adminCatherine Murombedzi H I V Column
DEBATE can rage over the issue of commencing one on Anti-Retroviral Therapy (ART) the moment they test HIV positive and it is healthy that we can agree to disagree. When one gets a headache there are two reactions, either one takes a painkiller immediately or one tries to weather the headache by drinking lots of water and lying down etc.
It is how one chooses to manage the headache that counts. Currently when one tests HIV positive they require to have a CD4 count and a liver test function done. The CD 4 counts cells and see the balance between the red and white blood cells.
The white blood cells are defensive and when these are destroyed the immune system is thus damaged. The World Health Organisation recommends that one is commenced on ART at a CD4 Count of 500.
In 2011 WHO recommended a CD4 Count of 350 prior to that it was a CD4 count of 200. For Zimbabwe the upping of the CD4 Count to 500 meant 1 400 000 people needed to be catered for on the ART programme. The national programme run by Government in 2013 had 670 000 on ART. This meant more funding was needed to have all in need under the umbrella.
Today +500 000 people still need to be commenced on ART a feat that needs strong funding. Domestic fund has not been growing as anticipated as more firms closed shop. In 2013 the National Aids Trust Fund harnessed $36 million through the National Aids levy.
The national Aids levy taxes three percent of a worker’s taxable income not 3 percent of earnings so you can see that with the informal sector not contributing we are far from filling the jar although the national needs keep ballooning.
The Global Fund gave Zimbabwe $520m for HIV and Aids, TB and malaria for the period 2013 to December 2016.
Dr Meg Doherty of the WHO Department of HIV and Aids said the organisation will issue new guidelines later this year recommending treatment for all who test HIV positive, regardless of CD4 cell count.
Dr Doherty said this at a conference that ended in Vancouver, Canada last month. The new recommendation follows results from two large randomised trials, TEMPRANO and START, both released this year which showed that starting treatment at a CD4 cell count above 500 cells/mm3 resulted in less serious illness and Aids-related deaths than if treatment was deferred.
The new guidelines recommend that:
1. Treatment for adults and adolescents regardless of CD4 count, prioritising those with a CD4 count of below 350 cells/mm3 and those with AIDS defining illnesses.
2. Treatment for all children
3. Treatment for all pregnant women, leading to lifelong treatment (Option B+)
4. Pre-exposure prophylaxis should be offered as an additional choice for people at risk of HIV infection.
These new guidelines will further add weight to the UNAIDS 90-90-90. This aims to diagnose 90 percent of people with HIV, treat 90 percent of people diagnosed with HIV and achieve undetectable viral loads in 90 percent of people on treatment by 2020. UNAIDS is also pleased to announce that MDG 6 which aimed to halt the spread of HIV and have at least 15 million people in need of ART on treatment has been achieved.
“The treatment access target of 15 million people by 2015 was surpassed in March 2015. At the end of 2014 we had 40 percent of people living with HIV on treatment worldwide,” UN secretary general Ban Ki-moon reported in Geneva last month. When unveiled the new guidelines imply that 36,9 million people globally will need to receive anti retroviral therapy by 2020.
The new guidelines will present major challenges for countries, especially those that rely heavily on donor funding like Zimbabwe.
Brazil was given as an example of a country doing well in providing treatment for all who needed it since 2013.
That southern Africa carries the burden of more HIV infections is not arguable. In Zimbabwe the figure is high and when the new guidelines are unveiled it will mean more in need will not be catered for in the national basket.
Dr Iris Shiripinda, lecturer in the Faculty of Health Sciences at Africa University weighed in saying testing and treatment sounded good. However, there should be no blanket measure when responding to the pandemic.
“Testing and treatment sounds very good. However, I am rather concerned about these suggested guidelines especially in low resource countries where treatment is not yet available to all who are eligible for treatment as of today. Why does the WHO not ensure a 100 percent rollout first, at affordable prices?” Dr Shiripinda queried.
She went on to say life-long therapy was not easy and should be approached with caution.
“Secondly, issues of people having to stay on life-long therapies, taking medications day-in-day-out for the rest of their lives have proven to pose serious challenges. It is already hard to finish a course of medication for one week, so if people have to start therapy on just testing HIV positive irrespective of their state of health, is that not a sure way of predestined therapy failure and death. Lastly, WHO has this far not ensured supply, affordability and accessibility of ARVs to those who cannot afford them. I am rather baffled by this suggestion,” said Dr Shiripinda.
Care and retention seems to be lagging behind in Zimbabwe as we find that a person started on ARVs and faces treatment failure faces challenges.
Martha Tholanah a person living with HIV and an activist said treatment and care needs to be revised locally. She gave an example of a 35-year-old mother of two, single on ART and has been asked to take a viral load test. A viral load test is the golden standard to assess treatment success. At laboratories in town the test costs $80 to $100. At Newlands clinic and FACT Mutare where it is slightly lower it costs $35.
Is Zimbabwe able to cope given that at a CD4 count of 500 we still have many people living with HIV not yet commenced on ART?
Online Reporter