Chioma Nwuba Wows the Crowd at AIDS 2012

Chioma Nwuba at AIDS 2012 discussing sustainability and local ownership.

Chioma Nwuba at AIDS 2012 discussing sustainability and local ownership. (Photo credit: S. Holtz/MSH)

The Kwara state of west-central Nigeria suffers many health-related challenges: an HIV prevalence rate of 2.2 %, a large geographic area, difficult terrain, a rural population, poor access to health facilities, long waiting time at facilities, and shortages of human resources for health. These are some of the factors thought to contribute to poor uptake of HIV testing and CD4 investigation (a test to determine whether or not a patient is eligible for HIV treatment) and the high level of attrition of patients living with HIV at all stages of the treatment process — from HIV testing to commencement of treatment to long-term treatment.

Enter Chioma Nwuba, laboratory specialist with the Prevention and Organizational Systems – AIDS Care and Treatment Project (ProACT) in Kwara state to the XIX International AIDS Conference. On Wednesday, July 25, Chioma presented “A laboratory-based approach to reduce loss to follow-up of HIV positive clients” to a standing-room only crowd at the oral abstract session on HIV linkage retention in care. She described the “MSH” leadership and management approach used by the ProACT project: The hospital management committee assessed the situation and made decisions that ultimately streamlined service delivery at the facility — ensuring sustainability and local ownership.

Thanks to the intervention: data clerks now fill laboratory request forms instead of clinicians; lab technicians collect and test blood rather than clinicians; escort services are strengthened so patients are enrolled and undergo lab tests on the same day; lab tests are provided Monday through Friday rather than just once a week; and test results are provided quickly to ensure initiation on treatment.

Twelve months after the intervention, the number of clients accessing CD4 investigations increased from 53.8% to 93.3%, the number of clients lost along the treatment process reduced from 58.7% to 10.7%, turnaround time for certain test results decreased from 7 days to 24 hours and the average client wait time decreased from 4 to 1.5 hours.

The project staff have found that strengthening laboratory systems helps increase uptake of CD4 investigations, shorten client waiting time and ultimately reduces loss-to-follow-up, especially among clients attending clinics from hard to reach communities with difficult terrains.

ProACT is a five-year, 60-million-dollar, follow-on project to the Nigeria Leadership Management and Sustainability (LMS) AIDS Care and Treatment Project (LMS-ACT). ProACT supports HIV & AIDS and TB services in six Nigerian states: Kogi, Niger, Kwara, Kebbi, Taraba, and Adamawa. The project places a strong emphasis on building the capacity of government and civil society organizations to strengthen health and HIV & AIDS systems for delivery of integrated health and HIV & AIDS and TB services.


On Day 3, Three Women, Three Calls: Keep Mothers Alive, Make Women Count, Invest in Programs for Girls

XIX International AIDS Conference (AIDS 2012) Washington D.C. Wednesday Plenary Session Linda H.ScruggsAIDS Alliance for Children, Youth and FamiliesUnited StatesUSA and Canada © IAS/Ryan Rayburn -

XIX International AIDS Conference (AIDS 2012) Washington DC, Wednesday Plenary Session, Linda H. Scruggs. © IAS/Ryan Rayburn –

Day three of the XIX International AIDS Conference opened with an impassioned plenary by three powerful women speakers, calling for more concerted action for women and girls living with HIV, particularly adolescent girls.

Dr Chewe Luo, Senior Advisor HIV/AIDS, UNICEF, spoke about the Global Plan to Eliminate New HIV Infections in Children by 2015 and Keeping Their Mothers Alive. Targets of the plan include: 1) Reducing infections in children by 90%. (In 2011, 333,000 children were infected with HIV, with 29% of new infections in Democratic Republic of the Congo, Nigeria and Malawi.) 2) Reducing HIV-related maternal deaths of women during pregnancy, delivery or post-delivery, by 50% by 2015.  3) Eliminating mother-to-child-transmission.

Luo highlighted the benefits of giving triple therapy or single dose Nevirapene throughout breast feeding; this could reduce mother-to-child-transmission to less than 5%. She described pilot studies in 11 countries and improvements in access to antiretrovirals (ARVs) for women: from 48% in 2010 to 57% in 2011. Despite improvements in Eastern and Southern Africa, the Caribbean, Eastern Europe and Central Asia, “we still need to do better in Western Africa,” she said. The decline in HIV infections in children was roughly 10.8%  from 2010 to 2011 but, “this is not enough,” said Luo. “We should have reached 20% by now.”

She cautioned that treatment should have started earlier for pregnant women and cited several options that countries have, mostly based on cost: Option A and B which are treatment therapies for the mother for a limited time and the newer Option B+ which provides triple ART for pregnant women for life.

“We will not achieve the goal of eliminating PMTCT without some serious innovations. And that’s what this strategy [Option B+] is about,” said Luo.


Malawi is the first country to implement Option B+. “We need to look at PMTCT as a component of ART and access treatment early,” said Luo. “This is the bottom line for me.”

“Option B+ must be scaled up. I applaud Malawi for being so bold.” Benefits of Option B+ include reduced infant HIV infection.

Luo then turned her attention to the “unacceptable” percentage of children not receiving ART. “We are failing to reach children,” she said.

She ended with a call to action. We need to: 1) simplify our prevention approach and integrate PMTCT and ART programs at the community level; 2) introduce innovative approaches to reach adolescent girls and pregnant teens; 3) change treatment regimens for children; and 4) collaborate with community groups.


Linda Scruggs, a consultant and a woman living with AIDS, delivered an inspirational account of her own struggles and brought her rousing comprehensive agenda to “Make Women Count” and end gender discrimination and stigma to a standing ovation. Scruggs told many stories of both gender inequity and gender empowerment.

“For the last 20 years, women have been asking for an international platform for their rights, to count us in. Today I stand to give us direction and a recipe for change. We want women  to work with women that have the tools for us, by us, with us. … It is not enough to create a task force or write a paper, what we need is to be part of the solution. We are the Mothers of the Earth.”

Linda reflected: “What does a woman with no self- esteem look like?  What does a woman whose uncle molested her look like? What is a woman who can’t read or write, broken and voiceless? That woman was me.”

Linda told stories of women, broken or affected by disease. “We are at the table and a force to be reckoned with. We need a big change and need to create jobs and training for HIV positive women.”


Dr. Geeta Rao Gupta, Deputy Executive Director of UNICEF, also made the case to turn the tide for adolescent girls and highlighted the need for gender equality. Adolescent girls aged 15 to 24 bear the brunt of the epidemic. Of the 4.8 million young people with AIDS, 3 million of them are girls.

The challenges of adolescent girls are immense: early sexual debut, child marriage, increased risk of HIV and STIs, sexual violence, and risk of early pregnancy and HIV infection. Many are forced early into transactional sex to survive or they depend on older men to survive. Most lack basic information on condoms or sex education.

Geeta offered recommendations to accelerate the pace of protection for adolescent girls:

  1. We need relevant national plans for high impact with emphasis on girls. Few country plans include anything about adolescent girls.
  2. We need to educate girls — empower them to make choices.
  3. We need to start early; make adolescents visible in routine data systems and follow their health status after age 5. (Right now, they don’t appear in the data unless they get pregnant or contract HIV and then they are included with adult data.)
  4. We need to invest in innovations to reach adolescent girls through social media and networks.
  5. We need to engage with adolescents as partners.

As Anthony Lake of UNICEF has so eloquently said: “We invest so much in keeping girls alive in their first decade of life. We must not lose them in the second.”

We need a world that is AIDS-free and fair for all women and girls. That must be our legacy.

Barbara Ayotte is MSH’s director of strategic communications.