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How community groups help people living with HIV achieve viral load suppression

Jennifer Atieno, 54, has been living with HIV for the last 12 years.

Ever since she tested positive to the virus and was enrolled for antiretroviral therapy (ART), Atieno has been taking her medication without failure.

When we, a group of journalists from the Media for Environment, Science, Health and Agriculture (MESHA) met her last week, she was in a group of other women and men who are also living with HIV in a homestead in Rarieda, Siaya County, in western Kenya.

They formed the group to encourage and advise each other to live positively with the virus. Their group known as Nyakongo Group has 12 members, who meet once every three months.

“In this group we discuss how best we can live and protect ourselves with regard to drugs we all take,” she said.

Before the group was established, Atieno got her medicine from a health facility after every three months. However, since last year when they formed the group she has been able to limit the number of hospital visits and save on transport.

“Each of us contributes Ksh10 and we give to one of us who goes to the facility and bring medicine for the 12 of us. We then agree on whose home we meet then each of us takes their drugs for the three months,” she said.

Nyakongo is one of the Community ART Groups (CAGs) under a programme supported by the Centre for Health Solutions (CHS), a Non-Governmental Organisation (NGO). The NGO has trained peer educators working under the programme.

“The groups should only visit hospitals twice a year because clients are supposed to take home drugs meant for six months,” said Millicent Kanyala, a peer educator at Madiany Sub-county Hospital in Siaya County.

“But they cannot go with the whole six months’ drugs, so they are given drugs for the first three months, then the refills are done after three months.”

CHS allows clients to voluntarily choose a community group they want to belong to. Members of each group has members who are familiar with each other to allow openness and peer interaction without fear of being stigmatised. Each group has a leader and the names and contacts of members are contained in the CAGs’ diary book.

“The diary informs me of when each group is supposed to visit the facility. So, I prepare the drugs well in advance and call their peer leader and tell them the date they will be taking drugs in their community,” said Kanyala.

CAGs are a model for ART distribution, where groups of people living with HIV rotate for clinic visits and drug refills while dispensing drugs to their peers in the community and ensuring peer support.

“The uptake is steadily good and every member wants to join community groups. So far, we have 90 community groups with a total of 822 members. In 2017 we only had 22 groups,” said George Nyakora, adherence counsellor at Madiany Sub-county Hospital.

In 2017 when Madiany Sub-county Hospital launched the programme, viral load (the amount of HIV in the blood) suppression was at 84 per cent. Mr Nyakora says this model has since helped the facility to achieve a viral load suppression of 96 per cent as at November 2021.

“Initially in 2017 the suppression cut off point was 1,000 copies/mL, currently it is 400 copies/mL. Anyone who achieves viral load suppression of below 400 copies/mL is considered to be doing well in terms of ART uptake,” said Nyakora.

He said viral load that is more than 400 copies/mL means the immunity level has dropped or is dropping and the likelihood of contracting opportunistic infections is very high.

***A MESHA (www.meshascience.org) Feature – December 2021

 

By Tebby Otieno

One Health the gateway to human, animal and environment wellbeing, say experts

Applied research through the One Health approach will lead to health investments that will accelerate economic development and reduce social inequalities, experts have advised.

Speaking to science, health and environment journalists, Delia Randolph, professor of food safety systems at the Natural Resources Institute in the UK, said One Health allows for integrated thinking across three sectors – human health, animal health and environment health.

Randolph, also a contributing scientist at the International Livestock Research Institute (ILRI), said One Health is therefore a collaborative, multisectoral, trans-disciplinary approach that cuts across the local, regional, national and global levels.

Bernard Bett from the One Health Research, Education and Outreach Centre (OHRECA) said One Health and the Sustainable Development Goals (SDGs) are closely linked.

One Health, he said, contributes to SDGs 1, 2, 3, 12 and 17 (no poverty, zero hunger, good health and well-being, responsible consumption and production, partnership). More so, the One Health approach contributes to SDGs 5, 6, 10, 15 (gender equality, water and sanitation, reduced inequality, life on land).

“Ending poverty and other deprivations goes hand in hand with improvements on health, education, reduced inequalities and economic growth,” said Mr Bett.

He said based on the One Health approach, genomic analysis of SARS-CoV-2, the virus that causes COVID-19, has boosted the capacity of COVID surveillance in Kenya.

In this regard, he said, testing for SARS-CoV-2 using qPCR has been ongoing at ILRI since 2020. A total of 24,398 samples have been tested and results shared with the Ministry of Health (MoH).

The ILRI laboratory where genomic analysis is ongoing is part of a network of facilities in the country that is supporting COVID-19 genomic surveillance.

Genomic analysis is the identification, measurement or comparison of genomic features such as DNA sequence, structural variation and gene expression. Essentially, genomics is the study of genes that makes it possible to predict, diagnose and treat diseases more precisely.

Bett said the genomics laboratory “has received additional funding to the tune of $1 million from the Rockefeller Foundation to support genomic surveillance of SARS-CoV-2 in the Eastern Africa region.

He also delved into intersectoral collaborations for rabies control in Machakos, saying that Kenya has increased coverage of control measures.

This is a step in the right direction as rabies remains a serious public health issue. Canine rabies, he said, causes an estimated 55,000 deaths annually across Africa and Asia.

As such, with the most effective strategy towards minimising human exposure being controlling rabies in dogs, OHRECA and VSF Germany are in collaboration to develop sustainable and scalable vaccination strategies for rabies through the One Health approach. Bett said that through the collaboration, the target is to vaccinate 200,000 dogs per year.

“New knowledge on the impact of climate and land use change on zoonotic diseases occurrence is being used for contingency planning,” he said.

OHRECA is leading studies to identify drivers of Crimean Congo hemorrhagic fever in Burkina Faso and Rift Valley in Kenya.

On institutionalising One Health in Kenya, Dr Athman Mwatondo, who is the co-head of Zoonotic Disease Unit at the Ministry of Health, said the Unit was formed between line ministries of human and animal health.

Established in 2012 through a Memorandum of Understanding (MoU), the Unit’s structural office is in Kenyatta National Hospital grounds, at the MoH grounds.

The Zoonotic Unit, Mwatondo said, has a mission to “establish and maintain active collaboration at the animal, human, and ecosystem interface towards better prevention and control of zoonotic disease.”

The Unit’s priority areas of outbreak investigation and response include the Rift Valley fever, anthrax and rabies, with a view to particularly eliminating rabies.

Mwatondo spoke of the need to create sustainable county level One Health platforms that will facilitate the devolution of the One Health approach.

Progress thus far includes the epidemiological investigation of a Rift Valley fever outbreak in humans and livestock in Kenya in 2018. Outbreaks of the Rift Valley fever were recorded in Wajir and Siaya counties in 2018, Murang’a from 2019 to 2021 and Isiolo in 2020 and 2021.

There was also an investigation of recurrent anthrax outbreaks in humans, livestock and wildlife from 2014 to 2017.

Mwatondo said rabies elimination activities include improving access to post-exposure prophylaxis and rabies education and awareness. Thus far, he said, there has been coordinated mass dog vaccinations in two pilot counties.

Mwatondo said the challenges in implementing the One Health approach include difficulties in coordinating multiple partners and operationalisation difficulties such as high staff turnover.

He said there is a need for domestic funding of One Health activities for sustainability purposes and to understand and adapt because the One Health approach is not a one size fits all.

By Joyce Chimbi

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Surgeries take back seat as Coronavirus rages

In March last year when COVID-19 was first detected in Kenya, the country’s 47 governors rushed to set up isolation centres in their respective counties.
The centres were to be equipped to deal with the rising numbers of patients who had contracted the disease.

Several months later, hospitals were jammed with COVID-19 patients, forcing governors to redeploy healthcare workers to concentrate on battling the pandemic.

This move led to stalling of some critical medical procedures and services such as surgery, leaving those in need in pain after Intensive Care Units (ICU) were dedicated to deal with serious COVID-19 patients.

For healthcare workers in most public hospitals, it was a delicate balancing act, as they dealt with the pandemic while trying not to ignore other critical medical procedures that patients needed.

At the Coast General Teaching and Referral Hospital (CGTRH) – the largest hospital in the Coast region, which serves Kwale, Kilifi, Taita Taveta, Tana River, Lamu and Mombasa counties – surgeons were forced to come up with alternative plans to help prevent their patients from succumbing to their ailments.

“I had to take care of my patients. Because there were no surgeries; it meant taking care of their medical condition through medicines just to keep them going,” said Dr Peter Sore, a cardiac and thoracic surgeon who heads the heart clinic at CGTRH.

Dr Sore said surgeons at the hospital were forced to come up with initiatives to manage patients suffering from chronic illnesses.
The specialist had planned to operate his critically ill patients only to shelve their surgeries due to COVID-19 and instead focused on relieving their pain.

“It was sad watching our helpless patients die; we could not do anything since theatres had been turned into COVID-19 facilities,” On March 22 this year, the doctor was heartbroken when the much awaited resumption of open heart surgery at CGTRH was cancelled.

“Everything was set for resumption of the open heart surgery. We were collaborating with our specialist colleagues from Kenyatta National Hospital who were to travel to Mombasa for the operations, but could not after President Uhuru Kenyatta announced lockdown in five counties with high infection rates including Nairobi. That was a major setback,” said Dr Sore.

At his clinic in the facility, he used to attend to 25 patients but nowadays only 10 patients turn up. “Surgeries are crucial for patients’ survival,” said Dr Sore.

CGTRH has six main operational theatres. However, shortage of ICU staff has been another major challenge.

“Some of the staff who were manning the ICU for surgical patients were redeployed to take care of those battling the virus. It was sad that surgeries could not be performed because

ICUs were converted to COVID-19 facilities to take care of those battling the virus,” added the senior doctor.

The specialist is among doctors who have been conducting surgeries on COVID-19 patients with surgical issues.

Dr Sore said he was distressed when some of his patients succumbed at home due to the pandemic.

“My patients were afraid of the hospital, saying they could contract COVID-19, but their conditions, which needed surgeries, worsened day by day. I knew things were really bad when one of my patients who needed an endoscopy succumbed because we could not do the crucial surgery to save his life,” said the medic with over 30 years’ experience.

To ascertain the extent of COVID-19 impact on healthcare, Dr Sore advised the government to conduct research to show how the disease has affected Kenyans.

“COVID-19 has affected surgery practice, slowing down our work and leaving our patients in agony. We have new procedures; before conducting any surgery, you have to do a COVID-19 test,” he said.

Dr Hemed Twahir, an official of the Mombasa County COVID-19 Response Committee, said the pandemic has brought to the fore critical health issues that should be addressed.

“The most important lesson I have learnt is why we must enhance and strengthen primary healthcare. A lot of what is happening could have been handled better and a lot of positives that have been witnessed is because we have managed to strengthen primary healthcare,” said Dr Twahir.

The medical director at the Aga Khan Hospital in Mombasa lauded the government for incorporating community health workers who have enhanced contact tracing and hygiene in communities.

“The basic primary healthcare unit is very crucial. In the future, we should learn that treating a problem is more expensive than prevention. I have learnt that you cannot deal with a pandemic on your own,” Dr Twahir added.

The pediatrician said the world managed to control Spanish flu in 1918 better than it has done with coronavirus.

“Because there wasn’t as much traveling as currently. If we put ourselves together globally, we can come up with appropriate good outcomes. Within a year of coronavirus vaccine, we have had malaria vaccine coming up, that is a very big lesson,” he said.

Due to the pandemic, Dr Twahir said most hospitals have now strengthened their health systems, especially for critical healthcare.

“For a long time a lot of health institutions all over the country were lacking critical care, essential things like oxygen and ICU. But COVID-19 has taught us that we need to be prepared in taking care of critical care patients, counties have now gotten ready,” said the pediatrician.

Mombasa Governor Hassan Joho resolved to improve accessibility to quality and dignified affordable healthcare with heavy investment in medical infrastructure, equipment and human capital.

“We are strengthening the local healthcare systems, enhancing training and capacity building of our medical staff while also increasing awareness of respiratory complications in the community,” he said.

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Telemedicine’s vital role in HIV management during the pandemic

Not only did COVID-19 trigger panic among people living with HIV as the initial fear, anxiety and stigma created scenes reminiscent of when HIV/Aids was declared a national disaster, it also triggered a series of events that could have serious ramifications for them.

HIV experts and activists such as Justus Oluoch based in Kisumu County now decry the great shift from HIV/Aids prevention and response to COVID-19. It all began with the Kenya Medical Research Institute suspending all HIV viral load testing to focus on the coronavirus back in April 2020.

“Granted, the pandemic was unexpected and extremely overwhelming, so something had to give, especially because ours is a cash strapped health infrastructure,” Oluoch, also a clinician working in a Prevention of Mother to Child Transmission (PMTCT) programme, explains.

“Machines used to process HIV samples for viral load tests and Gene-Xpert machines used to test tuberculosis (TB), which is a prevalent HIV-defining disease, are being used to process coronavirus samples,” he expounds.

In the last decade, research has shown the extent to which a viral load test is critical for initiating patients newly tested for HIV on treatment and is routinely used in monitoring and management of HIV patients throughout their lives.

Oluoch cautions that at the moment, nationwide, viral load tests cannot be undertaken because of a stock out of viral tubes used to collect samples, also a consequence of the pandemic.

These, among many other challenges, have necessitated the activation of telemedicine to ensure HIV patients continue to receive optimum care and at the same time are protected from COVID-19.

Telemedicine has especially become critical within the context of lockdowns and travel restrictions and, a fear of patents visiting health facilities for fear of contracting COVID-19.

“I lived in Kisumu County when I first got tested and my interactions with nurses and clinicians were very good. I was responding very well to treatment and my viral load was very low or what they call undetectable levels, which means that I could not transmit HIV,” says Francis Onyango*.

Four years ago, Onyango got a job transfer to Nakuru County where he is still based. However, he did not transfer to a facility in Nakuru for fear of stigma in case his HIV status was discovered. Besides, he preferred his primary facility back at home because HIV case management was very good.

And his story is not unique especially among patients who visit health facilities for routine check-ups every one month or every three months, depending on circumstances.
Some patients have faced serious difficulties as lockdowns and travel restrictions have characterised the last 16 months of the pandemic in the country.

“This is why telemedicine has become important in the management of HIV patients. Besides those seeking treatment far from their areas of operations, some counties are expansive and patients rarely seek treatment in their areas of residence.

People move from one sub-county to the neighbouring sub-county in search of treatment because stigma and discrimination is still a reality,” Olouch says.

Anita Nyambura, a consultant laboratory technician with a private hospital in Nakuru County, states that telemedicine is the provision of health services, in this case for people living with HIV through a wide range of platform such as video, phone calls, social media and mobile phone apps designed for this very purposes.

She says that telemedicine is especially popular among adolescents and young people and across age and gender as it minimises clinical visits.

“Patients responding well to treatment are often provided with antiretroviral drugs to last them for a period of three months and in the intervening period, they maintain contact with their health care providers through telemedicine,” Nyambura expounds.

She adds that one of the primary benefits of telemedicine is that it helps retain patients in HIV care, especially those who live far from their primary health facility.
Telemedicine also provides privacy for patients concerned about revelation of their status if they are seen attending a HIV clinic. The system also provides flexibility in terms of booking and scheduling appointments.

“Retaining patients in HIV care and treatment is critical especially because patients lost to follow up or patients who have not visited their primary health facility for more than 30 days and are feared to have stopped treatment, are vulnerable to advanced HIV disease,” says Olouch.

“Advanced HIV disease or progressed HIV patients have a low CD4 count of less than 200. They have a high viral load, meaning that the amount of HIV in their body is very high.

They can easily transmit it and they are extremely vulnerable to diseases such as TB, meningitis and now, we are seeing a type of cancer called Kaposi sarcoma and cervical cancer among women of reproductive age,” he expounds.

Emerging research into the use of telemedicine to manage HIV patients has shown high patient satisfaction rates and a willingness among patients recruited into ongoing studies to continue with the new approach.

Despite emerging data showing that telemedicine is important in providing critical care for HIV patients, the approach is still in its nascent stage but nevertheless gaining pace.

In Kenya, for instance, as of February 2021 and in a move necessitated by the pandemic, the Kenya Medical Practitioners and Dentists Board Council (KMPDC) had approved 20 hospitals to roll out telemedicine services amid COVID-19 containment measures.

“Telemedicine is not an innovation that you roll out just because you can, it needs regulation and issued approvals are subject to review every three months. Still, the country is yet to enact laws regulating telemedicine but in the meantime, the e-Health guidelines of 2019 provide a guiding framework,” Nyambura observes.

She further says this approach may present a number of challenges especially in the prevention of HIV as it seems to work best among patients already in HIV care and treatment who are responding well to treatment.

Nevertheless, as the pandemic unfolds and with a need to keep HIV patients protected from COVID-19, telemedicine is a critical intervention that simply cannot be ignored, experts emphasise.

*Names changed to protect identity

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Weather forecast app to help farmers reduce losses

The unpredictable weather conditions caused by climate change has become prevalent, forcing farmers to rely on speculations while farming. This has greatly affected crop yields and lowered productivity.

With over 80 percent of farmers dependent on rain-fed agriculture, there is a need to be able to predict the weather patterns in order to plan accordingly.
To address the issue, the Kenya Agricultural and Livestock Research Organisation (KALRO) has developed a digital app to help farmers easily access weather information.

Researchers believe if farmers use the online weather platform, it is possible to adapt or mitigate the effects of adverse weather conditions through predicted weather forecast.
Irene Kimani, KALRO ICT specialist, says the Kenya Agricultural Observation Platform (KAOP) is a forecasting tool that assists farmers to monitor weather through their mobile phones.

She says KAOP is able to provide data on previous rainy days and predict long-term trends.
“KAOP is an app that has been giving me accurate information on weather forecast and some agronomy advisory services. Some of the information I have been getting is like the rainfall amount to be expecting and when to plant, harvest and what to grow at a particular season,” says Margret Wambui, a farmer in Njoro, Nakuru County.

Wambui, who is also an agrovet shop attendant, says since she started using the app, she has advised many farmers visiting her shop using the application.
“I share the information I get from KAOP with my customers when they come to buy seeds or chemicals. I ask them where and when they want to plant and I check on weather conditions for that particular day because some chemicals work best with minimal rainfall, otherwise they will incur losses and blame the chemical for not working,” she says.

Using the online application, farmers can now get weather information for seven days before and after.
Kimani says the application is designed to provide agronomic advisory services to farmers by providing information on actions they need to take in the various stages of farming, including soil preparation, sowing, adding manure and fertilisers, irrigation, harvesting and storage, as well as marketing period based on the weather conditions predicted.
Collins Kipchumba, a farmer in Njoro Rumwe farm, says since he started using the app, his production of Nyota beans has doubled.

“I learnt about the app in a farmers’ platform and since I started using it my bean production has increased from four bags per acre to eight bags per acre. For instance, if I want to spray, the app will indicate the strength of the wind in a particular day. If it is windy I will postpone my spraying to a calmer day to avoid losses, says Kipchumba.

“When I want to harvest, I use the app to check weather conditions to avoid post-harvest losses that maybe caused by rains.”
John Maina, Agriculture Chief Officer in Nakuru County, says the county has introduced this platform to farmers.

“By embracing the technology they have been able to bring the youth onboard who are particularly encouraged to download the app and use the information to do farming,” Maina says.

“This technology is assisting to know or predict how the weather is going to be in good time and give the farmers an opportunity to plan their production.”
The ICT specialist notes that the technology is 95 percent accurate, has the capability of forecasting weather within a radius of 9km and can zero-in on an individual farmer’s farm.

“Through the system, farmers get advisory services in time, hence alleviating losses they incur because of climate change. In the wake of Covid-19 pandemic, and at a time when traditional in-person farmers’ visits have been severely constrained, such phone-based advice is cost-effective and plays a key role in improving the productivity in farmers’ fields,” says Maina.

The tool developed by KALRO is among the ICT-based applications that KALRO is leveraging to bridge the gap of access to information between researchers and farmers, especially during Covid-19.
Since its launch, there has been increase of downloads by over 5,000 and 2.7 million website visits.

This indicates that the uptake is good and that farmers now have an easier way of seeking assistance from agricultural experts through the incorporation of digital technology into agricultural research.

Besides the KAOP technology, there are over 30 mobile applications that have previously been launched by KALRO to assist farmers with systematic information on how to manage crops. In addition, other apps address fall armyworm reporting and mapping, grey leaf spot disease resistance maize varieties and maize lethal necrosis disease control.

The technology is 95 percent accurate, has the capability of forecasting weather within a radius of 9km and can zero-in on an individual’s farm.

 

How to access: KAOP is easily accessible as a mobile app via google play store by downloading on https://play.google.com/store/apps/details?id=com.andromo.dev724321.app929771 or through a website www.kaop.co.ke .

Issue--July-2018

The catch 22 situation in using HIV self-test kits

Several years ago, Tony  Nyongesa, who lives in Nairobi, would walk into a health facility every three months to test for HIV.

This was until last year when he learned of the self-test kit from a scientist friend.
“I first visited him in his office where he tested me and I saw how it worked. He then gave me two kits and instructions on how to use them.

I went home and my wife and I took the test together,” Nyongesa narrates. The 32-year-old teacher says they received their results in less than 10 minutes. He admits this option has saved him and his wife fear and stigmatisation from people.

He still takes the test every three months, only that this time he uses the self-test kits, thanks to his friendship with the scientist.

“Before I could go for a test, I was very worried of people talking. I would also ask myself, ‘what will happen to me if I test positive’,” he says.

Gideon Oduk, a resident of Busia County, has also used the self-test kit. He says in 2019 when he wanted to know his HIV status, he walked into a support centre in the area where he was given the kit.

“I talked to a friend who does HIV testing and counselling and he gave me a kit and told me how to use it,” Oduk says.

He says his worst moment was the period he was waiting for the result. He says he was apprehensive of what would happen next if the result turned out positive.

“I used it once and I have not had reasons to do another test. Self-test is more confidential,” he says.

For a musician based in Nairobi, however, he first and last heard of self-test kits in a local radio programme. He says he heard a guest in the show talk about it and how easy it is for one to test at the comfort of their homes. Unfortunately, he has never seen the kit or heard of it again.

“The government should supply more self-test kits and make them available to the local people. They should also do more awareness,” he urges.

The kits have been supplied in some institutions of higher learning. They are also available in health facilities, some at a fee and others for free.

A counselling psychologist specialised in HIV, Alfred Nandwa, says the self-test kit is a remarkable step in the fight against the scourge, but it has its own challenges. For instance, it may at times give false results, which is dangerous.

“When you walk into a health facility for a test, there is usually pre-test and post-test counselling. But in using self-test kits there is no counselling, which is also dangerous,” says
Nandwa.

If the test result is positive, says Nandwa, the person is supposed to visit the nearest health facility for a confirmatory test. He also raises a concern about partners accepting the results, saying some may live in denial.

“When people in a sexual relationship decide to do self-test then one turns out to be positive and they have had unprotected sex, a dangerous fight may ensue between them,” says Nandwa. In doing a self-test, one can either use blood base or oral base sample, which you swab from your gums.

Prof Kenneth Ngure of Jomo Kenyatta University of Agriculture and Technology (JKUAT) says selftest kit is mostly targeted at men because they have a poor health seeking behaviour and their uptake of HIV services is lower.

“They are known as screening tools. So, when the result is positive or one is unable to interpret it, they are required to go to a facility for confirmation. However, for a negative result, you don’t need to go for confirmation,” he said.

Prof Ngure was speaking during a science café on HIV prevention organised by the Media for Environment, Science, Health and Agriculture (MESHA) on August 28, 2021. The café was attended by science and health journalists from Kenya.

Kenya launched the self-test kit in 2017 in response to the low testing rates, especially among young men.

According to UNAIDS, in 2015, there were an estimated 78, 000 new HIV infections in Kenya. UNAIDS report also indicates that around 400,000 of the 1.5 million people living with
HIV in Kenya by then did not know that they had the virus and so did not seek life-saving treatment.

 

By Tebby Otieno & Godfrey Ombogo

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Kenya receives strawberry-flavoured ARVs for children

Kenya is expected to roll out the strawberry-flavoured tablet for children living with HIV anytime, having received the first shipment in July.

Unitaid, a global agency that raises money for HIV interventions, confirmed it had distributed 100,000 packs of the dolutegravir formulation in Kenya, Nigeria, Malawi, Uganda, Zimbabwe and Benin.

“Thanks to Unitaid and CHAI_health, children in Nigeria, Malawi, Uganda, Kenya, Zimbabwe, and Benin now have access to the best HIV medication adapted to their needs,” Unitaid said in a tweet on July 29.

This was also confirmed by Unitaid spokesman Herve Verhoosel in a statement to Reuters.

“With the recent delivery of the formulation in those 6 first countries, this project is now a reality,” Verhoosel told the news agency.

Unitaid, Clinton Health Access Initiative (CHAI), and national ministries of health are partnering with the US President’s Emergency Plan for Aids Relief (PEPFAR) to drive early access to the drug in the six countries to generate feedback on early use, to help inform wider adoption and scale-up.

Jacqueline Wambui, a Kenyan activist who has lived positively for 17 years, welcomed the development.

“The issue is so touching to me personally. Just to realise that the children seemed to be having difficulties in taking the syrup because it was too bitter.

We have come a long way with medical formulations for paediatric HIV,” she told members of the Media for Environment, Science, Health and Agriculture (Mesha) in a webinar on August 27.

She added: “We have moved from pills to a syrup to a pellet that was mixed with food, which was also difficult for some of the children. It is our hope that more of such innovations will be designed to make HIV care a pleasant experience for people living positively, including the children.”

The new dolutegravir formulation is the first-line HIV treatment recommended by the World Health Organisation (WHO) from the age of four weeks and 3 kilos (6.6 pounds).

However, it had been out of reach for babies because of the lack of appropriate formulations.

To make it accessible, Unitaid and CHAI last December reached a pricing agreement with the generic drugmakers, Viatris and Macleods, to buy the formulation at a yearly cost of $36 per child, down from around $400.

The DTG is more effective, easier to take for children, has fewer side effects than alternatives, and has a high genetic barrier to developing drug resistance. It is expected that it will enable children to successfully remain on medication and prevent thousands of premature deaths each year.

“This groundbreaking agreement will bring quality assured dispersible DTG to children at a record pace. Ensuring access to this treatment will transform the lives of children living with HIV, helping them to remain on treatment and saving thousands of lives,” said Unitaid’s Executive Director Philippe Duneton in a statement in December 2020 when the
agreement was made.

In 2020, after the deal was announced, Kenya’s Health Cabinet Secretary, Mûtahi Kagwe, said, “Kenya intends to be a first adopter of the new paediatric DTG 10mg
formulation, which will improve treatment, reduce unpleasant side effects, and help children to adhere to their treatment and live healthy lives.”

He added: “We are delighted that for the first time Kenya and other countries can provide children the same quality of treatment as adults, which has been made possible through the development of this new formulation.”

By John Muchangi

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Back to drawing board for HIV vaccine search

The journey to search for HIV vaccine will take longer. This is after data showed that an investigational HIV vaccine regime did not provide sufficient protection against HIV infection.
The study known as Imbokodo (HVTN 705/HPX2008) was carried in a population of 2, 637 young women in Malawi, Mozambique, Zambia, Zimbabwe and South Africa who are at high risk of acquiring HIV.

Although the clinical trial for the vaccine has failed the efficacy, the vaccine was found to have a favourable safety profile with no serious adverse events.

“The Imbokodo vaccines did not contain HIV and the vaccines were therefore unable to transmit HIV to study participants. All women who joined the study were always provided risk reduction counselling on ways to keep healthy and prevent HIV acquisition,” reads the statement from Johnson & Johnson, the manufacturer.

In what has become an all too familiar outcome in the decades-long search for an effective human immunodeficiency virus, acquired immunodeficiency syndrome (HIV/AIDS) vaccine, yet another candidate has failed in a large-scale study.

“We have to fundamentally relook at what we’re doing,” said Glenda Gray, who heads the South African Medical Research Council and oversaw the protocol for the trial, which compared the efficacy of the vaccine to a placebo.

The study tested whether the Imbokodo vaccine regimen could prevent women from getting HIV. Over 2,000 women were enrolled and given four different shots over 12 months. The first jab, meant to ready (prime) the body to produce defences against the virus was administered followed by two booster shots. Vaccinations were completed in June 2020.

The results, announced on August 31, 2021 by J&J in a press release, found 63 infections in the placebo group compared to 51 in participants who received the vaccine whose efficacy was 25.2 percent—too low to make it useful.

Even though the vaccine, supported by both the U.S. National Institute of Allergy and Infectious Diseases and the Bill & Melinda Gates Foundation, was found to be safe and did not cause any harm, it had a wide “confidence interval” in that result, and it did not reach statistical significance.

Confidence intervals measure the degree of uncertainty or certainty that something like a vaccine will be effective.

“The trial held great promise that it might prevent HIV but findings showed the vaccine does not provide sufficient protection. There was some hint that it was partially working which is not strong enough to get it licenced hence the trial has been stopped,” explained Mitchell Warren, executive director, AIDS Vaccine Advocacy Coalition.

According to experts, so far, the Imbokodo study has produced “more” promising data than two other disappointing AIDS vaccine efficacy trials.

“We always hope that efficacy trials will show positive results that lead directly to new prevention options,” noted Mr Warren. “It is very disappointing that this particular vaccine candidate did not work in this trial, but the trial was well-conducted and got an answer quickly.

HIV remains a global threat, and a safe, efficacious, and accessible HIV vaccine is still needed to contribute towards curbing new infections and providing a durable end to the
pandemic. In 2020, there were 37.7 million people living with HIV, with 53 percent being women and girls. The UNAIDS estimates that about 6.1 million people did not know that they
were living with HIV in 2020.

J&J’s chief scientific officer, Paul Stoffels, says despite the failure, a second efficacy trial of a similar vaccine in a different study population will continue. That Mosaico trial, which is taking place in the Americas and Europe and started in 2019, involves 3,800 transgender people and men who have sex with men.

“This is in no way the end of the search for an HIV vaccine,” added Warren. “We still hope for a positive outcome from the ongoing Mosaico and PrEPVacc studies, which combines evaluation of experimental HIV vaccines and pre-exposureprophylaxis in East and Southern Africa from 2018 to 2023.

Warren spoke during a webinar attended by scientists and journalists which was hosted just few hours after the announcement of the HIV vaccine failure report, on August 31, 2021.

By Elizabeth Merab & Tebby Otieno

Pre-Exposure Prophylaxis uptake is gaining momentum

A HIV prevention expert has urged Kenyans to continue using Pre-Exposure Prophylaxis (PrEP) as it has proven effective in reducing risk of infection transmission.
Prof Kenneth Ngure, in his address at the 39th edition of Science Media Cafe by the Media for Environment, Science, Health and Agriculture (MESHA), says the
uptake of PrEP was encouraging, especially among key populations.

“One of the main challenges to the uptake of PrEP as a prevention method has been the delivery which requires one to visit a health centre. Innovation on delivery models has seen an increase of one hundred and ten uptakes in the number of people getting on PrEP globally,” he said.

Further, he noted that in addition to the oral PrEP model, WHO has recommended using Dapivirine Vaginal Ring as an HIV prevention method.

According to Prof Ngure, the global target was to have three million people on PrEP before 2020. As at 2021, it is estimated 1.3 million people are on this prevention method.

Oral PrEP is taken in a single tablet every day. The pill prevents the virus from copying itself in the body and contracting of HIV when exposed. The Dapivirine Vagina Ring stays in one’s body for three to six months, it releases chemicals that prevent HIV infection, explained Prof Ngure.

In the just-concluded IAS conference 2021, Microbicide Trial Network (MTN) presented a research study on the adherence of dapivirine vaginal ring and oral PrEP in adolescent girls and young women in Africa. According to Prof Ngure, the research was conducted in Uganda, Zimbabwe and South Africa.

“The efficacy adherence for those over 25 was 61 per cent, those of 25 was 10 per cent, while those between 18-20, there was no efficacy,” said Prof Ngure.

Research reported by AVERT, a UK charity that uses digital communications to build health literacy on HIV and sexual health, on global information and education in HIV and AIDS has shown that PrEP has reduced the risk of HIV infection from unprotected sex by over 90 per cent and more than 70 per cent in people who inject drugs. These statistics include individuals with lower adherence levels.

Pre-exposure prophylaxis usage gains traction, surpasses PEPFAR target

Oral Pre-exposure prophylaxis (PrEP) uptake is on a steady rise and Kenya now has Africa’s largest PrEP programme.

In 2016, a year after the World Health Organization (WHO) released new guidelines recommending that PrEP be offered as an option for people at a substantial risk of acquiring HIV, Kenya included this cost effective option in its HIV prevention tool box.

Today, an estimated 111,000 to 112,000 individuals are on PrEP, over and beyond the US President’s Emergency Plan for AIDS Relief (PEPFAR’s) target of 99,896.

Initially offered to key populations such as sex workers, men who have sex with men and drug users, the assessment for PrEP eligibility was subsequently broadened to address other groups of interest including those with an HIV incidence or new HIV cases greater than three per 100 persons per year.

Young women journalists at a past science media cafe by MESHA. PrEP has proven effective for people at a higher risk of acquiring HIV and have limited options to protect themselves.

Such groups include young people, adolescents and women as they are disproportionately affected by the virus, and in which the number of new cases per 100 people who test positive for HIV meet WHO definition of a priority group.

PrEP is available free of charge in more than 3,000 health facilities spread in priority areas where HIV burden is heaviest in the country. Thus far, government statistics show PrEP uptake is highest among couples and female sex workers.

As per the Ministry of Health guidelines, PrEP is offered to HIV negative persons with a sexual partner known to be HIV positive and not on antiretroviral treatment (ART), or the HIV positive partner has been on ART for less than six months.

There is a substantial risk of acquiring HIV if the positive partner is suspected to have poor adherence to ART, or the person’s most recent viral load or amount of HIV in their body is detectable. Experts advise condom use if a HIV positive partner has a low or undetectable viral load.

Eligibility to receive PrEP further includes sexual partner(s) of unknown HIV status, has multiple sexual partners, has had STIs, engages in transactional sex, injects drugs or are from high HIV burden settings.

Individuals that recurrently use postexposure prophylaxis (PEP), which is started within 72 hours after a possible exposure to HIV and those with a history of having sex whilst under the influence of alcohol or recreational drugs as a habit, especially injection drugs where needles and syringes are shared are also included.

Inconsistent or no condom use or inability to negotiate condom use during intercourse with persons whose HIV status is unknown or couples trying to conceive where one partner is HIV positive also meet the threshold to receive PrEP.

The individual receiving PrEP must have a confirmed HIV negative on the day of PrEP initiation and must also not present with a current or recent (within one month) illness consistent with acute HIV infection such as fever, sore throat, muscle or joint pains, swollen glands, diarrhea or headache in combination with a preceding high-risk exposure for
HIV.

A person who has chosen PrEP as an option must use medication as instructed, consistently and must be willingly to attend follow-up evaluation appointments with their health providers. This is critical as evidence shows PrEP reduces the risk of HIV infection from unprotected sex by 90 percent, and risk of acquiring HIV from injecting drugs by more than 70 percent.

Importantly, research shows these statistics include individuals with lower PrEP adherence levels. The actual level of protection for those that adhere or take PrEP as
instructed is higher and near 100 percent.

PrEP has proven effective for people at a higher risk of acquiring HIV and have limited options to protect themselves through condom use or being in monogamous relationships. This is the same protection that women now seek from the dapivirine vaginal ring.

Touted as a game changer as it affords women the option to protect themselves on their own terms, the vaginal ring is yet another much needed option to broaden the HIV prevention model, especially for women who remain at a greater risk of acquiring HIV. Still, eight months down the line since WHO put a stamp of approval on the vaginal ring as a viable option for HIV prevention, it is not clear what steps Kenya has or is taking to include it inw existing HIV prevention programmes.

A HIV prevention tool box with many options could change the trajectory for women, young people and adolescents. Increased availability and accessibility of discreet HIV prevention choices could significantly help them to overcome both gender and age related barriers that face this cohort along their HIV prevention journey.

 

By Joyce Chimbi