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Sunday Ikpe, is the health Informatics team lead, University of Maryland Baltimore in Nigeria. In this interview with ANTHONIA OBOKOH, Ikpe gives an insight on how the NAIIS survey was carried out and what Nigeria can do to achieve better collection of health data.
What is Maryland Global Initiative Corporation (MGIC) all about?
The Maryland Global Initiative Corporation (MGIC) presence in Nigeria is as a nonprofit affiliate of the University of Maryland Baltimore (UMB) that works in research and program implementation servicing the areas of health service delivery, health workforce development, quality improvement, laboratory systems strengthening and health care policy development with a special focus on infectious diseases, maternal child health, non-communicable chronic illnesses and neglected tropical diseases.
In Nigeria, it started in 2004 as the technical partner to the Catholic Relief Services AIDS Relief Consortium, implementing HIV Care and treatment services in 16 states. MGIC has implemented programs in collaboration with World Health Organisation (WHO) to increase tuberculosis case detection in Nigeria and scale up these detection and treatment services to important underserved areas and populations.
What projects are supported by your organisation in Nigeria?
Currently we support the Nigeria Centre for Disease Control (NCDC) in surveillance and also support a number of the President’s Emergency Plan For AIDS Relief (PEPFAR) projects in Nigeria.
More recently, UMB have done some work with the NCDC who we are currently supporting in issuing surveillance in 28 states and the Federal Capital Territory now and we are hoping to expand that to the remaining states. We support their work around surveillance of anti-microbial resistance including their laboratory and diagnostic efforts too.
Last year 2018, we got involved in running the largest HIV survey ever done in which was the Nigeria HIV/AIDS Indicator and Impact Survey (NAIIS) project in a consortium with partners including AFENET and funded by the United States Centers for Disease Control and Prevention (CDC), Global Fund and the Federal Republic of Nigeria.
The project was implemented throughout the entire country and looked at identifying the HIV prevalence as well as prevalence of Hepatitis B and C infections. This is central to evaluating where Nigeria stands in the 90-90-90 cascade for HIV control. This refers to knowing the percentage of people living with HIV AIDS who know their status, the percentage of HIV patients on treatment and the percentage of HIV patients on treatment who have viral suppression.
How was data collected during the Nigeria AIDS Indicator and Impact Survey?
What we did was that we had this done computer-assisted. We had 190 teams spread across the country and distributed across each of the geo-political zones. We had between25-35 teams in a state working at each time collecting data at different levels.
Prior to the start of the survey we worked with the Nigeria Population Commission to determine what distribution would be statistically representative using their own data base to identify enumeration areas in the country. That was the first step of data that was collected to identify where exactly we should go to.
Then the next step was community engagements. We followed proper process getting consent from the communities, household and the individuals we interviewed and all of these were captured on these tablets and transmitted in due time to the central office in Abuja, a command and control center where we could actually visualize and bore the progress of the survey real time. Doing these, we were able to also track what could go wrong in terms of quality and communicate to those in the field from the call Centre which was set up for this purpose.
What were the routine challenges faced before, during and after the survey in completing the survey?
There was a challenge in identifying the right people, recruiting and training them in a very short period of time and they been able to assess them and confirm that these people were good enough to go out to the field. We had to be sure that the laboratorians were qualified and trained also for human subject research since we were going to take blood samples and were going to deal with people including children aged 0-14 years.
During the course of the survey, the overall coordination had the potential of becoming a logistical night mare but overall we surmounted this challenge by getting in the right people and instituting the right processes. The major challenges were really around the current political and geographical situation of Nigeria, I mean the challenges with difficult terrain including mountainous and riverine areas.
What were the measures put in place to manage the data?
The survey had to meet certain requirements that are best practice. We ensured that we were collecting data and we also took not just behavioral data but also metadata including timestamps and geo-location. We had a team of data monitors stationed in the NAIIS central office who monitored the data coming in real time with their focus on completeness, accuracy and human subject matters.
There were routine meetings which held twice daily to monitor the progress of the survey and identify issues so they could be mitigated immediately. These were done along with risk assessment with consideration for all the active states and teams at every point. He had the obligation of ensuring the teams sent on national duty all returned safely.
What was the role of government in collection, storage and processing these data?
Apart from its role as sponsor and project owner the Government of Nigeria was actively involved in the survey. Activities that involved the government represented by the Federal Ministry of Health and NACA included coordination of the Technical Committee meeting held monthly to review the status of the project; field activities – particularly observation of field teams to ensure they kept to the protocol requirements of the survey. Notably other government agencies that were involved were the National Bureau of Statistics and as previously mentioned the Nigeria Population Commission.
How different was NAIIS compared to other PHIAs (Population Based HIV and Impact Assessment
This was significantly different from other PHIAS in several ways. First off, this was the first PHIA being handled by the University of Maryland Baltimore. We had to deal with a sample size never previously dealt with in any single country in Africa. To achieve the goal and to do it in shorter time than in any previous survey we had to be innovative and thus had a team of brilliant Nigerians working for the University of Maryland Nigeria Program who came up with technology tools and solutions and pulled off a successful survey and did so with quality and on time.
What lesson can Nigeria learn from this survey?
There has been a lot to learn from the survey in all of its stages and leading up to its successful implementation. We learnt that we have it in us as Nigerians to do extra ordinary things. A larger percentage of the planning and strategizing for this survey were the product of Nigerians finding solutions in innovative ways to a myriad of problems, tackling them one at a time. We saw dedication from the teams that fearlessly and tirelessly went out day in day out collecting data and I can tell you if you need people to go the extra mile then Nigerians will do that for you.
From a survey and scientific perspective the numbers for HIV prevalence in Nigeria were mostly speculative before the survey but now we can say we have accurate numbers. This experience can be extended to other areas and for other diseases to identify what the numbers are for us as country as this becomes a basis for planning, interventions, preventions depending on the study in view and the sector requesting the study.
Overall it was a worthwhile experience and showed that as Nigerians when we put our minds to it, we are capable of doing truly great things.