WHO guidelines give hope to Aids patients

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THE INTERNATIONAL medical humanitarian organisation Médecins Sans Frontières welcomes new World Health Organisation guidelines for HIV treatment.

THE INTERNATIONAL medical humanitarian organisation Médecins Sans Frontières/ Doctors Without Borders (MSF) welcomes new World Health Organisation (WHO) guidelines for HIV treatment and calls for the improvements to be rapidly implemented, enabling people and programme outcomes in developing countries to benefit. MSF also stressed that increased international support will be needed.

MSF Zimbabwe

WHO recommendations include earlier anti-retroviral therapy (ART) for people living with HIV, improved protocols to prevent HIV from being transmitted from mother to child and regular and more effective monitoring of people’s “viral load” to ensure treatment is working.

“Early HIV treatment makes a major difference – it keeps people healthier and also helps prevent the virus from spreading within communities, but we need the political and financial support to see these recommendations rolled out rapidly,” Unni Karunakara, International president of MSF said.

Use of “viral load” monitoring to ensure anti-retroviral medicines are keeping the virus suppressed is another critical advance in the recommendations.

Viral load works best when linked to robust adherence support and shows multiple benefits for patients and treatment providers alike. “Viral load testing is an effective monitoring tool, especially in deciding when to switch patients on first-line treatment to second-line drugs.

“That is why here in Zimbabwe MSF is supporting the Ministry of Health and Child Welfare in setting up a viral load machine at the National Microbiology Reference Laboratory. With these new guidelines our collective goal should now be to scale up: To reach more people, retain them on treatment and with an undetectable viral load,” Fasil Tezera, MSF head of mission in Zimbabwe, said.

With the new WHO guidelines, the number of people now eligible for treatment will rise substantially.

“These new treatment recommendations are ambitious and needed; they’re also feasible,” Karunakara said. “Now is not the time to be daunted, but to push forward with what we know works to get the best treatment possible to the most people, as soon as possible.

“Countries should implement these new WHO guidelines and accelerate treatment without delay, so it’s critical to mobilise international support to enable them to do so, including funding for HIV treatment programmes from donor governments and the global fund.”

Tapiwa Mupepe, a government medical officer at Gutu Rural Hospital, said the new guidelines are very beneficial, but also urged donor agencies to support the implementation of the new guidelines.

“This will definately come with a huge financial implication hence donor commitments should reflect the increased treatment targets to support the swift implementation of the new guidelines as a strategic priority,” Dr Mupepe said.

Svorai Musimudziwa, one of the 54 000 people living with HIV receiving life saving treatment in the MSF projects across Zimbabwe, said the switch to fixed dose combination anti-retrovirals from the triple-therapy regimen eased her pill burden.

“I started taking ARVs in April 2008 in Buhera and I would experience severe side effects which resulted in my hospitalisation on numerous occasions as I couldn’t cope.

“But I was latter switched to one pill per day in June 2012 and since then my health has really improved,” Svorai said.

MSF’s experience treating HIV in developing countries since 2000 has shown that, through adapted treatment delivery strategies — combined with supportive policies — scale-up of quality care to large numbers of people is feasible.

Drugs must be easy to take and affordable; treatment monitoring is essential and must be coupled with effective counselling for people with problems adhering to treatment; and people must be empowered and encouraged to take on a larger role in the management of their care.

For example, one strategy MSF piloted in Mozambique in order to simplify care and help people stick to their treatment has been to form small patient groups, with a different group member going for a check-up each month and getting a medicine refill for the whole group.

This model not only simplifies care for people but also frees up health staff time to focus on more critical cases. But through its work, MSF is also confronted with many of the people who continue to be locked out of treatment and special attention must be paid to ensuring these countries are not left behind.