Barriers to the uptake of oral pre-exposure prophylaxis among young key populations in Nigeria

BACKGROUND

Young key populations (YKP) contribute to the burden of HIV in Nigeria and are a priority population for oral pre-exposure prophylaxis (PrEP). However, their uptake of PrEP remains low. We assessed the main barriers to PrEP uptake and the variation among YKP (15-24 years) in Nigeria.

METHODS

This study was a secondary data analysis of the 2020 Integrated Biological & Behavioural Surveillance Survey conducted among key populations (KP), including female sex workers (FSW), men who have sex with men (MSM), people who inject drugs (PWID), and transgender people (TG), in 12 states in Nigeria. A closed-ended question asking the main reason for not taking PrEP among KP who had never taken PrEP was included in the surveillance questionnaire. We collapsed the responses into six barrier themes. Using multinomial logistic regression analysis, we examined the association between the barriers (dependent variable) and KP group (independent variable), controlling for age, educational attainment, religion, marital status, employment status, and geopolitical zone.

RESULTS

A total of 1776 YKP were included in this study. The most cited barriers by KP group were: lack of access (28.3%) and fear of side effects (28.3%) by FSW; lack of interest (37.1%) by MSM; low risk perception (65.5%) by PWID; and lack of access (34.4%) by TG. The odds of reporting fear of side effects, lack of access, lack of interest, and nonspecific/others reasons were significantly different by KP group.

CONCLUSIONS

The barriers limiting the uptake of PrEP among YKP vary by KP group. Our results highlight the need for KP-specific interventions to improve the uptake of PrEP among YKP in Nigeria.

Awareness and uptake of oral pre-exposure prophylaxis among adolescent and young key populations in Nigeria: a secondary data analysis of the 2020 Integrated Biological & Behavioural Surveillance Survey

Oral pre-exposure prophylaxis (PrEP) is a critical intervention for HIV prevention among key populations (KP) in Nigeria. However, little is known about its coverage among adolescent and young key populations (AYKP). Using the 2020 Integrated Biological & Behavioural Surveillance Survey conducted among KP, including female sex workers (FSW), men who have sex with men (MSM), people who inject drugs (PWID), and transgender people (TG), we assessed the awareness and uptake of PrEP among AYKP (15-24 years) in Nigeria. We performed weighted descriptive statistics and logistic regression analyses. Of the 6882 AYKP included in this study, 36.1% were aware of PrEP, ranging from 47.9% in MSM to 19.8% in FSW. Compared with FSW, MSM (aOR = 3.7, 95%CI = 3.22-4.35) and TG (aOR = 2.6, 95%CI = 2.18-2.98) had significant higher odds of PrEP awareness. Among those aware of PrEP, 24.5% had ever taken PrEP. The uptake of PrEP varied by KP group: TG (28.1%), MSM (25.3%), PWID (18.0%), and FSW (14.4%). MSM (aOR = 2.6, 95%CI = 1.72-4.07) and TG (aOR = 2.7, 95%CI = 1.71-4.14) had significant higher odds of PrEP uptake relative to FSW. The awareness and uptake of PrEP among AYKP in Nigeria is low. This calls for more awareness creation about PrEP addressing the barriers that limit its uptake.

Stakeholders’ Perspectives on the Financial Sustainability of the HIV Response in Nigeria: A Qualitative Study

BACKGROUND

Countries in sub-Saharan Africa, including Nigeria, continue to depend on donor funding to achieve their national HIV response goals. The Government of Nigeria has made limited progress in translating political commitment to reduce donor dependency into increased domestic investment to ensure the sustainable impact of the HIV response. We explored the context-specific factors affecting the financial sustainability of the HIV response in Nigeria.

METHODS

Between November 2021 and March 2022, we conducted document reviews (n=13) and semistructured interviews with purposively selected national and subnational stakeholders (n=35). Data were analyzed thematically using the framework of health financing functions comprising revenue generation, pooling, and purchasing.

RESULTS

Stakeholders reported that there is a low level of government funding for the HIV response, which has been compounded by the weak engagement of Ministry of Finance officials and the unpredictable and untimely release of budgeted funds. Opportunities for domestic funding include philanthropy and an HIV Trust Fund led by the private sector. Integration of HIV treatment services into social health insurance schemes has been slow. Commodity purchasing has been inefficient due to ineffective coordination. Government stakeholders have been reluctant to support one-stop-shop facilities that target key and priority populations.

CONCLUSION

Opportunities exist in the government and private sectors for improving domestic health financing to support transitioning from donor support and ensuring the financial sustainability of the HIV response in Nigeria. To ensure that domestic financing for the HIV response is stable and predictable, the amount of domestic funding needs to increase and a framework that incorporates donor transition milestones must be developed, implemented, and monitored.

Improving the coverage of prevention of mother-to-child transmission of HIV services in Nigeria: should traditional birth attendants be engaged?

Traditional birth attendants (TBAs) play an important role in the provision of care to pregnant women in rural parts of Nigeria, but they are barely engaged by the formal healthcare system in expanding the low coverage of prevention of mother-to-child transmission of HIV (PMTCT) services. Using a systematic approach, we engaged TBAs in Abia and Taraba States to scale-up PMTCT services under the National Agency for Control of AIDS Comprehensive AIDS Program with States. We conducted mapping of the TBAs, built their capacities, obtained their buy-in on mobilization of their clients and other pregnant women for HIV testing service outreaches, and established referral and linkage systems. A total of 720 TBAs were mapped (Abia 407; Taraba 313). Three hundred and ninety-nine TBAs who participated in the capacity-building meeting were linked to 115 primary healthcare centers (PHCs) in Abia State, while 245 TBAs were linked to 27 PHCs in Taraba State. From July 2016 to March 2017, the outreaches contributed 20% to the overall total number of pregnant women counseled, tested and received results, and 12% to the total number of HIV-infected women identified. There was a considerable yield of HIV-infected pregnant women among those tested in the TBA outreaches in comparison with the supported antenatal facilities (2% versus 3%, respectively). Engaging TBAs has the potential to improve the coverage of PMTCT services in Nigeria.