Abuja, 7 August, 2023 - Before her wedding plans in 2009, Floral Okon was unaware of what Human Immunodeficiency Virus (HIV) was.  Hence as part of the church pre-wedding requirements, she gladly went with her fiancé for an HIV test in a health facility.

“As part of the pre-wedding requirement in my church, my fiancé and I were required to conduct HIV screening. 
I recall exclaiming wonderful when told at the health facility that my result was positive because I thought positive was a good result,” she recounted. 

An unfortunate fallout of her HIV-positive status was that Flora could not go ahead with her wedding as planned, because her fiancé who turned out negative called it off. 

On the bright side, Flora has since been on anti-retroviral drugs. With suppressed viral load (undetectable HIV Virus), Flora is now married and with HIV-negative children. 
HIV is a virus that attacks the body's immune system and if not treated, can lead to AIDS (acquired immune deficiency syndrome). Once people get HIV, they have it for life. But with proper medical care, HIV can be controlled.

Mrs Okon, a volunteer at a health clinic, recalled that at the initial stage, taking time off work to get to the health facility for medical care and to pick up her drugs was cumbersome, but thanks to the government-introduced Differentiated Service Delivery for HIV Treatment (DSD ART), access to HIV care has become much easier. 
“I am enrolled in a facility-based DSD ART. The model is a perfect place for me to receive care as services are provided specifically to my needs and I see the doctor once in six months and pick up drugs as prescribed. 

Nigeria adopted the DSD policy in 2019 and with the  collaboration of all stakeholders; PEPFAR, Global Fund, Network of people living with HIV, implementing partners, civil society organization and private sector, eight health facilities and six community-based DSD ART models are currently being implemented across the country.  

The DSD model is a client-centred approach that simplifies and adapts HIV services to reflect the preferences and expectations of various groups of people living with HIV (PLHIV) while reducing unnecessary burdens on the health system.

“The adoption of DSD in this facility has helped reduce the workload, “from attending to about 70 clients per day to between 4 to 5 clients per day, Dr Cheta Otodile, the ART Coordinator HIV/AIDS resource centre in Rivers State said.

Dr Otodile noted that the strategy has allowed the health facility to move away from the “one size fits all” model, to tailored HIV services to serve the diverse group of PLHIV who seek treatment in the facility. 

“We now offer more intensive service delivery for people starting newly on HIV treatment, PLHIV with opportunistic infections and other illnesses, people who need follow-ups and others.

Meanwhile, stable clients based on their preference could choose a facility or community-based DSD model to receive their drugs,” she explained.

The community-DSD model entails that stable clients can get drugs delivered to their homes or pick up from identified community pharmacies.

To Dr Otodile, the community model has helped to ensure clients in riverine hard-to-reach locations have access to Anti-retroviral Drugs. 

“These clients are referred back to the facility when they have complaints or other health needs”.

In his contribution,  Dr Clement Adesigbin, the head of the treatment component of the National AIDS and STIs Control Programme (NASCP) said, “DSD has played a significant role in tailoring HIV service delivery to meet the needs of PLHIV and relieving the burden on the health systems.” The all-inclusive support of all stakeholders

WHO provides technical guidance to the government of Nigeria on DSD implementation. “With over 90% of diagnosed PLHIV placed on treatment, Nigeria is near achieving epidemic control,” WHO Country Representative,  Dr Walter Kazadi Mulombo mentioned. 

Dr Mulombo reiterates that the integration of DSD into primary health care (PHC) services and communities brings services closer to those needing the services and is a path towards achieving Universal Health Coverage (UHC)”. He called all Nigerians to know their HIV status by getting tested in order to end HIV/AIDS epidemic as a public health threat by 2030. 

Technical contacts:

Dr Odunlade Oluwafunke; Email: ilesanmio [at] who.int (ilesanmio[at]who[dot]int)

Ms Momodu Halima; Email: momoduh [at] who.int (momoduh[at]who[dot]int)