By Kudakwashe Pembere
African governments must address the emerging saddening trends of advanced HIV where people are still dying due to lack of diagnostics and data driven policies.
Addressing the media during a plenary press conference on Advanced HIV, HEPS Uganda Executive Director Mr Kenneth Mwehonge said apart from TB being a comorbidity killing people living with HIV, Cryptococcal meningitis is a threat that needs to be nipped.
“One, I wanted to start with the number of dead, and it’s very, very sad that we have 30 million people on treatment, but that has not translated into reduced death. The coverage is high, but the deaths have persisted.
“So that’s a big, big shame for all of us, and yet it’s preventable. And it’s preventable in these three ways. One, as my colleagues have said, we need to test for advanced HIV disease among two categories of people.
“People newly entering into care. WHO has updated guidance last year, which provides a package of care.
“We need that adopted in two policies in each country. Two, not only adopted, because we track adoption, we are doing great, but implementation. And you know why?
“Because we are seeing 80% of people that get advanced HIV disease and are dying from typhoid, are those that have been in care and fallen out. But the challenge is testing them for CD4 count is not readily available for them,” he said.
He said for those who would have defaulted, returning to HIV care, the diagnostics are scarce in Africa.
“We are doing better in terms of those newly entering care, but not doing terribly but for those that are returning to care. So we need that addressed by each government. Secondly, we need to confirm their tests. Once your CD4 is confirmed to be below 200 cells per milliliter, then we do what we call a crab test, which confirms whether you have CryptoCoccal.
“And if it’s positive, then we do a confirmatory test, what is popularly known as lumbar puncture. And that access to that is also a big problem. And we need that budgeted for by all governments, by all countries. We need PEPFAR and all multinationals to fund it.
“We are not doing so badly. When it comes to treatment, once they’ve done the confirmatory test and you’re positive, there are no commodities. WHO now has confirmed that they are highly effective treatment, popularly known as the LAMP single high dose of Lipsomal Amphothycin B combined by Flutaxotine, Flucytosine and Fluconazone. It’s a triple therapy. That’s what’s recommended. We want commodities for that in every country,” he said.
He said some African countries are not committing money towards the fight against advanced HIV.
“We are seeing both from Global Fund and PREPFAR, that’s where there’s a gap. No one wants to commit money there. We’re also seeing it in countries with the domestic resources. No one is committing money there,” he said
The HEPS director also said African countries need information on the data around advanced HIV.
“So those are our concerns, but also around data. We need guidance from the World Health Organization on the specifics you have talked about. Who are these women? Who is dying? Are they women? Are they men? Are they children? We need that in two countries reporting it and avail to us,” he said.
Ms Patricia Ochieng from Kenya said absence of critical lab components for diagnosing advanced HIV have resulted in clinicians in her country demotivated in doing the tests.
“We find that we have these machines in our countries, some of them have been broken, there are no reagents. Clinicians, because of work, are not doing what the guidelines say.
“We have guidelines in countries like my country, Kenya, which states very clearly that the person who’s coming in for the first time, they need to have a CD4 test done. But because sometimes those things are not within, or because sometimes the conditions are just that, people are put on treatment and missed, and yet they could be having AHD,” she said. “So by the time they start treatment, I respect him, and the ADHD is also in. So a person is dying of pre-tropical meningitis, a very painful death that can be averted. Sometimes, yes, it is diagnosed, but they are not in the patients.”
Dr Donald Tobaiwa, Zimbabwe’s focal person for the Global Fighting Coalition said it was important for African governments to collate data on advanced HIV for themselves to improve decision making instead on relying on PEPFAR data.
“On the data issue for countries that have been engaged under the Country Operational Planning Process, the PEPFAR planning processes, Global Fighting Coalition started pushing PEPFAR to include AHD.
“And when they started to measure AHD, so from the PEPFAR data it starting trickling in to the country. What we then need to do is for governments to make proper decisions, we then cannot just rely on that data.
“So the fact that that data is coming through means there is a bigger problem. So we cannot continue to wink at a girl in the dark, we need to make decisions based on the overall data. So you find the data now trickling in from PEPFAR programs, but we need data from around the country. So porosity of data affects decision making and people will be dying in the process,” he said
African countries urged to prioritise Advanced HIV data and diagnostics
