When the Global Fund released the Results Report 2021, the team at ProtectingGlobalGains.org recognized the importance of its message. The report makes clear that progress against major long-standing diseases lost ground during COVID; that the issue is urgent; and finally that strategies exist that not only protect the gains to date against killers like tuberculosis (TB), HIV and malaria, these same strategies also strengthen health systems against future health threats. In one way or another, the stories of innovation we’ve covered since the early days of the COVID pandemic showcase what has emerged to be key pillars to resilient health systems- strong connections between clinics and community health services, well-leveraged data and technology, readiness to adapt, and keeping clients and communities at the center of the response,

The Results Report highlights a story from Nigeria, which exemplifies the swift, community-centered action that can sustain progress made on public health targets in the midst of a crisis like COVID-19. This story, provided below in full, describes how Nigeria pivoted quickly when access to clinics to test for endemic diseases, such as HIV and TB proved challenging due to COVID-19 safety protocol. Instead, community health workers and COVID-19 contact tracers were trained up to go door to door in the community and conduct in-home TB and HIV tests. Health workers also focused on reaching pregnant women with testing, to connect any positive HIV cases to PMTCT services. The number of new cases of HIV detected, according to the Results Report, improved dramatically from the previous (pre-COVID) year, going from approximately 50,000 to 60,000 a year to 350,000. It’s a feat few other nations achieved, and it’s the kind of results that will help Nigeria reach UNAIDS targets to end the HIV epidemic by 2030. Jean-Thomas Nouboussi, who oversees the Global Fund’s work in Nigeria, said changing their strategy quickly, being flexible about implementation, and investing in the training community health workers needed was necessary to keep the testing program working. “We had to find a way to move the services to where people were. We focused on getting into the community.”

Nouboussi said when the program moved into the community the impact went beyond testing. “Thinking this way about testing then leads more people to connect with other health services. And now the community is involved in managing health and keeping people healthy.”

Helping people to understand their HIV status is the first step in epidemic control. As the COVID-19 pandemic shut off access to clinics and testing all over the world, global efforts to hit urgent targets are at risk. But Nigeria found a way to beat back those pressures. Nouboussi says other successful innovations taken up because of COVID will now be mainstreamed. These include providing six months of treatment drugs to those who test positive, so they can limit clinic visits, and working in communities to ensure pregnant women who are HIV positive get connected to care that will keep their newborns HIV negative. Nouboussi warns adaptations that reflect what the community wants and needs are essential, “Countries need to know that you can’t do it without the community. Donors need to know that funds must continue to flow even when a pandemic is shutting things down. Programs need to know they should adopt flexible management and innovate. And remember, there are no positive long-term outcomes if you exclude the community.”

Nigeria: integrating health and community systems to boost HIV testing

When COVID-19 struck in Nigeria in 2020, the country went into lockdown. As the virus overwhelmed systems for health, many clinical facilities were swiftly turned into COVID-19 isolation centers, displacing the delivery of other lifesaving health services, including those for HIV. By May 2020, HIV services and programs were greatly impacted, and the number of people testing for the virus dropped dramatically.

Dr. Gambo Aliyu, the Director-General of the National Agency for the Control of AIDS, a Principal Recipient of the Global Fund, described how his team acted quickly to bring HIV services closer to the people. “We decided to move to the community, we decided to move to integrated services,” he explains.

Integrating health services meant that when community health workers were out looking for cases of COVID-19, they were also looking for cases of HIV and TB. That led to great success. People who previously did not have the time or means to go to health facilities were now being reached. There are an estimated 1.7 million people living with HIV in Nigeria. Finding them is vital to the fight against HIV in the country. “On average, before COVID-19, we were identifying 50,000-60,000 individuals in a year,” Dr. Aliyu explains. However, over the last 18 months, by working through integrated community systems, his team has identified 350,000 new individuals living with HIV and referred them to treatment, bringing the total number of people identified to 1.6 million. “So this effectively brought us closer to controlling HIV in Nigeria.”

While testing dropped drastically worldwide in 2020 due to COVID-19, thanks to Dr. Aliyu and his colleagues, Nigeria is one of the few countries to actually increase the number of people diagnosed with HIV compared to 2019. This effectively brought us closer to controlling HIV in Nigeria. Community health extension workers make their way to a patient’s home in Ondo, Nigeria.