THE Secretary General of the Sadc Parliamentary Forum Dr Esau Chiviya has hailed the decision by Zimbabwe to adopt the single HIV tablet, saying the country had shown leadership in the fight against the epidemic.
Staff Writer
Zimbabwe recently said it would introduce the three-in-one anti-retroviral treatment (ART) tablet as the country moves to contain its HIV/Aids epidemic. The new single tablet has a combination of three drugs (Tenofovir/Lamivudine/EfavirenzTLE), a departure from the previous complicated treatment of three different tablets namely Tenofovir, Lovovidine and Nevirapine (TLN).
In a statement, Chiviya lauded the initiative and said it also marked the beginning of more work for Zimbabwe, where approximately 1,5 million people — about 188 000 of these children below the age of 15 — are reported to be living with HIV.
“Despite well-documented challenges, Zimbabwe seems to be taking leadership in the war against HIV/Aids in Southern Africa. The reported decision by Zimbabwe to introduce the three-in-one ART tablet can be viewed as a giant step towards removing barriers to effective treatment of HIV/Aids,” Chiviya said.
Challenges Galore
Chiviya said for Zimbabwe and many other countries working towards halting and reversing the HIV/Aids epidemic, the challenge has been on how to keep patients on treatment for life and, specifically, on how to ensure that the patients can afford the treatment, access medication and services and that they can religiously take the medication as prescribed to ensure efficacy under optimal conditions.
“The designers of these medicines require that they are taken at regular intervals, consistently and in the correct doses. Additionally, they require that the outcome of the medication or treatment be monitored continuously to ensure that parameters – either in the patient or the drugs – do not change.”
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He said this final requirement remained a major challenge on the African continent because even the physical realities under which the medications are taken vary tremendously from country to country.
“For much of Africa, these conditions are typically low resource settings in which affordability is an issue. On some parts of the continent, national health systems are weak and delivering drugs on a regular basis, sometimes for up to 50 years for any particular patient while ensuring that such an individual can remain on treatment and take it at the appropriate doses is not easy.”
Experts say storage in the homes across the continent in which these drugs are administered should be done carefully if the drugs are to retain their potency and efficacy. This implies that, parameters that include heat and moisture become important given that many of the drugs used to fight HIV/Aids are designed outside the continent. Unless they are stored properly, they might not produce anticipated results. They may even lead to drug resistance.
Said Chiviya: “The patient must be committed, the health system must be able to deliver the medicines, the country must be able to afford it, and the doctors and other health practitioners must understand the conditions under which these medicines are administered. Yet these conditions can change, even when dealing with the same patient. For instance, the patient’s standard of living may fluctuate and with it nutrition, necessitating certain changes to be introduced.”
He explained that adherence was a major factor in Africa because patients were prone to suffer from conditions for which they may require to take additional drugs.
“Often this is the reality for HIV patients in Africa. More than half of them would also succumb to TB and so they would have to deal with more tablets. The patient may fall prey also to a myriad of other so-called opportunistic infections.
Understandably, but erroneously, in the fight against HIV/Aids many people think of just the administration of drugs for HIV/Aids when the reality is that often there are more drugs required in treating the patient.”
Bold steps
According to Chiviya, it has been a long walk from the situation of utter hopelessness that existed in the 1980s when HIV was first encountered on the African continent.
“In those days HIV was like a death sentence. Many countries have made significant breakthroughs to the point where now we are talking about treatment. The science around managing the epidemic has also evolved.”
He said by adopting the three-in-one HIV/Aids tablet, Zimbabwe was making another quantum leap after putting many of its people that require treatment on three doses, in addition to treating them for other conditions.
Need for all hands
Chiviya’s view is that that, health workers are probably the least effective in achieving social change at the community or household level.
“Social change requires the active participation of everyone including the opinion leaders. So leaders at all levels – including parliamentarians – must get involved. Our political leaders should be part of the socio-technical change.”
He said the same tactics politicians use to convince the electorate to support them must be extended to changing the social and health habits of their followers.
“The mere fact that they have been elected by a constituency suggests that they have sway over the constituency. It should be their moral obligation to understand this radical change in medication, support it and present it to the people in a manner that enables them to understand it and comply.”
Beyond the patient
Chiviya’s view is that the benefits of this latest initiative by Zimbabwe would go beyond the individual patient taking the medication.
“Science has proven beyond reasonable doubt that putting people on treatment is also a control measure. Transmission rates go down as medication reduces the patient’s viral load. It is to be imagined that in Zimbabwe and other developing countries, poor adherence to treatment has been a huge concern as patients moved and drugs fluctuated in availability.”
He said it was reasonable to expect that now with this single dose, costs would go down correspondingly. The single tablet might also bring relief to patients in that they may no longer have to remember to take the drugs several times per day.
“Adherence is intricately related to one’s lifestyle. Not many people just sit at home watching the clock while waiting to take the next dose of their medicine. Many have other chores. Others travel. They might forget to take their medication as prescribed if the medicines are many. With the introduction of the three-in-one pill by Zimbabwe, patients can choose convenient times to take their medication. Care-givers who until now had to closely monitor patients to ensure that they take medication as prescribed might also get relief from this new initiative.”
On the technical front, Chiviya expressed the hope that this treatment would be available also to children and the elderly and that the government would strengthen its health care system to ensure that laboratories are available to monitor outcomes and complications, should there be any, from this single dose. That is on the technical front.
Education crucial
On the social front, the Sadc PF head the change from three or more tablets to just one constitutes a major shock and an incredible change for the patient, who might think he/she is no longer taking enough medication or is being short-changed.
“Accordingly, patients need to be informed and educated so that they understand that they are not losing anything by drinking only one tablet where they were used to taking near handfuls of tablets and thought highly of them. The health care workers also require re-orientation. Some of them may not be convinced that they are doing the right thing dispensing only one tablet.”
Local resources
A major shortcoming of many African governments is that they seldom use local resources to solve local problems. The overall strategy for controlling HIV/Aids still includes many other strategies which need to be emphasised at all times.
“Zimbabwe is to be applauded for introducing an Aids levy as well as for her gallant efforts in popularising the Aids insurance. We believe that these initiatives would enable the country to commit even more local resources towards HIV/Aids responses.”
He said MPs can advocate for the strengthening of pharmaceutical industries.
“Ideally, there is need to move towards manufacturing this single dose locally and to train more people in the dispensing field, particularly pharmacists. Parliamentarians can and should help their Parliament to channel more resources towards re-education of everyone including the seasoned doctors.”
He opined that the Sadc region might need to urgently consider how to support each country to have its own pharmaceutical manufacturing plant. He suggested that if that is not possible these plants can be set up regionally.
“It is remarkable that in the era of generic drugs some countries in Sadc are already producing ART drugs locally. One hopes that when the long-awaited Sadc Regional Parliament comes into being, it would be seized with, among other things, promoting the production and use of drugs locally to limit dependence on foreign sources.”
He concluded that given that already approximately 80% of all drugs used in HIV/Aids mitigation are produced outside the continent, the need to ensure quality assurance becomes self-evident to guard against fake drugs.
“Good laboratories and systems are needed to achieve this,” Chiviya said.
