Implementing quality assurance for laboratory-based and point-of-care HIV testing in Nigeria

The African National Congress sentinel survey in Nigeria has shown a steady decrease in HIV prevalence since 2001, with the following trend: 5.8% in 2001, 5.0% in 2003, 4.4% in 2005, 4.6% in 2008, 4.1% in 2010, and 3.4% in 2013.1,2 Despite this favourable picture, Nigeria has a mixed HIV epidemic and has populations and States where the prevalence is significantly higher than the national estimates (Figure 1). Nigeria has a population of 173.6 million.3 It is estimated that about 3.2 million people live with HIV in Nigeria and about 220 393 new HIV infections occurred in 2013, with 210 031 deaths from AIDS-related cases.2 Only about 42% of those who need antiretroviral therapy are covered. Only 4.1% of HIV-exposed infants and 17% of women who tested positive for HIV received their virological and serological test results at the appropriate time, respectively (Table 1).2,4 Prevention of mother-to-child transmission of HIV coverage is about 20.2%, with only 4.6 % HIV-infected pregnant women assessed for antiretroviral therapy eligibility, through either clinical staging or immune monitoring tests during the period.2 Viral load coverage is only 10% (Institute of Human Virology Nigeria, unpublished data), with just 419 reported laboratory-based CD4 instruments and 27 CD4 point-of-care (POC) instruments5 (Table1). According to the 2010 Integrated Biological and Behavioural Surveillance Survey, HIV prevalence among the most at-risk populations in Nigeria is much higher than among the general population. Prevalence is estimated at 27.4% among brothel-based female sex workers and 21.7% among non-brothel-based female sex workers. Men who have sex with men had a prevalence of 17.2% (Table 1).2,6