Institute of Human Virology of Nigeria

Despite significant advances in HIV antiretroviral treatment, and proven efficacy of HIV prevention options, an effective and affordable HIV vaccine is still necessary for the elimination of HIV, particularly in Africa. Furthermore, viral and host factors unique to the African continent provide a strong scientific rationale for local vaccine discovery efforts. Several key challenges hamper Africa's vaccine research and production capabilities. These include inadequate funding for African-led research, equipment and infrastructure challenges, lack of preclinical evaluation capacity, limited manufacturing facilities for clinical-grade vaccines, and a shortage of scientists with specialized laboratory, bioinformatics and biostatistics training. A recently established African-led consortium seeks to strengthen African HIV vaccine contributions by providing support, training and funding to address these gaps by strengthening discovery research and conducting early phase clinical trials of existing and novel Africa-derived vaccine candidates while strengthening African manufacturing infrastructure and capacity. Constant and robust community and stakeholder engagement will be key to ensuring the success of the consortiums’ efforts in providing sustainable vaccine development, manufacturing and clinical testing in Africa. Given the magnitude of the HIV burden in Africa, with largely undescribed viral and host diversity, it is vital that HIV vaccine discovery evolves to include the underutilized scientific expertise and capacity on the African continent. Recent interruptions in the funding of consortia in Africa threaten this type of progress and can derail progress in vaccine discovery.

Limited access to disaggregated pediatric antiretroviral therapy (ART) data by weight, as recommended by the World Health Organization, made treatment optimization challenging. This article describes the treatment optimization interventions for children and adolescents living with HIV (CALHIV) implemented by the Faith-based Action for Scaling-Up Testing and Treatment for Epidemic Response (FASTER) initiative, assesses changes in optimal ART and viral load suppression (VLS) over time and offers lessons learned.

During January 2020–December 2021, FASTER supported treatment optimization in 245 high-burden facilities across Nigeria, Tanzania, Uganda and Zambia. We collected and analyzed quarterly ART uptake for CALHIV 0–19 years by regimen and weight band (3–19.9, 20–29.9 and ≥30 kg) as the primary outcome in FASTER-supported sites to inform course correction. We also analyzed VLS and viral load coverage among CALHIV between FASTER-supported and non–FASTER-supported sites.

Quarterly ART data analysis informed targeted ART training and mentorship of 1230 health workers and 4927 community members. A total of 225 facilities reported regimen data, covering 30,208 CALHIV. The proportion of CALHIV on optimized treatment regimens increased from 49.0%–66.4% at baseline to 82.6%–91.9% at endline across countries. VLS increased from 79% to 91% in FASTER sites and 77% to 90% in non-FASTER sites.

We saw dramatic improvements in optimal ART uptake overall. FASTER-supported interventions, such as data use and training, may have contributed to these increases. Optimal ART uptake likely contributed to improvements in VLS observed in both FASTER and non-FASTER sites given efforts to drive nationwide scale-up of optimal ART.

The Nigeria Centre for Disease Control and Prevention, as part of the strategic approach to the COVID-19 outbreak response in Nigeria, coordinated the implementation of an integrated disease testing (IDT) strategy with support from multiple partners. This involved adaptation of existing US President's Emergency Plan for AIDS Relief (PEPFAR)– and Global Fund–supported molecular laboratory networks and integration of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) testing into these. This enabled the country to provide large-scale testing and rapid return of results for SARS-CoV-2 from 2020 to 2022. IDT provided an opportunity for mainstreaming outbreak response into existing human immunodeficiency virus (HIV) and tuberculosis testing laboratories. Lessons learned from this have informed the adoption of IDT across the country laboratory network as an efficient approach to multiple disease testing and pandemic preparedness and response in Nigeria.