New HIV drug a game changer?

Debate over toxicity

To Dr. Stephen Watiti, one of the first medical workers to come public about his HIV status, challenges with HIV drugs are still a big debate in the country because Uganda cannot afford up to date HIV medicines which scientists have made in a way that attacks the virus in different ways. He says because of this, many people on treatment have continued to endure toxic drugs. And, he is a victim too.

“The drugs I took at first were very toxic. They killed the virus and also killed my nerves. I live with the effects up to now,” he told journalists during a workshop held at the African Center for Media Excellence (ACME).

He speaks of how he was first enrolled on a drug called stavudine which has since been phased out because of severe side effects. He says the medicine can cause women to lose their hips and some clients develop a hump on their backs. It’s because of such effects that some of the drugs used here are no longer used in America. “What is good for Americans is good for us too but we have to look for money,” he says.

Because he is now on second line treatment, Watiti will not use the new drug. But, he says such innovation in treatment will drive the country into achieving its HIV related targets such as the 90-90-90 UNAIDS target of ensuring that 90% of the people know their HIV status by 2020, 90% of those tested positive being enrolled on treatment, and 90% of those on treatment suppressing the virus to undetectable levels.

The introduction of TLD poses renewed questions about the sustainability of supply. No government official is sure yet about the quantities of TLD to be shipped into the country.

government does not have much control of how much of the drugs will be available because it only allocated Shs100 billion to procurement of ARVs from local pharmaceutical CIPLA Quality Chemicals. Procurements of more HIV/AIDS drugs, including TLD, can only come courtesy of donors like Global Fund and the U.S. President’s Emergency Plan for AIDS Relief (PEPFAR).

Phil Dimon, the Spokesperson of the US Embassy Kampala says to help ensure availability of adequate quantities of the drug; U.S$16.7 million has been allocated under PEPFAR to kick-start and support public sector TLD procurements.
He adds that of the US$408 million funding that PEPFAR plans to send to Uganda the coming Financial Year 2018/19, up to U.S$90.3 million is planned to go towards ARVs.

However, while the government is planning for a rapid process of first ensuring that all clients getting medicines from Private not for Profit (PNFP) facilities across the country are enrolled on TLD by December and all those getting refills from public facilities are covered by next year, Mutema warns of the glitches that might come with the rush.

People on HIV treatment; unlike other patients, he says, are very particular when it comes to their medicines and some might not easily allow switching without being sensitized on why they really need to transition.

If patients are expected to be moved by July, Mutema says Ministry of Health should have already provided an addendum to health workers explaining to them how and why they are switching. These then would allay the information to their clients.

The other key issue according to him is ensuring that people on treatment get their doses sustainably without stock outs since they now know that whoever is tested is enrolled on treatment immediately.