Fighting HIV/AIDS

Uganda’s tough choice between prevention and treatment

Kampala, Uganda | FLAVIA NASSAKA | Uganda will in 2019 launch two researches aimed at preventing the spread of HIV/AIDS. The first, dubbed ‘Deliver’,will be based on ring laced with the HIV drug Dapivirinebeing placed in the vagina and an oral drugTruvadataken daily as preventive (Pre Exposure Prophylaxis – PrEP) measures against HIV infection.

The research will involve only pregnant women – 750 of them. Of these, 500 will use the vaginal ring. The objective will be to see if use of the vaginal ring and the oral medicine can keep both the mother and unborn child safe.

The second study codenamed MTN -043 will enroll up to 200 breast-feeding mothers to see whether the same drug can keep the mother and child safe.The studies will be done at the Makerere University – Johns Hopkins University (MUHJU) research collaboration facility in Mulagoin Kampala.

They are among studies announced recently at a meeting of world experts on HIV/AIDS who gathered in Madrid, Spain, to discuss the strides made, the challenges faced, and the way forward in preventing the HIV/AIDS epidemic. The researches were agreed against a background of previous failure – as the earlier set date for ending HIV/AIDS; 2030, appeared unachievable.

This time, the experts were optimistic that recent innovations in prevention of HIV infections will enable countries make reasonable strides.

Today, adaily pill ofTruvada takenas an oral PrEPby a HIV negative individual at risk can provide them up to 95% protection once used as directed. This was first approved for general use in 2012 in America after its efficacy being proved through studies done earlier in high prevalence countries such as Uganda, Kenya and South Africa.

After 2012 many countries started adopting the use of oral PrEPand soon researchers realised they could use the same approach to come up with other products for prevention that do not involve swallowing a daily pill. That is how the medicated vaginal ring was born.

The researchers launched sites in different countries; including Uganda, to study whether a medicated vaginal ring can protect women from infection. Later, in 2016, initial resultsshowing efficacy were released.

Since then, researchers have dived not only into studying different products ranging from injections, douches, gels and lubes but also tweaking the already available ones to meet various people’s needs.  For instance, some products are now being considered as both a PrEP and a contraceptive.

The driving forcefor the researchers has been a combination of PrEP’s effectiveness and the discovery that people living with the virus cannot transmit it to others once they become undetectable. This duo-pronged intervention, it is believed, can bring the HIV/AIDS epidemic to a swift end.

But, there is an ugly fact.

Even as oral PrEP has been around for more than half a decade, only 309,500 people are using it globally and the number of new infections is also not going down.

According to the latest report released by the Joint United Nations Programme on HIV and AIDS (UNAIDS), 1.8million people got infected in 2017. Almost the same number was recorded in 2016 and 2015. These figures were quite depressing for researchers attending the conference. Many questioned whether they are not doing enough.

A look at the strides made by Uganda helps understand the worry of researchers.

Uganda has been involved in the HIV/ AIDS research since its early days, when AIDS was vaguely described as ‘slim’ – a mysterious illness that could claim a life in just a matter of days. Researchers went into laboratories, they established what the new disease actually was, what caused it, and how. Today, they are looking into vaccinestosave thousands.

Dr. ClementiaNakabiitois one of those researchers who have been involved since the early days. When we met, a senior researcher based at MUJHU had just concluded another PrEP study where she had enrolled women on an open label study to evaluate how the vaginal ring is likely to perform when women persistently use it. She did not give details of her findings but she says the percentages in effectiveness were higher than the initial study where women did not use the dapivirine ring persistently and yet others were enrolled on a placebo – a drugless ring.