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New guidelines on HIV treatment excite patients

By Agengella Abushedde

But can caregivers raise the new money needed to implement them?

News that the World Health Organization (WHO) has recommended that antiretroviral therapy (ART) be given to HIV patients earlier has been welcomed by patients, medical personnel, and HIV/Aids activists.

WHO based its recommendation on evidence that earlier drug intervention helps people with HIV to live longer, healthier lives and substantially reduces the risk of transmitting the virus to others.

The new guidelines released on June 30 at an AIDS conference in Malaysia recommend that drugs be initiated as soon as a patient’s CD4 count falls below 500 cells per cubic millimeter of blood.

The CD4 count is an index for how much of the immune system has been destroyed; 500 is the bottom of the normal range while a patient below 200 is at high risk of fatal infections. Until the new recommendation, a CD4 count of 350 cells per cubic millimeter of blood has been the cutoff point recommended in Uganda for patients to be started on ARTs since 2010.

Margaret Happy, the gender advocacy advisor with the National Forum for PHA Networks in Uganda (NAFOPHANU) says she is very excited that more people will become eligible for treatment. But she is also aware of the reality.

“I am aware that even before the new guidelines there have been cases of people that are eligible for treatment but have not been receiving it,” she said.

Only 62 per cent of an estimated 600,000 people needing ARTs have been getting them, according to ministry of Health statistics.  While the new guidelines increase the number of people eligible for ART, it also puts more demands on health systems and increases the costs since it could involve a transition to more costly ART regimens and patient monitoring approaches.

The latest Stock Status Report issued by the ministry of health as of May 01 indicates that the ministry has had stock shortages of HIV test kits and specific ARVs from the National Medical Stores and Joint Medical Stores among other suppliers.

A 2009 study by the WHO in Uganda in 2009 put the cost of ART at between US$328.77 (Approx. Shs 820,000) and US$469.77 (Approx. Shs1.2 million) per patient per year depending on whether or not additional overhead and capital costs are included.

The cost of treatment has changed but remains far too high for most Ugandans and the government.

As a result, funding for most ART projects in Uganda is from the US Government through The US Centers for Disease Control and Prevention (CDC).

Asked whether Uganda’s leading HIV/AIDS care giver, TASO, will be able to supply medicine to new patients arising from the new guidelines, the Programme Officer Advocacy and Public Relations, Peter Okiira, was positive.

“We will continue to dialogue with all our partners including the government of Uganda on increased funding for HIV treatment,” he said. He said TASO has running contracts with their development partners which allow them to have enough treatment for the clients under their care.  Currently TASO cares for 100,000 persons living with HIV on annual basis.

The new guidelines recommend starting treatment immediately upon a positive HIV test and regardless of CD4 count for people with active tuberculosis, hepatitis B liver disease, discordant couples, women who are pregnant or breast-feeding, and children under five years old.

In rare cases when the infection is caught very early, some may even be able to safely stop treatment after a year or two.

Another new recommendation is to offer all adults starting to take ART the same daily single fixed-dose combination pill. This pill can be used in adults, pregnant women, adolescents and older children.

From a purely medical perspective, Dr Kaggwa Mugaga, the country advisor WHO, says the new recommendations are exciting.  “Advances like these allow children and pregnant women to access treatment earlier and more safely, and move us closer to our goal of an Aids-free generation,” he told The Independent in an interview.  According to an official, the ministry of health is planning a policy briefing with other stakeholders to discuss the adoption of the new guidelines.

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