New hope for ending HIV

Shamiso Yikoniko

COVID-19 cases and mortality continue to rise globally resulting in extraordinary measures around the world to contain, slow the pace, or reduce the impact of the virus.

Of note is the necessary ‘evil’ where most countries have resorted to lockdowns at the peak of the pandemic in-country as a precautionary measure to slow down the virus.

The global death toll reached slightly above 230 000 and confirmed cases stood at 3, 2 million as of 3 May (WHO, 2020).

In Zimbabwe, as of 3 May 2020, there are 34 confirmed cases and four deaths.

The ongoing pandemic is elevating the concerns about the burden this pandemic could be having on people living with HIV.

While there is no evidence yet to prove how much risk Covid-19 poses for people living with HIV, there are possibilities that the pandemic could disrupt access to treatment, testing, and retention in care.

The Zimbabwe Government with assistance from its development partners has put in place measures for continuum of care for people living with HIV to guard the gains achieved so far in the HIV fight.
Multi-month dispensing of ART and TPT drugs

With the restrictions to movement imposed to minimise the rate of coronavirus transmission, some people living with HIV might not be able to access health facilities for anti-retroviral therapy (ART) refills and tuberculosis preventive treatment (TPT).

Tuberculosis (TB) and HIV are a deadly combination with TB being the number one cause of death for people living with HIV accounting for more than 30 percent of deaths (UNAIDS, 2018).

The effect of lockdown has already been felt in the early days of Wuhan, China and India due to travel restrictions where residents faced challenges in accessing HIV drugs.

Multi-month dispensing of ART of at least three months’ to a maximum of six months’ supply remains the most plausible option to prevent people living with HIV from defaulting and reduce the risk to the coronavirus infection to both themselves and health care workers serving their needs.

New hope
ART is the new hope for stopping HIV and it is, however, critical to stay on treatment. Adherence is critical in suppressing the virus and the level of drug concentration should be maintained so that treatment becomes effective.

Zimbabwe currently has 1, 4 million people living with HIV and 86, 8 percent of those are on ART while 86, 5 are virally suppressed (ZIMPHIA 2016).

ART helps people living with HIV live longer, healthier lives and lower the chances of passing HIV on to others. How does one adhere to ART?

By taking ART at the right time, following advice to take with or without food and avoiding any drug interactions.

While high adherence levels can be achieved in both resource-rich and resource-limited settings following initiation of ART, long-term adherence remains a challenge regardless of available resources.
Some people living with HIV stop taking their medication due to several reasons, among them fear of disclosure, faith healing, stigma and discrimination among other reasons.

If one defaults on treatment for whatever reason, the virus mutates and becomes resistant to drugs being taken thereby resulting in treatment failure and widening the treatment gap.

To avoid rates of HIV infection and HIV treatment defaulting to skyrocket during the Covid-19 pandemic, people living with HIV are encouraged to adhere.

Support systems
Sometimes adherence can be difficult. One may need to get used to the changes treatment makes in their life.

PEPFAR maintains that people living with HIV can sometimes be more likely than others to need extra help, from friends, family, neighbours, community health workers, and others. If one becomes sick, make sure you stay in touch with people who can help you.

Also make it a point to make sure you can maintain a social network remotely, such as online or by phone. This can help you stay socially connected and mentally healthy, which is especially important for people with HIV.

The HIV response relies heavily on peer outreach and peer support and with the lockdown it is next to impossible. Hence, it is important that health professionals make use of phone calls or electronic follow-up to support adherence to drugs and to give guidance on how to manage side effects.

All the measures being taken in Zimbabwe will contribute to avoiding potential disruption to HIV prevention, testing and treatment services during the Covid-19 pandemic and to ensuring that people living with HIV are not left behind.

Shamiso Yikoniko is the technical advisor Advocacy and Communications at Zimbabwe Association of Church Related Hospitals.