Parirenyatwa’s AHF Centre of Excellence surpasses viral load suppression target

The Parirenyatwa Group of Hospital Opportunistic Infections clinic which is also an AIDS Health Foundation Centre of Excellence as of June 2022 had 5 620 clients with the majority being females while the pediatric ward had about 400, inversely seeing males being many.

By Kudakwashe Pembere

This was revealed during a media tour of the facility on Thursday.

Addressing the press, Dr Pascal Shambira who heads this centre of excellence said their cohort comprised of the first, second and third line regimens of ART.
“So how many patients do we see in this clinic. Our Cohort summary as of June 2022, we had 5 630 patients, the majority are female who are 3 320 and males are 2310. Most of our patients are on First line ART we had 4 439 and 1 100 are on second line and 91 patients are on 3rd line ART,” he said.

He also said they exceeded the 95 percent yardstick for HIV viral suppression.

“Our goal for providing patients Living with HIV is for them to lead a life that is normal and it is now possible because of antiretroviral therapy. The medications that we use of the side effects are not as common as before although they still occur. The benchmark on monitoring how well they are doing is the viral load. And the WHO is for those on ART to have at least 95 percent viral load suppression. That is when we do the tests, the expected results should be zero or the target should not be detectable. So our viral load suppression at this clinic is 96 percent which means we are actually exceeding the target. So, we would like to think we are doing well in terms of patient outcome although there is room for more improvement,” Dr Shambira said.

He explained why people end up on second- and third-line treatment regimens citing factors such as poor adherence, ART mal-absorption, and drug to drug interaction.

Dr Shambira said suboptimal adherence occurs when clients start defaulting their medication with malabsorption being due to chronic which interferes with ART absorption, and drug-to-drug interaction which occurs people are on TB treatment such as Rifampicin.

“Once a patient gets a resistant mutation, their viral load will start to increase. That we call virological failure. After virological failure, their immunity starts to be affected reflected by a falling CD4 count. And later, they can start to have clinical manifestations which we call clinical failure.

“So it happens in stages, virological failure, immunological failure and clinical failure. That is why it is important as I said before the gold standard to monitor is Viral Load so that we manage to diagnose this early enough before they actually fall sick.

“So, we mentioned suboptimal adherence, malabsorption, drug-to-drug interaction but sometimes it can happen that someone who has a high viral load and has a resistant type of virus can actually transmit it to an HIV negative person.

“We call that transmitted drug resistant virus and they might not respond to drugs which are used as first line drugs because they were infected by a virus that is already resistant to the first line medication,” he said.

For children between the ages of zero and 13 years, Dr Dr Tariro Chuma-Mutize stated in their cohort, they witnessed an 85 percent viral load suppression rate.

“The pediatric consultation room is where we see children living with HIV. We manage them from the time they get their diagnosis to where we initiate them on antiretroviral medication and where we follow them up until they become adolescents and they transition to the adolescent clinic until they become adults. So, our current cohort is about 400 children and about 280 are boys and the remainder are girls.

“We are doing fairly OK. We are doing pretty well in terms of them being managed on antiretroviral medication. I think we have what we call a viral load suppression of about 85 percent. So that is pretty remarkable,” she said.

Dr Chuma-Mutize added, “So, children are a special population because they depend on caregivers for medication. So, they are really a population that needs a lot of psychosocial support. Otherwise, so far, we are happy with what the parents are doing with the services that we are rendering and the progress that we have.”

AHF is also supporting other facilities like Glen View Polyclinic and Sally Mugabe Central Hospital in Harare in the provision of HIV services.

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