Health
Microbicide, Solution To Female HIV Infection?
Since the Human Immune Virus and the Acquired Immune Deficiency Syndrome (HIV/AIDS) pandemic became known in Nigeria in the mid eighties, no illness has caused more commotion and separated families and friends alike.
From being a rumour initially, it became a cruel reality which raised so much pandemonium that how it is transmitted from person to person became more horrifying and confusing almost by the day.
However, from the mid eighties to now, so much water had passed under the bridge. Form being regarded as the most dreaded diseases, which had no cure, HIV/AIDS is now manageable.
In fact, research has proved that an infected person can live a normal life like every other person. All it requires is awareness in the part of the infected person.
In spite of this encouraging development, however, research has also shown that the virus is still spreading and fastly too, for various reasons, which include the fact that people, mostly out of fear of being discriminated upon, prefer to keep their infection to themselves, or refuse to know their status.
Research has alo showed that majority of those infected are women, thus raising questions regarding why it is so.
It did not take long for researchers to reason that perharps this will not be far from the fact that women seem to be the most vulnerable when it comes to adopting preventive measures during heterosexual intercourse.
This is because the presumed efficacy of such preventive measures as abstinence, use of condoms and being faithful to a partner could not stop more women from being infected. Hence the decision to come up with a preventive measure strictly to be controlled by women.
In the words of Dr. Orikomaba Korifama Obunge, consultant clinical microbiologist and Head of Medical Microbiology department, University of Port Harcourt Teaching Hospital (UPTH) ‘‘a lot of them (women) are still being infected, not because their partners are a little bit more adventurous, and the ability of them negotiating for the use of preventive measures such as condoms is not working much as it should.
‘‘The issue is that, can we not provide a preventive measure that is controlled by the women, that is capable of forming a barrier during heterosexual intercourse?’’
It is the search for this measure, according to Dr Obunge, that resulted in the emergence of a concept of a microbiocide by a group of researchers and activities, which also include Dr Obunge.
According to a recent UNAIDS estimates, in 2009 more than 33 million people were living with HIV and approximately 2.5 million people were newly infected.
The estimates also showed that worldwide, nearly half of all individuals living with HIV are now women, who acquired the virus largely by heterosexual exposure.
Further more, many women, because of limited economic options and gender inequality, cannot reliably negotiate sexual encounters, leaving them vulnerable to unwanted pregnancies and sexually transmitted infections (STIs), including HIV.
Thus, with clinical deployment of safe and effective HIV Vaccine still likely to be years away, topical microbicide formulations that are applied vaginally or rectally are receiving increasing attention as another strategy for HIV prevention.
The microbicide is a product in the form of a gel which could be infected intraveinously with the sole objective of preventing the transmission of the virus during heterosexual intercourse to the woman.
According to the researchers, a review of preclinical and clinical research on the development of microbicides formulated to prevent vaginal HIV transmission yielded 118 studies globally.
Presently, mathematical modeling has shown that if there is such a preventive measure that is workable, then millions of new infections could be prevented and it would be an encouragement for donor agencies to start working on it. Hence the emergence of research on microbicides.
In the words of Dr. Alan Stone of the Medical Research Council in the United Kingdom, ‘‘the development of an effective microbicide is a global priority of the highest order… The question is not whether the microbicide approach will prevent HIV infection but, rather, what proportion of HIV infections it will prevent.’’
Towards coming up with such a microbicide, two research organizations, FHI and Vera Halpen using collaborators in various countries embarked on research for the purpose. In Nigeria the collaborators were Dr. Orikomaba Korifama Obunge and Dr F.S.Ogusola of the university of Lagos.
The research went through the first and second phases, which are smaller studies that look at safety at does and at efficacy before this third phase which entailed randomized clinical/controlled trails on large groups of participants to look at the efficacy of the microbicide.
The products of the investigation were 6% Sodium Cellulose Sulphate (CS), which is a gel that was tested as a possible topical microbicide, but in 2007 was found to be in effective. Researchers thought that CS could potentially block HIV infection (and possibly others STIs) by creating a barrier between the virus and the woman’s cells in the vagina which the virus targets for infection. This would make it more difficult for the virus to enter the woman’s cell.
The other products of investigation are vaginal gel, single use applicator, and 3.5ml of gel.
According to the researchers, the study design at this phase III entailed randomized placebo controlled trail, in which a total of 2160 women at high risk of HIV/STI were in Lagos while the other half were in Port Harcourt.
The placebo is not the treatment being tested, but looks exactly like the treatment. For topical microbicides trails, the control group received a gel that looked and was used the same day as the gel given to the intervention group, except that it did not contain the microbicide.
Placebos are used in blinded clinical trails so that participants for twelve months, while tests were carried out for HIV, gonnorhoea and Chlamydia at baseline and at each monthly follow up visits.
A summary of the research showed that the duration of the study was 12 months of participants recruitment, 12 months of product used for each participants and 26 total months in the fields including screening and close-down, while the primary objective of the study was to determine the effectiveness of CS gel in preventing male-female vaginal transmission of HIV infection among women of high risk.
The primary endpoint is the incidence of HIV-1 and HIV-2 infection as determined by detection of HIV antibodies from all Mucosal Transudate (OMT) specimens, while the secondary objective is to determine the effectiveness of CS gel in preventing malae-female transmission of gonnorrhoea and chlamydial infection among women at high risk.
The secondary end point is the incidence of the genital gonorrhea or chlamydial infections as determined by DNA probe technology from self-administered vaginal swabs .
At the end of the study, it was found that the CS gel (this microbicide) did not protect against HIV and canot be used, “there were more infection in CS group compared to the placebo group from other studies outside Nigeria resulting in the stoppage of the study on CS3, and the preventive measure (HIV risk reduction messages works)”
It was thus agreed that community/scientist rapport must recognize that community involvement is an essential component in microbicide trail; that the approach to such involvement must consider the local setting (community politics and environment) that the relationship is a dynamic one.
Others are that it is clear the development of a topical microbicide to prevent the sexual transmission of HIV is scientifically, ethically and culturally complicated; and that in spite of these the benefit in lives protected may far exceed those risks seen and, as yet, unforeseen.
The implication of the foregoing is as encouraging as it is dreadful. Encouraging because by this and other researches carried out, all in pursuit of a solution to the HIV/AIDS pandemic show that there is a relentless quest to get a solution .
However, the situation looks dreadful considering that such solution seem to have remained evasive and hence almost impossible to come by.
This, therefore, is an indicator that a lot of work still needs to be done to thoroughly put the transmission of HIV under check, particularly as it concerns the most vulnerable groups.
Such areas that require more job to be done include community sensitization/involvement, capacity building programmes for various stakeholders, including families.
The question that should thus be on every bodies mind is “which way forward in HIV prevention.”
Sogbeba Dokubo
To address the increasing number of rape and defilement cases in Lagos communities, the State Ministry of Health has trained healthcare workers on the prevention and management of sexual assault cases.
The Director, Public Affairs in the ministry, Tunbosun Ogunbanwo, in a statement on Monday said the training equipped health workers with the knowledge and skills to provide professional, compassionate, and timely care to survivors.
Dr Folasade Oludara, Director, Family Health and Nutrition, State Ministry of Health, said the growing number of rape and defilement cases in Lagos communities necessitated the upskilling of healthcare workers who are often the first responders to survivors.
Oludara, represented by Dr Oluwatosin Onasanya, Deputy Director, Child Health, said the government recognised the critical role of health professionals in both clinical management and legal documentation of sexual assault cases.
She explained that the training was designed to ensure healthcare workers are adequately equipped to identify, document, and manage sexual assault cases effectively.
According to her, the training will strengthen Lagos’ coordinated health system response to gender-based violence.
She disclosed that the state government had already provided equipment and specimen collection tools to health facilities, noting that the training complemented this investment by building the competence of personnel handling such sensitive cases.
Oludara explained that doctors and nurses at the primary, secondary, and tertiary levels who serve as first contact points for survivors were carefully selected from all 57 LGAs and LCDAs, particularly from areas with higher incident rates.
The SGBV Programme Manager, Lagos State Ministry of Health, Dr Juradat Aofiyebi, emphasised that the capacity-building initiative was a strategic step toward improving survivor-centred healthcare delivery and prosecution outcomes.
Aofiyebi added that the training underscored the government’s commitment to reducing the prevalence of sexual assault through a robust, multi-sectoral approach.
“The training provides healthcare workers with the knowledge to properly identify survivors, document findings accurately, and provide comprehensive care, all of which contribute to justice delivery and prevention of repeat offences.
She said the ministry would sustain such training to ensure that every survivor who presented at a Lagos health facility received quality, non-judgmental care.
Mrs Adebanke Ogunde, Deputy Director, Directorate of Public Prosecutions (DPP), Lagos State Ministry of Justice, highlighted the importance of medical documentation in sexual assault trials.
She explained that most convictions hinge on the quality of medical reports and forensic evidence provided by healthcare professionals, noting that medical reports served as vital corroborative evidence in court, particularly in cases involving children.
“Your medical reports are crucial; they can determine whether justice is served or denied,” she said.
Ogunde reminded health workers of their legal duty to report suspected sexual assault cases to the police or the Lagos State Domestic and Sexual Violence Agency (DSVA).
Similarly, Dr Oluwajimi Sodipo, Consultant Family Physician, Lagos State University Teaching Hospital (LASUTH), underscored the importance of timely medical attention, psychosocial support, and non-stigmatising care for survivors.
Sodipo explained that immediate presentation within 72 hours of assault improved chances of preventing infections and collecting viable forensic evidence.
He commended Lagos State for sustaining its inter-agency collaboration and continuous professional training on SGBV.
Sodipo, however, called for the strengthening of DNA and forensic capacities, improved insurance coverage, and better remuneration for healthcare workers.
“We must sustain motivation and continuous retraining if we want to retain skilled professionals and enhance justice outcomes,” he added.
Also, Mrs Margret Anyebe, Claims Officer, Lagos State Health Management Agency (LASHMA), said domestic and sexual violence response had been integrated into the ILERA EKO Health Insurance Scheme.
Anyebe explained that survivors of sexual and domestic violence are covered for medical treatment, investigations, and follow-up care under the state’s Equity Fund for vulnerable groups.
“Hospitals are to provide first-line care, document, and refer survivors appropriately, while LASHMA ensures prompt reimbursement and oversight,” she said.
The technical session of the ongoing National Council on Health (NCH) meeting on Monday reviewed 35 out of the 82 policy memos submitted ahead of full Council deliberations scheduled for later in the week.
Dr Kamil Shoretire, Director of Health Planning, Research and Statistics, disclosed this on Tuesday during the Technical Session of the 66th Regular meeting of the NCH ongoing in Calabar, Cross River.
He said that 10 of the memos considered were recommended for Council’s approval, eight were noted, and 18 stepped down for further work.
According him, two additional memos were deferred and will be re-presented after revisions are made.
At the reconvening of the session, Ms Kachallom Daju, Permanent Secretary, Ministry of Health and Social Welfare, said that there were five memos from the Coordinating Minister of Health, adding that they were all related to the Department of Food and Drugs.
Daju said that the memos were stepped down on Monday and scheduled for re-presentation.
She also provided clarification on the previously contentious healthcare waste-management memo, explaining that the N3.5 million requests tied to the proposal had already been repurposed by the Global Fund.
“I have followed up, and I am informed that the funds have been reprogrammed. Just so we put it to rest, we will not be discussing that memo anymore,” she said.
She also said that the final memo considered on Monday was the proposal for the inclusion of telemedicine services under the National Health Insurance Authority (NHIA).
“The next memo scheduled for presentation is the proposal for the establishment of Medipool as a Group Purchasing Organisation (GPO) for medicines and health commodities in Nigeria.
Meanwhile, Dr Oritseweyimi Ogbe, Secretary of the Ministerial Oversight Committee (MOC), formally notified the Council of the establishment of Medipool, a new public-private GPO created to strengthen the procurement of medicines and health commodities nationwide.
Presenting an information memorandum at the technical session, Ogbe explained that Medipool was the first nationally approved GPO designed to leverage economies of scale, negotiate better prices, and ensure quality-assured medicines.
He said this was beginning with primary healthcare facilities funded through the Basic Health Care Provision Fund (BHCPF).
According to him, Medipool was established after a proposal to the Ministry of Health, followed by appraisals and endorsements by the Project Implementation and Verification Committee (PIVAC) and the Ministry of Finance Incorporated (MOFI).
“It subsequently received Federal Executive Council approval, with MOFI now owning 10 per cent of the company’s shares. The Infrastructure Concession Regulatory Commission has also approved its operations.
“Under the model, Medipool will work with Drug Management Agencies (DMAs) in all states to aggregate national demand and negotiate directly with reputable manufacturers to obtain competitive prices and guaranteed-quality supplies.
“The platform will function as a one-stop shop for DMAs, who will then distribute medicines to health facilities through existing state structures.”
Ogbe added that while Medipool will initially focus on BHCPF-supported primary healthcare centres, it was expected to expand to other levels of care nationwide.
“The organisation will provide regular reports to the ministry of health and participate in national logistics working groups to ensure transparency, oversight, and technical guidance,” he said.
The News Agency of Nigeria (NAN) reports that Day One of the 66th NCH technical session opened with a call reaffirming the Ministry’s commitment to advancing Universal Health Coverage under the theme “My Health, My Right”.
“The delegates also adopted the amended report of the 65th NCH, setting the stage for informed deliberations.
The implementation status of the 19 resolutions from the previous Council was also reviewed, highlighting progress and gaps.
The authorities of Police Clinic in Port Harcourt have reported high cases of Malaria in its facility.
The revelation was made by Mrs Udoh Mba Robert, a Chief Superintendent of Police and senior medical personnel in the Clinic.
She told The Tide that,”the Hospital admits sixty (60) to seventy (70) patients in a month”.
On how the facility runs, she stated that the hospital is under the National Health Insurance Scheme as most patients are treated almost free.
She maintained that staff of the hospital have been trained professionally to manage health issues that come under the purview of the National Health Insurance Scheme.
Mrs. Robert explained that malaria treatment also falls under NHIA, as patients are expected to pay only 10 per cent for their treatment while the government takes care of the outstanding bills.
NHIA, she further stated covers treatment and care for uniform personnel like the police force, military men, civil servants and all others working for the government.
Urging the public to seek professional medical attention, Mrs. Robert said the facility is open to workers in the federal services, especially police staff.
Favour Umunnakwe, Victory Awaji, Excel Nnodim
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