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Involving Nigerian Health Facilities with National HIV Case-Based Surveillance

An online meeting screenshot of many different groups of people.
Ciheb uses Project ECHO, a teleconferencing tool that links specialists with practitioners and creates “communities of practice” in underserved areas.

In a recent presentation, Ciheb in Nigeria introduced case-based surveillance (CBS) and its implementation in the country to more than 130 health facilities and about 800 participants. This presentation taught facility healthcare workers about CBS and how it is used to facilitate individual-level monitoring for the HIV epidemic, as well as to demonstrate the role each facility plays in the national implementation.

The presentation is a collaboration with the Federal Ministry of Health (FMOH) and the U.S. Centers for Disease Control and Prevention (CDC). It is also part of the ongoing Extension for Community Health Outcomes (Project ECHO™) initiative that uses telemedicine infrastructure to link specialists with facilities in underserved areas. Ciheb’s HIV CBS work is funded by the Strengthening HIV Field Epidemiology, Infectious Disease Surveillance and Lab Diagnostics (SHIELD) grant under PEPFAR. 

Dr. Ibrahim Ahmed El-Imam, who leads the Department of Epidemiology, Surveillance, and Evaluation at Ciheb in Nigeria, gave the presentation. As he described in his presentation, CBS is the systematic reporting and analysis of standardized information about cases diagnosed with HIV to a public health agency responsible for disease prevention, control, and action. It uses aggregated data to inform public health responses on a population level, not for individual patients.

“Effective HIV CBS can provide up to date population level data to inform decisions at different levels,” said Dr. El-Imam.

Ciheb in Nigeria is helping to support a multi-nation project using Project ECHOTM that will better equip healthcare workers to respond to increasing COVID-19 demands in remote locations. Read more 

HIV surveillance and surveys began in Nigeria in the early 1990s and has grown over the years. The Nigeria HIV/AIDS Indicator and Impact Survey that Ciheb conducted in 2018 was the largest household population-based survey conducted for HIV. Now, the coalition of Ciheb, FMOH, and CDC aim to continue expanding CBS through the use of the National Data Repository (NDR), which aggregates data from individual health facilities into macroscale national data.

“This is the way of the future,” said Dr. Mary Boyd, a commander and senior technical advisor with CDC. “I’m excited that Nigeria has actually adopted (CBS) before COVID, and certainly in the era of dealing with the COVID pandemic, this has become essential. Nigeria is on the platform for other countries to learn from.”

The workflow toward the NDR begins with individual health facilities. The data collected every day from routinely used patient registers becomes integrated into the facility electronic medical records and then fed into the NDR. At that point, all facility-level data are consolidated into a comprehensive list. The NDR allows for analytics and visualizations of large quantities of data, which in turn can help the country describe the HIV epidemic, guide targeted interventions, and accurately monitor the 95-95-95 targets.

CBS is currently implemented in 185 facilities in 18 states with plans for further expansion.

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