This presentation is in English.

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2. Welcome
.
Department of Defense HIV/AIDS Prevention Program
Military International HIV Training Program (MIHTP)
MIHTP-ECHO Training
.
Attendance: Please confirm To confirm attendance please
enter your (1) first name, (2) last name, (3) email, (4) country
in one line in the chat.
.
This MIHTP-ECHO Session will begin shortly. 2

3. Department of Defense HIV/AIDS Prevention Program
Military International HIV Training Program (MIHTP)
ECHO Rounds (Module 10)
.
Tuesday, April 27, 2021
.
07:00-08:30 (San Diego, CA, USA, UTC -8)
15:00-16:30 Republic of the Congo, Brazzaville [WAT; UTC+0100]
16:00-17:30 South Africa, Johannesburg [SAST; UTC+0200]
17:00-18:30 Kenya, Nairobi [EAT; UTC+0300]
2:00pm-3:30 pm (Coordinated Universal Time, UTC) 3

4. English Presentation The slides presented today will be in English but
you may follow along with a translated version that was emailed
yesterday to the email address provided during registration.
.
Attendance via Zoom Registration
The Echo Zoom system has recorded your attendance upon
registration. If each person has not preregistered, a link will be
provided in the chat at the end of this session.
.
Attendance Confirmation
To confirm attendance please enter your (1) first name, (2) last name,
(3) email, (4) country in one line in the chat. 4

5. Recording
For educational and quality improvement purposes, we will
record this training session. By participating in this session you
are consenting to be recorded.
PHI Prohibited
Do not share Protected Health Information (PHI) or personally
identifiable information during this MIHTP-ECHO session.
Questions
If you have questions or comments, please email: Jorge Martins
at jmartins@gsshealth.com 5

6. Helpful Zoom Tips
- Mute microphone when not speaking
- Position webcam so other participants can see you
- You are welcome to have your camera on but if your audio is not
clear you may want to stop your video
.
Questions
Questions will be addressed in Q/A at the end each presentation.
You can use the chat function to submit questions or ask in Q/A.
.
We appreciate and value your participation.
6

7. Cliquez ici et choisissez votre langue
7
Clique aqui para escolher o seu idioma
Click here to select your language
Computers
Computadores / Ordinateurs
Cell Phones
Telemóveis/Téléphones mobiles
Passo 2
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Instructions on how to select your language
Instruções sobre como selecionar o seu idioma / Instructions pour choisir votre langue
Passo 2
Passo 1
Welcome to MIHTP ECHO
Bem-vindos ao MIHTP ECHO / Bienvenue au MIHTP ECHO
Português
Français
Étape 1
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8. AGENDA
Welcome / Administrative Announcements: Mike Grillo, Ph.D. 10 minutes
ECHO Overview
MIHTP Overview
Presentation: COVID-19 Vaccine Update: Implications for PLHIV & Significance of Evolving
Variants
Allen McCutchan M.D. MSc 35 minutes
Professor Emeritus Question and Answers 15 minutes
University of California, San Diego
..
Presentation: COVID-19 Vaccine Roll-out Update in Nigeria: Implications for PLWH
Captain UO Adekanye 10 minutes
Ministry of Defense Health Implementation Program-United States Army
Medical Research Directorate, Nigeria Q&A 5 minutes
.
General Discussion and Close 5 minutes 8

9. 9
MIHTP-ECHO Staff
• Dr. Mike Grillo – Facilitator
• Dr. Allen McCutchan - Presenter
• Dr. Edward (Lalo) Cachay – Presenter
• Jorge Martins– Interpreter / DHAPP ECHO Coordinator
• Rémi Charlebois – Interpreter
• Rachel Crane – Session Facilitator
• Lindsay Dapremont - Session Coordinator
• Mike Duszynski - Session Coordinator
• Karen Chow - Session Coordinator

10. ECHO Introduction
Project ECHO® [Extension for Community Healthcare Outcomes] is a model of
distance clinical mentorship developed at the University of New Mexico to
improve access to care for complex health problems for underserved
populations.
Elements of the model include:
• Hub-and-spoke networks
• Communities of Practice
• Didactics and case-based learning
• Chronic disease management
10

11. The ECHO Model
Copyright © ECHO Institute 11

12. Improving Professional
Satisfaction/Retention
Supporting the Medical Home
Model
Cost Effective Care- Avoid Excessive
Testing and Travel
Prevent Cost of Untreated Disease
(e.g.: liver transplant or dialysis)
Integration of Public Health into
treatment paradigm
Potential Benefits of the ECHO Model
Quality and Safety
Rapid Learning and best-
practice dissemination
Reduce variations in care
Access for Rural and
Underserved Patients,
reduced disparities
Workforce Training and
Force Multiplier
Democratize Knowledge
12

13. § Mission
§ Provide flexible clinical training for clinicians in the prevention of HIV infection and
care and treatment for individuals with HIV infection receiving care through military
clinics and hospitals.
§ Objectives
§ Train medical personnel with the goal of transferring appropriate knowledge and
technology.
§ Promote HIV prevention programs through training of military medical providers
including prevention with positives programming.
§ Enhance the clinical skills of clinicians in the monitoring, evaluating, and follow-up of
patients with HIV infection. 13

14. § Collaboration of the Naval Medical Center San Diego (NMCSD), University of
California-San Diego (UCSD), and San Diego State University (SDSU).
§ Provide clinical training in HIV-related patient management, epidemiology, and
public health.
§ Emphasize understanding of military policies and
procedures regarding service members with HIV/AIDS.
A “train the trainer” method provides the
tools and educational materials to promote
current, up-to-date instructions to be taken
back to military medical community.
14

15. § DoD Policies and Procedures
§ DoD Instruction 6485.01
§ Army Regulation 600-110
§ Air Force Instruction 48-135
§ SECNAV 5300.30D/E Instruction
§ Discussion and support for developing
military HIV policies
§ Recruitment
§ Troop testing
§ Messaging for HIV negatives
§ Care and treatment programs for positives
15

16. § Behavior change
communication
§ Social marketing
§ Health Communication
§ SHARP & SHIP
§ Infection control for
health care workers
§ HIV Testing Services
§ Index Testing
16

17. § HIV clinical management training
§ Antiretroviral therapy, resistance, adherence
§ Opportunistic Infections, treatment and management
17

18. — Continuation of the program begins once trainees have arrived at home.
— Thank you and a “Next Steps” letter is emailed to all the participants.
— Keep in contact with DHAPP and your Desk Officer
— Start training others on the staff – (Call home anytime)
— Follow-up in the countries is ongoing through a variety of mechanisms
but mostly through close monitoring and discussions with DoD HQ staff.
— Follow-up evaluations have occurred showing increasing knowledge of our
attendees over time.
18

19. San Diego
MIHTP
(1 month)
Regional
MIHTP
(2 weeks)
Virtual
MIHTP-
ECHO
Total Attendees 288 126 644 +
attendees today
Physicians 255 - -
Nurses 7 - -
Auxiliary 26 - -
Total Courses 44 5 9
Total Countries 66 28 41 + new
countries today 19

20. — Angola
— Belize
— Benin
— Botswana
— Burkina Faso
— Burundi
— Cameroon
— Chad
— Colombia
— Cote d’Ivoire
— Comoros
— Djibouti
— Dominican Republic
— El Salvador
— Ethiopia
— Estonia
— Eswatini
— Gabon
— Georgia
— Ghana
— Guatemala
— Guinea Bissau
— Guinea Conakry
— Guyana
— Honduras
— Indonesia
— Jamaica
— Kazakhstan
— Kenya
— Kyrgyzstan
— Lesotho
— Liberia
— Madagascar
— Mali
— Malawi
— Montenegro
— Morocco
— Mozambique
— Namibia
— Nepal
•Nicaragua
•Niger
•Nigeria
• Papua New Guinea
• Peru
• Republic of South Africa
• Russia
• Rwanda
• São Tomé and Príncipe
• Senegal
• Serbia
• Sierra Leone
• South Sudan
• Swaziland
• Tajikistan
• Tanzania
• The Gambia
• Togo
• Uganda
• Ukraine
• United Arab Emirates
• Uzbekistan
• Vietnam
• Zambia
• Zimbabwe
20
Updated 3/31/2021

21. 21

22. Allen McCutchan, MD, MSc, Professor
of Medicine, Emeritus (Active) in the
Division of Infectious Diseases,
Department of Internal Medicine,
University of California, San Diego.
• Associate Program Director of the
MAS in Clinical Research Program
• Co-Director UCSD Military
International HIV Training Program
• Co-Director, UCSD Training Program
in Clinical Research Methodology
22
..
Background
• Graduate of Yale School of Medicine
• Captain, Medical Core, US Army, with
service in US / Vietnam War
• Fellowship in Infectious Diseases, UCSD
• Masters in Epidemiology, London School
of Hygiene and Tropical Medicine, UK
• Founder & Director Emeritus, California
Collaborative HIV Treatment Group
• Author or coauthor of 320 peer-
reviewed research papers

23. COVID-19 Vaccine Update:
Implications for PLHIV &
Significance of Evolving Variants
Allen McCutchan, MD, MSc
Professor Emeritus
University of California, San Diego
Version 8 of 4-26-21
23

24. Current COVID Global and
African Epidemiology
24

25. WHO global statistics of COVID Incidence as of 4/25/21
(2.0 %)
(1.9 %)
25

26. WHO COVID Incidence by region as of 4/25/21
26

27. Weekly WHO COVID Incidence in African Region as of 4/25/21
27

28. COVID Daily Incidence in 16 African Countries
(7-day average of cases/day up to 4/25/21)
Epidemic curves of
incident cases vary
among African
countries
- Steady increases in
Botswana
- Recent peaks in Togo
and Cameroon
- Multiple peaks of in
Ethiopia, Kenya and
RSA
28

29. COVID Immunology,
target antigens and immune
responses to COVID infection
29

30. Role of vaccine “spike protein” in SARS COVID-19 life cycle
30

31. Neutralizing Antibody Blocks Binding of SARS COV 2
to ACE2 receptors on human cells
31

32. SARS spike protein binding to human ACE2 Receptor
Site of binding of neutralizing antibodies
32

33. Neutralizing antibody to SARS COV2
• NA is generated by both COVID infection and by vaccines.
• Covid antibody is relatively easy to measure in serum, but
measuring functional antibody (NA) is more difficult than
antibody that simply binds to spike protein.
• Higher levels of NA correlate with protection from infection and
decreased severity of symptoms if infected.
• Levels after COVID disease and vaccination vary by several
logs among patients.
33

34. Levels of neutralizing antibody (NA) after COVID vary
greatly at 1.3 months and decline over 6 months
NA titer
(Log 10 of
Inhibitory
Concen-
tration
(IC50)
Baseline levels at 1.2 months vary by 1.7 logs and decline at 6.2 months
by an average of about one log (ie, by 10 fold or 90%)
Gaebler C, et al Nature 2021 591:639
104
101
34

35. COVID Vaccines:
Design, Mechanisms, Effectiveness,
Safety, and Duration of Protection
35

36. Messenger RNA-based vaccines
m-RNA vaccine in
lipid nanoparticle
How m-RNA vaccine mechanism for
inducing immunity to COViD-19 spike
1) Nanoparticles containing m-RNA of spike
protein are injected and enter muscle
cells where they make spike protien
2) Antigen presenting cells activate B,
CD4+ and CD8+ T-lymphocytes to make
neutralizing antibody (NA) and cell
mediated immunity (CMI)
3) High levels of NA correlate with
protection in persons, but CMI may be
important to killing infected cells
NA
CMI
36

37. Cell mediated Immunity to COVID or Vaccines
37

38. (Refrigerator)
(Regular Freezer)
(Ultra-cold freezer) 38

39. 39

40. Assessing the effects of vaccines: issues
• Populations studied – In what type of population is the vaccine
being tested
• Efficacy – clinical trials in highly-selected volunteers for early
stages of research (phase I and II studies)
• Effectiveness - trials in persons who resemble those in the
community (phase 3 research studies and application in the public
health practice)
• What issues make make efficacy > effectiveness
• Greater adherence to taking medication (an issue only for two shot
vaccines) and to study visits
• More igorous adherence to conditions of storage such as low
temperature (very important for some COVID vaccines)
40

41. Assessing the effects of vaccines: issues
• Outcomes – What is counted as a success or a failure
• For persons before COVID infection
• Transmission of infection -> reduces risk of infection to others
• Reduction of illness severity -> prevention of severe illness and
death reduces burden on health care system (need for oxygen,
hospitalization, admission to IC), and management of the dead
by hospitals and funeral industry)
• For persons who have recovered from COVID infection
• Boosting of immunity to prevent reinfection
• Treatment of the long-lasting symptoms of post-COVID
illnesses (“long COVID” or “Post Acute COVID Sequela” =
PACS) - not yet well documented
41

42. Phase 3 study of effectiveness of Moderna vaccine
for preventing severe outcomes of COVID
93.0%
(CI 89-96)
80
5.6
Placebo - 80
Vaccine - 5.6
Incidence rate of COVID
cases / 1,000 pts)
Vaccine efficacy
Placebo
Vaccine
42

43. Comparison of efficacy among 8 COVID vaccines
Any
symptoms
Severe
disease
Neutralization of SARS COV2 variants
Britain Brazil South Africa
Vaccine
43

44. Moderna vaccine is less effective in older non-White patients,
but still very highly effective and appears to be similar by sex and race
Baden, LR et al Efficacy and Safety of the mRNA-1273 SARS-CoV-2 Vaccine NEJM DOI:10.1056/NEJMoa2035389 44

45. Local adverse events: more
common than systemic AEs and
only pain was much more common
after both vaccine injections
Pain
Systemic adverse events all
increased more after the second
vaccine injection than the first
Rates of local and systemic adverse events after Moderna vaccine
Any reaction 45

46. Rates of anaphylactic reactions to m-RNA vaccines
21 = 0.000011 10 = 0.0000024
1.8 M 4.0 M
Pfizer Moderna
46

47. Who can be vaccinated
and in what order.
47

48. How can COVID vaccines control the
pandemic: Herd immunity
• Herd immunity (community or population immunity) is the
protection from an infectious disease when enough of a
population becomes immune through vaccination or previous
infection, to protect the rest of the population.
• Factors that increase herd immunity are the efficacy of the
vaccine and the percent of the population that is vaccinated.
• Herd immunity can be achieved by a combination of natural
COVID infections and vaccination even if the vaccine is not
100% effective.
• Epidemiological models of COVID suggest that vaccine efficacy
must be > 60% when coverage is 100%, and at least 80% when
coverage drops to 75%.
48

49. Who should be vaccinated against COVID first?
• Higher risk of exposure
• Medical: hospital personnel, ambulance drivers, undertakers,
and chronic elderly care staff and patients
• Essential workers: police and fire, food transport and sales,
public transportation, school teachers and staff, etc
• Residents in congregates settings: eg, military, prisons, schools,
• Higher risk for severe disease and death
• Older age
• Obesity (BMI > 30)
• Diabetes
• Chronic lung diseases (COPD, emphysema, or bronchitis)
• Immunosuppression (HIV, cancer, cancer hemotherapy, other
immunosuppressive drugs (rituximab)
49

50. What do we know about COVID in HIV-infected persons
§ COVID-19 infection rates may be increased because of social
conditions or poor access to health care rather than increased
susceptibility.
§ PWH with a high burden of comorbidities and low CD4 counts have
an increased risk of hospitalization.
.
§ PWH have worse clinical outcomes reflected by more frequent ICU
admission and mechanical ventilation.
§ PWH seem to have 30 to 50 % higher death rates from COVID-19.
§ Most PWH make good antibody responses to SARS-CoV-2, but low
CD4:CD8 ratio could compromise immune responses to acute COVID
or vaccines. 50

51. Main messages about COVID Vaccines in HIV
• An unknown number of HIV+ person were included in
vaccine clinical trials without obvious problems.
• Expert guidelines encourage giving HIV and other immune-
suppressed persons high priority for COVID vaccines.
• More specific data on safety and efficacy needs to be
developed.
51

52. Should people who have recovered from COVID be
vaccinated?
Yes, because: COVID infection induces immunity, but it is
not as strong as after vaccines and vaccines are safe after
COVID
§ Reinfection rates are reduced by 80-90% of that in those
without prior COVID, but this protection is not as good as
after the best vaccines (~94%)
§ Levels of neutralizing antibody are not as high as those after
vaccination and decline over the first 6 months.
§ Adverse reactions are not increased
§ COVID vaccine trials included persons regardless history
of COVID: for example 2.3% (n= 235) of Moderna vaccine
recipients in the phase 3 trial had antibody evidence of
prior COVID, and had decreased risk for adverse
reactions
52

53. COVID appears to induce substantial
immunity (resistance) to reinfection
• COVID reinfection rate was 11% over 6 months of follow-up
in British health care workers who had antibody evidence of
prior COVID compared to those without antibody.. Thus
reinfection was reduced by 89% and the cases tended to be
mild or asymptomatic.
• A similar study of US Marine recruits during the first 6 weeks
of their stressful and crowded basic training period of found
COVID reinfections were reduced by 84%
• Reinfection in the general Danish population was a) reduced
by 80%, b) similar for men and women and c) similar from
before to after 7 months of follow-up. 53

54. How will the genetic variants in SARS COV 2 affect
vaccine effectiveness: COVID transmission and
severity
54

55. Genetic variants of concern in SARS COV2
§ Three major variants that have rapidly become dominant within
their countries and regions of origin and are spreading
worldwide;
§ B.1.1.7 (Britain)
§ B.1.351 (South Africa)
§ B.1.1.28 also called P1 (Brazil)
§ All three variants have genetic mutations that change the amino
acids in the part of the spike protein that binds to the ACE-R on
human cells called the receptor binding domain.
§ These mutations have spread to many other countries and
threaten to spread faster and resist vaccines
55

56. Genetics of 3 Major SARS COV2 Variants
British variant B.1.1.7
Amino acids
N = asparagine
Y = tyrosine
E = glutamic acid
K = lysine
56

57. Effects of 3 genetic variants on aspects of SARS COV2
epidemiology and control by vaccines
• Greater transmissibility : All 3 variants have outcompeted and
replaced the original strains in their regions of origin. The British
variant appears about 50-70% more transmissible than its
ancestor
• Increased disease severity: The British variant (B.1.1.7) has
increased COVID mortality by 55-60% compared to its ancestor.
• Resistance to vaccine-induced immunity: The Astra-Zeneka
vaccine provided less protection from symptomatic infection in
phase 2 and 3 studies (70% for B.1.1.7 vs. 82% for non-B.1.1.7) 57

58. Spread of the British (B.1.1.7) variant
from UK to Europe from 12/2 to 3/21
Estimated increase in transmissibility of this variant is 50-70%
58

59. Comparison of NA induced by 5 of 8 COVID vaccines
Any
symptoms
Severe
disease
Neutralization of SARS COV2 variants
Britain Brazil South Africa
Vaccine

60. SARS COV2 variants and cell mediated immunity
• T-cell immunity to SARS COV-2 is directed at over 500 epitopes
(targets) on the entire virus, in contrast to neutralizing
antibodies which are directed to a small part of the viral spike.
• Of the three main SARS-CoV-2 variants from Britain, South
Africa, and Brazil, only a single amino acid change occurs
where T cells attach to activate cell mediated immune reactions.
• Since only one mutation could enable escape by modifying T
cell recognition, CD8+ T cells generated by an initial SARS-
CoV-2 infection should provide protection to people exposed to
any of the 3 variants.
• This prediction has not yet been proven in studies of patients.
60

61. Reasons that COVID variants may be controllable
• SARS COV2 mutates relatively slowly, so the generation of
variants depends on the large number of infected persons.
• If vaccines can control the pandemic in spite of current
variants, their generation of should decrease.
• Since rapid, universal, world-wide control of COVID by
vaccination is unlikely, variants will continue to appear and
may reverse protection from current vaccines.
• mRNA-based and other vaccines may be easily adjusted to
protect against new variants
• T-Cell mediated immunity (CMI) is important to control of many
viral infections and the current variants do not appear to have
increased resistance to CMI.
• CMI is difficult to measure and its role in control of SARS
COV2 is not well defined.
61

62. What are the social, economic, logistical and problems
of vaccinating the global population
§ Target is the world-wide human population which is:
• >7 billion persons.
• widely dispersed geographically,
• socio-economically, politically, and religiously diverse,
• mostly poor and under-educated (especially, in science)
§ Many people may be unwilling to be vaccinated (~40 in USA).
Vaccine hesitancy is more common in older, less educated, and
politically “conservative” men.
§ Vaccines are moderately expensive, require refrigeration and
sterile injection equipment and at least some medical skills
§ Animal reservoirs and genetic variation may undermine the long
term effectiveness of vaccines 62

63. COVID Denialism, Delusions and Vaccine Hesitancy
• COVID denialism is false beliefs that the pandemic is either:
• A hoax (lie) by the government designed to justify controlling the
population
• Not as serious or widespread as government and media portray it
• COVID delusions and conspiracy theories include these false beliefs:
• Scientists created/released COVID either intentionally or by accident
• Scientists and public health officials are exaggerating the seriousness of
the epidemic for political reasons or personal advantage
• Restrictions on travel, large indoor gatherings, requirements for masks
and distancing are unnecessary and illegal.
• Vaccine hesitancy includes these false beliefs that:
• Vaccines are undertested and therefore may be dangerous
• The injections might contain devices that can locate and track recipients
63

64. Reasons Africans give for vaccine hesitancy
Top 5 reasons for not taking
COVID vaccine
64

65. Dealing with COVID Denialism and Vaccine Hesitancy
• Communicating effectively with patients or groups
• Establish the reality and seriousness of the pandemic and be
positive about the protective effects of vaccines, masks,
distancing, and avoiding crowds (especially indoors, for
example at bars, restaurants or religious services where
singing and chanting aerosolizes SARS COV2
• Explain being vaccinated can both protect them and allow
them to visit safely with friends and family using the promise
of more relaxed restrictions:
• Level 1: All are vaccinated -> no restrictions
• Level 2: You, but not others are vaccinated -> masks and
distancing
• Level 3: No one is vaccinated -> All restrictions apply, ie,
masks, distancing, ventilate or meet outdoors if possible 65

66. Summary of vaccines and variants
• Safety and efficacy of COVID-19 vaccines have exceeded expectations
with high levels of protection from severe disease and lesser, but still
high, levels from infection
• Local and systemic side effects are common and short-lived and more
serious adverse reactions are very rare
• Remaining questions include vaccine efficacy in special populations
(HIV, children, malnourished, TB co-infected) and durability of the
vaccine immune response
• Fair and efficient vaccine distribution to all persons globally is an
ongoing challenge
• Vaccine hesitancy threatens adequate vaccine uptake, which is
necessary to control the COVID-19 pandemic
• SARS-CoV-2 variants are spreading rapidly and may effect
transmissibility, disease severity and vaccine efficacy
66

67. Questions / Comments?
(15 Minutes)
67

68. Captain UO Adekanye
Assistant Clinical Research Officer
Ministry Of Defense Health
Implementation Program
United States Army Medical
Research Directorate
68

69. COVID-19 Vaccine Roll-out
Update in Nigeria:
Implications for PLWH
BY
CAPT UO ADEKANYE
MINISTRY OF DEFENSE HEALTH IMPLEMENTATION PROGRAMME-
UNITED STATES ARMY MEDICAL RESEARCH DEIRECTORATE-
AFRICA/NIGERIA
69

70. BACKGROUND
• Over 164,233 confirmed COVID-19 cases
with 2,061 deaths as of 19 April 21
• HIV prevalence is 1.4%
• PLHIV ≈ 1.4 up to 10x mortality from
COVID-19*
• Ending the pandemic depends on global
vaccine coverage
*Osibogun A, Balogun M, Abayomi A, Idris J, Kuyinu Y, Odukoya O, et al. (2021) Outcomes of COVID-19 patients with comorbidities in
southwest Nigeria. PLoS ONE 16(3): e0248281. https://doi.org/10.1371/journal.pone.0248281 70

71. Technical Working
Group set up –
Nov 2020
Trainings and
vaccine arrival /
distribution
- Developed policy documents, guidelines, protocols,
training manuals
Trained ~6,500 Immunization managers and trainers at
National level and state level.
- Step downs to LGAs and vaccination teams
- First batch of ~4.925 million doses of vaccines received,
distribution plan and launching for 6th March. Accountability
framework and private sector engagement
- Launch of TEACH* strategy and Electronic Management
of Immunization Data (EMID)
- Electronic URL launched with 2.3 million electronic
registration within 24hours
*TEACH: Traditional Microplan, Electronic registration, Assisted registration and House to House e-registration
PRE-VACCINE ROLL-OUT ACTIVITIES
71

72. Vaccination rollout - target 37.85M eligible Nigerians
with 57.3M doses of COVID-19 vaccines
▪ 1: frontline
workers
▪ Some 60-
69 years
6.2m
doses
of AZ
• 2.8m eligible persons
• using Fixed post (60%) and
Temporary Fixed Post (40%)
• Campaign mode (~10days) in
rounds
Target Priority
Group
Phase 1
Phase 2
Vaccine
expected Population to be covered + Strategy
▪ 2&3: ≥50 –
59-70+, 18-
49 years
with Co-
morbidities
34.3m
doses
(AZ)
• 16.7m persons
• using FP (50%), TFP (30%), MT
(20%)
• Campaign mode (10days) in rounds
72

73. Vaccination rollout - target 38 M eligible Nigerians
with 57 M doses of COVID-19 vaccines
Phase 3
▪ Priority Group 4:
Focus on states /
LGAs with highest
burden and those
missing first 2 phases
18.4m
doses
(J&J)
• 18.4m persons
using FP (70%), TFP
(30%)
• Routine mode +
campaign
• 16.7m persons
• Vaccinated using FP (50%), TFP
(30%), MT (20%)
• Routine mode
Phase 4 ▪ Remainder of
eligible population
as vaccines become
available
Based on
available
vaccines*
• 70.2m persons
using FP (50%), TFP
(30%), MT (20%)
• Routine mode
73

74. COVID-19 Vaccine roll out and implications for PLHIV
Source: Daily Call-In Data
• HIV+ HCWs and PLHIV aged 60 – 69y in
phase 1
• Phase 2 for PLHIV aged 18 – 59y
• Phase 3 covers PLHIV missed in phase
1 and 2
• Phase 4 for remaining eligible persons
• Data limitation to monitor coverage in
PLHIV
74

75. Comments / Questions (5 Minutes)
75
- MODHIP
- USAMRD-A/N
- NCDC
- NPHCDA
- PEPFAR
Acknowledgement

76. Overall General Discussion and
MIHTP-ECHO Close
(5 minutes)
76

77. UCSD:
Steven Wiersma, MD, MPH Michael P. Grillo, PhD, MS Michael Duszynski
Deputy Division Chief Director, MIHTP Program Manager
ECHO Coordinator Branch Chief Country Programs UCSD School of Medicine
steven.t.wiersma.civ@mail.mil Michael.p.grillo2.civ@mail.mil mduszynski@health.ucsd.edu
Lindsay Dapremont, MPH Jorge Martins Allen McCutchan, MD, MSc
MIHTP Coordinator DHAPP Professor of Medicine
Desk Officer ECHO Coordinator amccutchan@health.ucsd.edu
Lindsay.m.dapremont.ctr@mail.mil jmartins@gsshealth.com
Edward (Lalo) Cachay, MD, MS
Professor of Medicine
ecachay@health.ucsd.edu
Karen Chow
UCSD School of Medicine
kkchow@health.ucsd.edu 77

78. • A special thank you to Captain UO Adekanye for presenting today.
• If you have not done so yet, please confirm attendance by typing your
(1) first name, (2) last name , (3) email and (4) country in one line in
this chat box.)
• If you have not zoom registered, you can do so by using the link
provided in the chat.
• We appreciate your participation in a brief survey on this session that
will be emailed to you.
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79. This MIHTP ECHO Round has concluded.
Thank you.
79