Building a Successful Military-to-Military Partnership through Confronting HIV: The U.S-Nigeria Experience.

BACKGROUND: The Nigerian Ministry of Defence-Walter Reed Army Institute of Research partnership was established in 2004 in response to the growing HIV/AIDS epidemic in Nigeria. METHODS: Here we discuss the emergence of HIV in Nigeria, highlighting the initial barriers to treatment delivery, and outline the origins of the international military-to-military partnership developed to confront the disease. RESULTS: With financial support from the United States President's Plan for AIDS Relief and Nigerian Government Counterpart Funding, we demonstrate how this program led to a successful and sustainable response in the fight against HIV in Nigeria. We detail the continued value of this collaboration in the form of sustainable treatment platforms, prevention strategies, and research projects, and explore the factors which strengthened, and hindered these efforts. CONCLUSION: The program is a model framework for international military health partnership based on the principles of shared responsibility, country ownership and goal attainment.

An Evaluation of Selected Populations for HIV-1 Vaccine Cohort Development in Nigeria.

Development of a globally effective HIV-1 vaccine will need to encompass Nigeria, one of the hardest hit areas, with an estimated 3.2 million people living with HIV. This cross-sectional Institutional Review Board (IRB) approved study was conducted in 2009-12 at four market sites and two highway settlements sites in Nigeria to identify and characterize populations at high risk for HIV; engage support of local stakeholders; and assess the level of interest in future vaccine studies. Demographic, HIV risk data were collected by structured interviewer-administered questionnaires. Blood samples were tested on site by HIV rapid diagnostic tests, followed by rigorous confirmatory testing, subtype evaluation and testing for HBV and HCV markers in a clinical reference laboratory. Of 3229 study participants, 326 were HIV infected as confirmed by Western Blot or RNA, with a HIV prevalence of 15.4%-23.9% at highway settlements and 3.1%-9.1% at market sites. There was no observable correlation of prevalence of HIV-1 (10.1%) with HBV (10.9%) or HCV (2.9%). Major HIV-1 subtypes included CRF02_AG (37.5%); G (27.5%); G/CRF02_AG (25.9%); and non-typeable (8.9%), with 0.3% HIV-2. Univariate analysis found age, gender, marital status, level of education, and sex under substance influence as significant risk factors for HIV (p<0.001). Educating and winning the trust of local community leadership ensured high level of participation (53.3-77.9%) and willingness to participate in future studies (95%). The high HIV prevalence and high risk of HIV infection at highway settlement and mammy markets make them well suited for targeting future vaccine trials in Nigeria.