are in a community and you go and test, we can refer you to a primary health care centre so that you can access antiretroviral drugs. If your situation is complicated, we can now refer you to the secondary health centre, which is the general hospital or a teaching hospital. Now, the reverse is also true. If you go to the teaching hospital and your situation is sorted out and you are doing fine, you don’t have to travel hundreds of miles. You can be referred to the general hospital near you so that you can just pick up your drugs. That downward referral is very important because one of the issues that happen to drugs is that for these drugs to work, you have to take them 95 percent of the time. So, leaving near where you collect your drugs is very very critical because if not, you will have problem with transport, you will have problem with accommodation. Beside, we are not just dealing with Tuberculosis. If you go down at each level, we are dealing with HIV, TB, and malaria and then prevention of mother to child infection to ensure that we are also taking care of antenatal care and ensuring women are delivering in the hospitals. It is like a decentralised programme, a comprehensive programme but integrated with TB, malaria, family planning, maternal and child health. Now, what have we done so far? Well, I am happy to inform you that a lot of it rested on Ray Ekpu because he is the chairman of our establishment committee. We have almost completed the placement of our staff; reorganised the structure as it should be. And let us now go into some of the other interventions which are important. This year, we have been able to develop our strategic plan. The strategic plan tells you where you are coming from and where you are going to be in the next five years. We have been able to plan from 2010 to 2015. 2015 is a very important year. It is the year that we will all account for the millennium development goals. And we did this in a unique way this year. We did this not only at the centre but we have done it for all the states except two. We did it for our six civil society network and we did it for almost 10 line ministries. It is from that long plan that we can take one or two year plan to operate. Secondly, we are mobilising funds for it. The strategic plan is very important. In that strategic plan, we have five major priorities. The first priority is taking comprehensive HIV services down to the grassroots, down to the communities through the PHC system, but also making sure that we integrate it. So, when we get to the PHC, we are not only putting HIV services but we work with our other partners so that TB is there, malaria is there and maternal-newborn service is granted. The second priority is prevention. We must cut down new infections otherwise, we cannot halt and reverse HIV epidemic which is the 6th millennium development goal. I don’t know whether you have been hearing the news recently. Nigeria is one of the five big countries affected by HIV where we now have more than 25 percent reduction in the incidents of HIV. It is exciting to us but we need to do a lot more. We have changed the way in which we are presenting our prevention services. From standing alone, we talk about awareness, we talk about behaviour change, and we talk about ABC. We are now saying we have to combine them. So if we go to a community, we will do one of three big things: behaviour intervention which includes awareness, behavior change and ABC. You know what ABC is all about: Abstinence, Be faithful, use Condom if you are having affair with somebody whose status you don’t know. But at the same time, we also address biomedical intervention which includes HIV testing, prevention of mother to child infection. We also have to address structural intervention. We may not be able to address all of them but we must pick one or two of them. One of them is gender issue, how do you empower women, give them more information, ensure that they can raise their economic status, even education, educating the girl child and stigma and discrimination.