PLHIV Community Welcome HIV Treatment Transition with Emphasis on Meaningful Involvement and Preparedness.
The Kenya PLHIV community affiliated to NEPHAK welcomes and supports the HIV Treatment Transition plans by the Ministry of Health with a strong call on the need for their meaningful engagement in the rollout of the transition plans. The PLHIV community through their representatives nominated by the NEPHAK (see photos above) also want the Ministry of Health and partners to support initiatives such as HIV Treatment Literacy to help improve the PLHIV preparedness for the transition and the changes that come with it. The Ministry of Health through the NASCOP is facilitating effective transition to more clinically appropriate regimens for children and adolescents living with HIV.
Antiretroviral treatment (ART) optimization is a key pillar in the AIDS-Free agenda to reach the goal of ensuring 95% of all infants and children have access to lifesaving treatment. Kenya has successfully scaled up pediatric ART reaching approximately 75,020 children living with HIV. Despite the tremendous gains, viral suppression is still sub-optimal amongst children and adolescents at 74% and 80% respectively in reference to the epidemic control goals of 95:95:95. The focus on children and adolescents living with HIV has gained momentum after it became apparent that they are some of the populations being left behind as the country works to accelerate the implementation of the fast track plan targets. Other populations being left behind include men and key populations comprising men who have sex with men (MSM), sex workers (SWs) and people who inject drugs (PWIDs)
Despite progress in recent years to provide ART to children living with HIV (CLHIV), attaining the third target of 95% viral suppression will remain an elusive goal without access to more effective treatment in age-appropriate formulations. Since 2013, WHO guidelines have recommended lopinavir/ritonavir (LPV/r)-based regimens for all CLHIV aged less than 3; however, the limited availability of a formulation suitable for infants and young children has remained a barrier to implementation. 2018 WHO Antiretroviral Therapy Guidelines update now includes dolutegravir (DTG)-based regimens as the preferred first-line regimen for infants and children aged 4 weeks–10 years.
NEPHAK and affiliate PLHIV networks are united in welcoming the transition because it means that the Kenya PLHIV community, including children and adolescents living with HIV, will now have access to better, safer and well-tolerated ARVs. For this to work, there will be a need for intensified and meaningful engagement of communities and especially people living with HIV who use and administer ARVs to their young ones. Such changes should also be accompanied by HIV treatment literacy to promote high-level retention to care and adherence to medication.
In supporting the transition, NEPHAK has also called upon the MOH leadership to ensure that the frontline HIV and TB programs staffing are provided with refresher training and drilled to comply with the requirements for new treatment. This call is based on the fact that health care workers are usually slow and reluctant to adopt new changes. The example has been seen with the dolutegravir based regimen where even after the WHO clarified that it is safe to use among women of childbearing ages, some health care workers are still discouraging women from transitioning to DTG.
In the proposed transition, the preferred treatment for 0-4weeks is AZT+3TC+NVP (orRAL) although NVP will be used in the absence of (RAL). At the same time, children of 20kgs and below should be given ABC+3TC+LPV/R and children of 20Kgs to 30kg or35 ABC+3TC+DTG. However, more deliberations are required. For the NEPHAK membership and the entire PLHIV community in Kenya, preference has been given to 30 kgs mark for the next level of treatment which is TDF +3TC+DTG which is also the WHO recommendation.
PLHIV Desperate Measures to Cope with ‘new Packaging of ARVs’.
In the last week's issue of this Bulletin, we shared about the proposal by the Ministry of Health and partners and especially the PEPFAR supported partner, USAID to change the packaging of HIV treatment medicines starting with the adult first-line ARVs. As we explained, the proposal is anchored on HIV differentiated care service delivery models. The proponents of the increased dosing in one package are basing their argument on the economic imperatives: It is easy to package and cheaper to transport (airlifting or shipping) and storage and ground transportation (distribution) is also cheap and simple. We stated that declining donor funding, economic and monetary arguments is the easiest and most plausible argument to put forth to support any change in the packaging of HIV medicines.
This last week, we reached out to our membership and asked what they will do or how they will cope should the proposal for bigger tins be implemented from the next month. Below are a few statements from volunteers on how they will cope. Listening to some of the proposed coping mechanisms, the main challenge has been and will continue to be carrying and storing the ARVs. As stated in the examples below, people are not comfortable being seen around with ARVs tins.
I am keeping the current smaller tins. So, I will be carrying the smaller tins to the facility. After I pick the new bigger tin, I will empty the medicines into the smaller tin and throw away the bigger tin … Male, 31 years, Kakamega County.
I have never carried even the smaller tins being used now. I usually take the medicines and put them in my bag. I will continue to do the same ... Female, 28 years, Kilifi County.
I am not carrying that bigger tin home. I will not. I will figure out what to do … Young female 19 years, Nairobi County.
Who needs those noisy tins? Who needs a bigger one? I think those responsible won't care. Let them bring the bigger tins. We won't pick them … Male, 27 years, Nairobi county.
I never keep such tins at home. I keep them away from home. Bring even a bigger container but my ARVs will stay only where I know and not at home … Female, 43 years, Kisumu county.
I have my bag to carry the medicines, I don’t need any container. I won't carry any …
Male, 33 years, Kisumu County.
PLHIV also need to be informed that depending on how medicines are stored either at home or anywhere, their potency can be interfered with especially if they are kept for more than two months. This should be part of the treatment preparedness and treatment literacy. Unfortunately, donors are no longer investing in community-focused interventions such as HIV Treatment Literacy. In the new proposal, some people shall be given ARVs for 4 or 6 months.
There is a proposal to package multi-month doses of ARVs in one container.
No end to AIDS without respecting human rights
Rico Gustav, ED, GNP+; Shannon Hader, Deputy ED, UNAIDS; Lucy Wanjiku, PYWV, and other dignitaries.
The Human Rights Council first examined the question of HIV and human rights 29 years ago, in 1990. Since then, it has been steadfast in its assertion that progress in the response to the AIDS epidemic is indissociable from progress on human rights issues. Today, as it discusses new recommendations on human rights and HIV, its work is more important than ever. A total of 48 countries and territories still maintain travel restrictions on people living with HIV. One in five people living with HIV report having been refused health care because of their HIV status, and in many parts of the world, people who use drugs and sex workers live in fear of arrest for being in possession of clean syringes or condoms.
Adolescent girls and young women are among those worst affected because of a lack of respect for their rights. In 2017, 79% of new infections among 10-19-year-old young people in eastern and southern Africa were among females. Inequalities and institutional barriers increase vulnerabilities and decrease access to services. Young people in 45 countries are unable to access sexual and reproductive health services or HIV testing services without parental permission.
At a meeting held on the sidelines of the 41st session of the Human Rights Council, co-convened by Brazil, Colombia, Mozambique, Portugal and Thailand, UNAIDS Deputy Executive Director, Shannon Hader, called on countries to dismantle barriers that prevent people from accessing essential services. “It has been four years since the world committed to ending the AIDS epidemic by 2030 and three years since the United Nations General Assembly adopted the High-Level Political Declaration on Ending AIDS, which included a commitment to remove human rights barriers by 2020. We have less than two years to deliver on that promise”.
The event marks the presentation of a report and recommendations on HIV and human rights being presented by Michelle Bachelet to the Human Rights Council on July 1. The report, resulting from consultations with civil societies, experts, governments and UN mandate holders in February, includes best practise examples, including on the training of health workers on ending stigma and discrimination, on decriminalizing drug use and same-sex sexual activity, model laws on HIV, the training of judges and lawyers, civil society advocacy, and international funding opportunities specifically for human rights programming.
“We cannot address the human rights dimensions of HIV without civil society, who plays a critical role” stated Rui Macieira, Ambassador of Portugal to the United Nations in Geneva. “The 2030 Agenda for Sustainable Development is an important agenda for people, planet, prosperity, peace, and partnership. In order not to leave anyone behind. States should increase their efforts to reach the most marginalized,” said Peggy Hicks, director of the Thematic Engagement, Special Procedures and Right to Development Division of the Office of the High Commissioner for Human Rights.
Member states will examine the recommendations that highlight how reforming criminal laws is critical to advancing progress towards the elimination of HIV, including laws criminalizing gender expression or adult consensual sex, including sex work and same-sex relations, as well as drug use. The recommendations include a call for strengthening cooperation at regional, sub-regional and global levels to support and invest in programmes and services that promote the right to health and rights of people living with HIV. This is important in the context of shrinking donor funding for HIV and health programmes, including in newly transitioned middle-income countries.
NEPHAK Weekly Bulletin is published by the Advocacy and Communications Office at the NEPHAK National Secretariat. Articles can be reproduced freely as long as NEPHAK is acknowledged. Further details can be obtained from The Editor Tel: 0720209694, Email:info@nephak.or.ke, Website: www.nephak.or.ke, Tweet us: @NEPHAKKENYA
