Biometrics in HIV treatment: Way to go!

By Lawrence Wakdet

When a dog bites a man, it is no news. But when a man bites a dog, that is news. So also with HIV. When HIV ravaged our lands unabated in the late 90s, it was news. Fast forward to two decades later. HIV infected people are the most healthy who know their health parameters. They enjoy the most rigorous of lab investigations, from baseline to regular tests.

Ask a person living positively with the disease, he or she knows his or her vital signs as basic as weight, height, blood pressure and pulse rate. Dig further. He or she would rap better than Chris Brown what his CD4 count or viral load or Packed Cell Volume, PCV values are. To a bystander, these values are too technical. But you a non infected person don’t even know ordinary BP or weight.

That apart, the Nigeria AIDS Indicator and Impact Survey, NAIIS has come and gone. And it has left a sweet-sour taste in the mouth. As least the numbers of people living with HIV is not as initially thought. Earlier estimates say about 3.4 million Nigerians live with the disease, accounting for almost 10% of the total burden of this disease in the world. Now, NAIIS, one of the world’s most efficient large scale surveys conducted in 6 months, has clarified that we actually have 1.9 million people infected in the land. I can’t argue with evidence-based medicine but my curious mind takes an average of what was met on the ground and the estimation of what’s on the ground. An average of 1.9 million and 3.4 million gives us 2.65 million. That’s on a lighter note.

One of the highlights of the survey is the fact that Nigeria is slowly but surely approaching epidemic control of the HIV virus. By that, it means that clients who take their drugs as a second religion are unable to pass on the virus vertically (mother-to-child) and horizontally (sexually between partners). That’s what’s reponsible for the new slogan U=U. That is Undetectable equals untransmissible. Nigeria will ever be grateful to the US PEPFAR, Global Fund, Government of Nigeria GON, donor agents like the US Centre for Disease Control and Prevention, CDC and the US States Agency for International Development, USAID implementing partners for much of the success of this intervention.

With new more potent anti-retroviral drugs, the seemingly impossible task now seems reachable.

But one of the main headaches of the HIV programme in Nigeria is the issue of clients lost to follow up. By this we mean patients who commenced ART and out of the blues, cannot be traced. They just vanish into thin air. They either, for one genuine or inexplicable reason, leave the hospital that enrolled them into care and either stop taking the medication completely or get it from another facility without proper documentation or referral to another facility of the client’s choice. The Journal of AIDS and Clinical Research published a LTFU rate of almost 10%, though other publications obtained a rate as high as 26%. Incidentally, the earlier study shows a loss of 41%, almost half of all, commenced newly on ART.

And unfortunately, all IPs until recently, had only the database of their clients. IHVN has its database of all its clients. So also CIHP, APIN, FHI360, CCFN and NACA as the case may be. In other words, there’s no central national database of all clients on HIV medication. If client A deserts UDUTH in Sokoto and enrols in BSUTH in Makurdi or National Hospital, Garki, nobody knows precisely.

And then Eureka. Science again to the rescue. Biometrics in anti retroviral therapy. It simply implies the use of fingerprints in client identification and appropriate service delivery. A code is generated instantly and can be accessed across a network of computers. Some of the world’s fastest fingerprint matching machines can achieve over 3 billion identifications within a second. That’s the speed of the information superhighway.

Luckily, biometrics is no rocket science. It’s everywhere in Nigeria. The banks take our biometric measurements. So also the National ID card, ‘international’ passport, drivers’ license and not the least all, the telecom industries namely Airtel, MTN and Glo. Unfortunately, all these agencies and multinationals, with government’s laissez fair attitude, have failed to merge all these databases into a single national tool. Result is that we don’t know who’s a Nigerian or not. Criminals capitalize on this and wreck havoc. If not for CCTV footage, the Offa robbery guys would never have been identified even if they left fingerprints on Police vehicles. Mention must be made of the current effort at centralising or integrating various programmes into the National Data Repository, NDR. All data and indicators from different thematic areas are captured on a dashboard and is useful for decision-making, policy planning and review.

Good thing is that once biometric documentation of all HIV positive clients in Nigeria is done, we would be able to determine the exact number of people currently taking drugs. Currently about 1.2 million are on medication, leaving us with a deficit of 700,000 yet to be linked to care. We’d also be able to tell the actual incident rates or new infections nationwide.

Again, progress is being made in this aspect with the Incident Command System, ICS which profiles all active clients in HIV care real time. Since we have online medical records systems, patient management becomes digital and health information management easier to handle.

The pros far outweigh the cons. With biometric bio-data capture done, accessibility of care is enhanced. A client who’s displaced during crises or had an emergency travel out of his domain can get clinical care and medications at any service delivery points, SDPs. Once we eradicate or minimise high rate of client attrition, resistance to drugs will reduce since adherence counselling can be received at any SDP at any given time ‘t’. The logistics of this system can always be sorted out.

Moreover, this ‘tear-leather’ system eliminates fraudulent practice of collection of drugs from multiple centres. People with duplicate data will be sorted out promptly on fingerprint identification.

The drawback of using biometrics is unavailability of internet access especially in rural areas. That also can be sorted out using the INEC syndrome. Configure the databases to send data to a central database. Alternatively, ensure an offline data capture for onwards uploading later where internet access is guaranteed. Fears of client data confidentiality is unfounded as all care givers have received comprehensive training on the ethics of the health profession. It is virtually non-existent and clients should have no fear about the sanctity of their information. Any breach in this by a caregiver is liable to imprisonment, or payment of fines or both.

Biometric intervention in the implementation of HIV care, support and treatment is a gold standard. The Government of Nigeria has endorsed it. I wouldn’t know anyone who’d oppose this innovation. Let’s shout it from the rooftop. Biometrics is the way to go.

Lawrence Wakdet is a Public Health specialist and Health Communicator, he wrote in from Jos, Plateau state, Nigeria. You can reach him on [email protected]

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