New earlier HIV treatment recommendation
Start treatment at CD4 counts below 500 cells/mm3 and not 350 is the new recommendation from the World Health Organisation (WHO) announced at the International Aids Society conference this week. The WHO estimate early treatment could prevent three million deaths and 3.5 million new infections between 2013 and 2025. The new guidance would make 25.9 million people eligible for treatment.
The new guidelines also recommend partners in serodiscordant relationships i.e. when partner is HIV positive and the other negative should start treatment as soon possible regardless of CD4 count. Pregnant women, women who are breastfeeding, children below the age of five, children over five years with a CD4 count below 500 cells/mm3 should start treatment immediately.
Viral load testing is also recommended as the approach to monitor how effective the treatment is, together with CD4 cell counts.
The drugs of choice should be tenofovir disoproxil fumarate (TDF) based formulation— the pill a day introduced in Malawi is a TDF based formulation. This at least means Malawi would not have to change its drug protocol to meet the new guidelines.
The guidelines have been welcomed by a number of organisations. However, the first reaction by most delegates at the conference was…how much will this cost and where will the money come from? The Joint United Nations Programme on Aids estimates that the projected 2015 global budget of $22-24 billion could meet these new guidelines. The increase in numbers could be met through reducing the cost of medicines as volume increases and having more efficient delivery systems. There will also be future cost-saving in terms of less hospitalisations and treatments of diseases associated with HIV.
Reducing the cost of treatments is possible. Between 2011 and 2013 the cost of drugs to prevent mother to child transmission reduced from $800 to $100. South Africa has the lowest price in the world for cost of treatment at $127 per person per year. Countries such as Zimbabwe have introduced a mobile phone levy to support health budgets and Zimbabwe’s Aids levy — a three percent income tax – generated more than $26 million in 2011. Uganda and Kenya have also looked into taxing alcohol, tobacco or cash transfers as ways to generate much needed funds for Aids programmes.
Meeting the new guidelines in Malawi would not only require additional finances, but improvement of HIV testing and counselling (HTC). Only about 40-50 percent of people infected with the virus in Malawi know they are infected. A number of challenges hamper efforts to increase testing, periodic stock out of HIV test kits, low uptake of HTC by couples and by males. Last year’s national HIV testing day was poorly organised and patronised. What do you think can be done to increase the number of people who get tested for HIV?
