Introduction

Lagos State has a mixed HIV epidemic party driven by the key and general populations. The state has an estimated population of above 24 million (Lagos Bureau of Statistics), with the Adolescent and Young People (AYPs) accounting for 43% of the population. The adolescents (10-19 years) account for 8% of persons living with HIV according to findings by the Nigeria HIV and AIDS Indicator and Impact survey (NAIIS 2018).

The low access and uptake of HIV Testing Services (HTS) by adolescents and young people coupled with risky behaviours, such as multiple sexual partners, transactional sex, gender-based violence and HIV stigma and discrimination increases adolescent vulnerability to HIV infection. The HIV and AIDS social stigma has significantly mired the uptake and utilisation of HIV prevention services by AYPs.

Description

The aforementioned created the dire need to strengthen the existing youth friendly HIV and AIDS prevention interventions in the State. In view of the importance of the youth in the State development plan, the Lagos State AIDS Control Agency (LSACA), the organisation in charge of the city's multi-sectoral HIV/AIDS response, collaborated with the Ministry of Education and the Ministry of Youth and Social Development. This collaboration was to roll out the AYP HIV Prevention Campaign in the State run Secondary and Tertiary Education institutions and the youth centres.

The design and execution of the State level AYP HIV prevention campaign involved the use of a multi-layered approach, which increased the AYPs demand creation for HIV testing. The state reactivated the Family Life HIV/AIDs Education in the 354 State Junior public schools, in collaboration with the Ministry of Education.

Furthermore, LSACA trained 31 Youth Officers from the Ministry of Youth and Social Development on HIV counselling and testing, deployed HIV Self-Testing kits with HIV Information, Communication and Education materials (IEC) alongside condoms to the 31 youth centres in the State. The youth who need further information on HIV or tested positive are linked to the Information Center through a mobile phone toll free line 6222 for counselling and referral to care. This toll-free line was created by the National Coordinating Agency with the support of UNICEF.

To address the low access and uptake of HTS in the state by AYPs, the year 2020 World AIDS Day platform, was used to officially launch the deployment of HIV Self-Testing (HIVST) Kits in the State, using a political influencer: the wife of the State Governor. In a bid to increase the awareness, the Agency also partnered with Academia, the Nigeria Institute of Medical Research (NIMR) Yaba, Lagos, to create awareness of HIVST kits through a youth oral presentation competition. The top ten youth groups proceeded to design social marketing strategies and awareness creation for an increased demand and uptake of HIVST kits among the youth in Lagos. The winners of the competition were awarded with 1,000 units of HIVST kits, for a revolving social marketing strategy designed by the group which is currently sustained and has increased stock/demand by 20%, one year after the competition. The platform of Anti-AIDS clubs in Secondary and Tertiary institutions was also used for awareness and demand creation for HIV self-test kits with the support of LSACA.

Data Collection

The State, implementing partners and CBOs adopted the National HTS data collection tools to document HIVST uptake in the period under review. The validated HIVST data from the State was reported to the National Agency for the Control of AIDS (NACA) and the Federal Ministry of Health (FMOH) as HIV testing in-disaggregated data (RTS and HIVST).

The baseline data for HIV Self Testing in the State was zero prior to the December 2020 launch of Self-testing, however, since the launch, the State has recorded the use of over 44,028 HIV Oral Self-test kits, which accounts for 17.7% of the of Non-health sector HIV testing services as of December 31, 2021.

The city had a target of achieving 50% of the rapid testing conducted among the youths within the year under review (December 2020- December 2021). By the end of the year 2021, the total HIV rapid testing conducted among the Youths aged 15 to 35 was 34,196 and the HIV self-testing achieved was 44,028 with the support of various stakeholders (the State, CBOs, and Implementing Partners).

Results, Outputs, and Outcomes

1. These strategies account for a 129% increase in acceptance and demand generation of HIV self-testing. The increase in self testing uptake since the launch shows significant return on investment in terms of increased demand for HIVST services in the state.

2. The mode of delivery of HIVST that encourages confidentiality and reduced stigma has resulted in an increased demand for the service among the youth.

3. There is an ongoing pilot project designed to support the supply of HIVST kits to Private Patent Medicine Vendors (PPMVs) free of charge, to be sold to the clients for between $3-$4 per unit, and the proceeds used in a revolving scheme. The country is currently developing data collection tools to capture the HIVST data of these clients.

Lessons Learned

1. Increased availability and access to the HIVST kits, through Government, implementing partners and over the counter in for profit pharmacy establishments will sustain the momentum for the increased demand currently achieved.
2. Increased involvement of the youths in HIV program design, planning and implementation, improves program outcome and effectiveness.
3. The use of the political platform increased the publicity and awareness creation on the product, it also increased Government commitment and domestic resource mobilisation for the state’s HIV/AIDS response.

Conclusion

1. The introduction of HIV self-testing kits in the state HIV/AIDS response has increased the youth demand and uptake of HIV testing services.
2. Youth involvement in the designing, planning and implementation of youth related intervention is vital towards successful program outcome and sustainability.