Dr. John Idoko is Director General of Nigeria’s National Agency for the Control of AIDS (NACA). He started his position just three months ago. For the last 14 years, he has worked on AIDS programs, where his last job was principal investigator of the Harvard PEPFAR program in Jos – overseeing one of the largest clinics in Africa, treating 11,000 AIDS patients.
Q: What do you think about some of the messages from this conference — that AIDS programs are wasteful and they need to be more efficient?
JI: I agree a lot with that. One of the things that fascinates me, is that quality reduces cost. And if we can harmonize programs, we can also reduce cost.
Q: Can you give me an example of how higher quality cuts costs?
JI: My background is in AIDS treatment. I think if you do viral load testing (which tests for the amount of virus in the blood stream) then you can improve the quality of treatment, and I think will save money in the long run. In doing so, you can identify when patients fail and you can change their treatment.
One other area where quality is important is when you go to lower levels of the health system. You can integrate things, instead of running a parallel program. In some facilities, you can offer voluntary counseling and testing, malaria treatment, TB, family planning, palliative care, and orphans services.
Q: How does this relate to treating HIV patients?
JI: All these diseases are related to HIV – malaria often is a concurrent co-infection, TB is a frequent co-infection, and family planning is one of the four prongs for prevention of mother to child. HIV is involved in all these things. So instead of packing the interventions in separate places, you bring them together.
Q: How is Nigeria’s fight against AIDS being hurt by the global economic crisis?
JI: It is a huge issue. Nigeria’s main source of funding is oil, and there has been a drop in the oil price. That has reduced the budget for HIV.
Q: Are you asking donors to help make up the shortfall?
JI: Donors also are having trouble. The Global Fund has a 10 percent cut across the board, PEPFAR has basically a flat-line budget.
Q: So what will you do to make up the shortfall? Will you cut programs?
JI: We are trying to work with our partners to look at our priorities. It may mean we will prioritize programs as well as reduce duplications. It appears that some programs might suffer — scaling up of treatment may be affected. Right now in Nigeria, we have 300,000 people on AIDS treatment, but we have an estimated 800,000 to 1 million who need the drugs.