Although HIV prevalence among adults is low (3.1%) compared with that in other sub-Saharan African countries, the total population living with HIV is about 3.5 million, making Nigeria the country with the second-highest HIV burden in the world (30). There are wide interstate differences—Benue State has a HIV prevalence of 15.4% and Zamfara State 0.9% (31). In 2013, there were 51,000 new HIV infections among children, which accounted for one-quarter of all new HIV infections among children in the 21 Global Fund priority countries (32, 33). In 2014, new infections from adolescents and youth age 15–24 years were estimated at 227,518 (25%), with females disproportionately more affected than their male counterparts (34).
Nigeria was one of the few countries with low coverage of PMTCT services and corresponding little improvement in reduction of new paediatric infections (35). By 2012, PMTCT services were being offered in 1,320 out of the over 26,000 facilities countrywide, reaching about 19% of pregnant mothers with HIV testing and counselling (HTC) and about 17% of HIV-positive mothers with antiretroviral for PMTCT (36–38). Thus, paediatric infections in Nigeria account for 29% of the global burden and 12% of HIV-associated maternal deaths (39). The Nigeria National Acceleration Plan for Paediatric ART reported that about 380,000 children were living with HIV in Nigeria. HIV testing services identified only 9% of children living with HIV and of these only 21% accessed ART compared with 48% of adults.
ART coverage for children and adolescents living with HIV is low compared with adults, where ANECCA implemented a regional project to improve coverage and quality of care.