Imagine living in a remote village in Nigeria, dealing with HIV, and suddenly facing a heart issue or a kidney problem on top of it. In the past, you’d have to travel hours—or even days—to a teaching hospital for expert help. That’s exhausting, expensive, and sometimes impossible. But what if the experts came to you? That’s the exciting idea behind a program that’s changing lives and making HIV care smarter and fairer for all.

HIV care in Nigeria has come a long way, but the big question is, how do we make it last? How do we ensure we’re building systems that don’t just fix problems today but keep working strong for years, ensuring everyone gets high-quality treatment, no matter where they live or how much money they have? 

That’s the heart of the Enhanced Expert Support Initiative (E2SI)—a practical, people-first model implemented by ECEWS under the USG-funded ACE5 project. E2SI connects specialists from tertiary hospitals, like pediatricians, kidney experts (nephrologists), heart doctors (cardiologists), and infection specialists, with everyday health workers in rural clinics across Akwa Ibom, Lagos, and Cross River States. The result? People living with HIV get better care close to home, and government health workers gain skills that stay in the system.

So, how does E2SI actually work?

• Specialists visit rural clinics: Specialists visit primary healthcare facilities to provide consultations and review complex cases side-by-side with local staff.
• Learning happens on the job: Health workers learn on the job, watching and working with the Specialists to build confidence and expertise.
• Tough cases are solved together: Everyone discusses cases together, strengthening multi-disciplinary decision-making.
• Support continues between visits: Between visits, they stay connected online for advice and tracking progress.

The best part is that these specialists are already on the government’s payroll and do this work at little or no extra cost. It’s a win-win that strengthens the whole health team without relying on outside help forever.

At its heart, E2SI is about investing in people. When you mentor local actors, you create a ripple effect: Skills grow, communities thrive, and HIV care becomes something that endures. No more quick fixes that fade away; this is about real resilience.

E2SI demonstrates that sustainability is achievable when equity guides program design. It raises important questions for all of us working in HIV response: Are we creating programs that empower locals to handle things on their own? Can we design care systems that are reliable for the next decade or two? E2SI proves yes—we can. It ensures that every person, wherever they live, can access expert support and live a healthier, happier life. 

What Makes E2SI Sustainable?

Sustainability isn’t just about funding or drugs. It’s about people and systems:

• Mentorship over months and years, not one-off trainings 
• Shared expertise that stays inside the public sector 
• Capacity built in local teams, not just at top hospitals 
• Continuity, even when external support reduces