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Background:  In February 2001, the government of Nigeria commenced a nationwide provision of HAART to ARV-naïve patients using generic forms of NVP, d4T, and 3TC. Many challenges exist in assessment and uptake of the drugs. Our purpose was to assess the challenges in the ARV drug initiative in Nigeria.

Methods:  This was a retrospective study of 13 centers, 8 public and 5 private. Separate questionnaires were administered to clinicians and caregivers to determine knowledge of HIV/AIDS. Patients were randomly selected and interviewed to determine problems and challenges in drug supply, adverse reactions, adherence, and general quality of life. Determinants of nonadherence were also studied.

Results:  A total of 531 patients; 78% males, mean age 26±18 years, baseline median CD4 205 cells/mL, median viral load log₁₀ 4.70 (3.76 to 6.10) copies/mL. In 72% of patients after baseline CD4 and hemogram, no other tests were done throughout the 18 months under review. Only 43% had VCT and other counseling services, 21% could estimate CD4, and 1, viral load. Opportunistic infections, notably TB and fungal infections, were investigated in 28.6%, chemoprophylaxis given in 14.3%, and managed in 42.9% centers; 35.7% adhered to recruitment criteria like CD4 and presence of opportunistic infections. HIV/AIDS cases overburdened 50%, while only 42.9% had consent forms during the trial period. Only 25% of clinicians had adequate relevant skills on use of ART and 15% knew laboratory markers for HIV. There was general lack of technical laboratory skills with only 35.7% of follow-up at the centers. No lab performed resistance testing. Meanwhile, high cost of monitoring challenged patients, with only 9% getting regular CD4 and FBC, and 11.3% getting viral load estimates at baseline and 6 months. Traditional-medical preparations, diviner, and spiritualists were still patronized by 25%. Non-adherence characterized 15%, for reasons including adverse effects (7%) and stigmatization. Determinants of non-adherence were sex, socioeconomic status, and education.  

Conclusions:  Provision of HAART in Nigeria faces many challenges in spite of patients’ apparent clinical improvement. Still needed are capacity-building, improved laboratory skills, cheaper monitoring tools, and resistance testing to avert treatment failure. Non-adherence is a major issue. Sustained advocacy on the political class is necessary to ensure provision of related services.

Keywords: Generic ARV drugs, HAART; Challenges; assessment