Kenya takes lead in approving daily oral pill to lower chances of getting infected with HIV

Posted by Jambo 

With approximately 1.6 million people living with HIV, Kenya has the world’s fourth largest HIV epidemic.

According to the latest issue of the Global Burden of Disease, published in The Lancet HIV Journal, Kenya is among nine countries in sub Saharan Africa that has a prevalence of more than 2.5 per cent of its entire population.

However, the country has made great strides including an increase in its antiretroviral therapy coverage.

Health Cabinet Secretary Dr Cleopa Mailu says that of the estimated 1.6 million Kenyans living with HIV, 900,000 have been put on ARV treatment.

The World Health Organisation also commends Kenya for reaching 66 per cent ARV coverage for all age groups which was higher than the general average for Africa, which stood at 56 per cent last year.

Additionally, Kenya has one of the world’s highest HIV testing rates with approximately 85 per cent of women and 72 per cent of men having been tested at least once, according to the 2014 Kenya Demographic Health Survey.

The most recent and bold step is the approval of oral PrEP as part of Kenya’s HIV Prevention Strategy.

South Africa is the only other country in Africa to have approved Truvada for PrEP.

Pre-exposure prophylaxis (PrEP) is the use of ARVs by HIV uninfected people, often those at very high risk for HIV infection, to lower their chances of getting infected.

Therefore, though Truvada was already registered for use as combination treatment for HIV, its approval for PrEP means that it has also been added to the HIV prevention toolbox.

In this regard, HIV negative persons at increased risk of HIV infection can now take a daily dose of the oral Truvada tablet and significantly reduce their chances of acquiring HIV from a positive sexual partner.

This follows a recommendation by the WHO in September 2015 that people at substantial risk of HIV infection should be offered PrEP as an additional prevention choice, as part of comprehensive prevention.

Several trials were conducted on the effectiveness of PrEP and where adherence had been high, significant levels of efficacy have been achieved.

Some of these trials were conducted in Kenya, for example Partners PrEP study amongst serodiscordant couples (one partner being HIV positive while the other being negative).

This new recommendation replaces the previous WHO recommendations on PrEP and enables the offer of PrEP to be considered for people at substantial risk of acquiring HIV rather than limiting the recommendation to specific populations.

It also allows the offer of PrEP to be based on individual assessment, rather than risk group such as men who have sex with men (as recommended previously).

That means if you are HIV negative and feel you are at ongoing risk of getting infected, you should be able to go to your health provider for a PrEP prescription.

PrEP can then be discontinued if the person taking PrEP is no longer at risk and when this is likely to be sustained.

Kenya is also one of the few countries that have formulated their own guidelines for PrEP.

This was an essential step as there was need for direction, ranging from eligibility criteria to who should

provide PrEP and where. Then comes the implementation plan where there is need for training of health professionals, education and raising awareness in local communities and resource allocation.

This is still underway with the Ministry of Health forming a technical team.

In addition, there are several donor-funded projects that are slated to offer PrEP within their mandate including Pepfar supported DREAMS initiative and Jhpiego.

Jhpiego was recently awarded $22.3 million (Sh2.2billion) over four years to scale up oral pre-exposure prophylaxis by The Bill & Melinda Gates Foundation, making it perhaps the largest donor funded programme of its kind; the first to deliver PrEP widely across a health system while promoting a sustainable service delivery model.

It will offer the opportunity to learn and develop new ways of ensuring that life-saving interventions reach those most likely to benefit, and to assess barriers to services as health providers integrate delivery of such interventions into routine health care practices.

It is evident that the approval of PrEP as part of a combination HIV Prevention package will enable a wider range of population to benefit from this additional prevention method.

More so, considering existing prevention gaps and the growing need for discreet methods among women who are disproportionately affected yet their voices remain muffled under

societal boxes and cultural roles.

Research is still ongoing for the use of microbicides in vaginal rings and long acting injectable antiretrovirals.

Dr Nelly Mugo, the head of The Sexual Reproductive Adolescent and Child Health Research Program at Kemri, says: “Prevention is holistic. Not many people are empowered, be it education or socioeconomic status, hence unable to negotiate behavioral change, they require options to safe guard themselves.”

Dr Mugo also emphasise-s the need for adherence. “ A popular analogy researchers like to use is that just like oral contraceptives, PrEP only works when taken. You can’t simply take it for a few days stop then resume and thus the need for training and education. The implementation will definitely pose challenges but these must be addressed both for individuals and the community.”

This calls for an inclusive communication strategy to present PrEP as a positive choice for people for whom it is suitable as part of other HIV prevention options.

PrEP should also remain part of a comprehensive package including HIV testing, counseling, condoms, ARV treatment for partners with HIV infection, voluntary medical male circumcision and harm reduction interventions for people who use drugs.

-the-star.co.ke