TLD regimen – best solution for people living with HIV
TTLD (TENOFOVIR + LAMIVUDINE + DOLUTEGRAVIR) REGIMENT IS THE BEST SOLUTION FOR PEOPLE LIVING
SANAC Civil Society Forum, a constituent member of the Community Constituency Covid19 Front (CCCF) in responding to the statement by the Gauteng Health Department on Tuesday, 19 May 2020 that over 11 thousand of TB and HIV-positive patients have failed to collect their medication since the start of the lockdown on 27 March 2020 is an issue that requires a combination of treatment literacy and ongoing social mobilisation for those infected, their families and communities. Adherence to treatment is the bedrock of gains made in South Africa’s response to HIV and TB as outlined in the National Strategic Plan on HIV, TB & STIs.
Huge stride have been done by civil society to get many people to test and get to know their HIV status, enrol for anti-retroviral treatment (ART) and adherence clubs for their support. These strides include addressing stigma or discrimination. The rise in numbers of those defaulting is as a result of poor communications and inadequate treatment literacy that was supposed to accompany the introduction of the TLD ART regiment for HIV positive patients. The lockdown which curtailed movement of people only worsened the situation.
SANAC Civil Society Forum through its various sectors will double the efforts to ensure that the current situation is reversed. “We will go to the frontlines to educate HIV positive patients switch to TLD in a way that will ensure smooth transition. This we will do by joining hands with the health facilities. We dare not fail” said Steve Letsike, Chairperson of SANAC Civil Society Forum. TLD is recommended by the World Health Organization for first-line treatment of HIV. It can also be used in second-line treatment of HIV.
Currently most PLHIV are on the TEE (Tenofovir + Emtricitabine + Efavirenz) regiment and there are guidelines on switching to TLD (Tenofovir + Lamivudine + Dolutegravir) regiment for stable patients. TLD is a new HIV Treatment – One pill, once a day. It is that simple. This new TLD regiment should be given to PLHIV who have their viral load suppressed or strengthened immune system. TLD has rapid viral suppression, rapid barrier to resistance, does not have interaction with hormonal contraception and has mild side effects if any. What makes it more effective is that it a smaller pill and you will be given a three months’ supply of TLD. This means people will find it easy to remain in care and adhere to treatment. We were never ready for Covid19 and its impact has disrupted lives, movement and livelihoods of people including contribution to the steep rise of over 11 thousand defaulters in Gauteng. Mabalane Mfundisi, the Co-Convener of the Community Constituency Covid19 Front states that “While we do not have data supporting risk of contracting Covid19 by People living with HIV (PLHIV) we cannot accept defaulting of HIV & TB treatment which will be an additional burden to an already overwhelmed health system”.
The majority of people who are on ART are women, and we have every reason to believe that they constitute a great number of these reported defaulters. Women who are pregnant or want to fall pregnant must have the side effects told them so that they are able to make informed decision. Letsike concludes by saying “Our responsibility as civil society is to ensure that we empower South Africans, especially women to know of their reproductive health rights so that they can select TLD at the right time in their lives in order to give them the best chance in having the family that they rightfully deserve.”
The World Health Organisation (WHO) warns that PLHIV not on antiretroviral therapy (ART) or who do not have a suppressed viral load are likely to have a compromised immune system and may be more vulnerable to opportunistic infection and disease progression. TLD provides a great opportunity to reach out to those not already in treatment to start their treatment and enjoy the benefits that come with this regiment.
With the rising number of cases of COVID-19 in South Africa, measures must be taken not only to contain the pandemic, but to ensure that other health services continue unhindered. Whilst there is not a considerable body of evidence available about increased risk of acquiring Covid19, suffering more serious outcomes and having higher levels of transmissions, people living with HIV with unsuppressed viral load and lower CD4 levels and people with active TB might be at an increased risk.
The current state of affairs has potentially set us back from our goal as a country to add an additional 2 million PLHIV on ART by December 2020 and we cannot afford a regression on the gains we have made. We will aggressively drive the TLD Treatment Literary Programme during the lockdown and beyond.
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About the SANAC Civil Society Forum (SANAC CSF)
The SANAC Civil Society Forum (CSF) is a formal advisory body established in 2012 by the South African National AIDS Council to facilitate the participation of Civil Society Organisations and networks, including those representing People Living with HIV, in the HIV and AIDS and TB within the National HIV response and for the implementations thereof National Strategic Plan (NSP) 2012-2016 through Sectors.
The SANAC CSF aims to promote an inclusive, competent and responsive civil society that effectively serves the needs of the people of the South African communities, by linking and diversifying civil society actors, expanding the sectors and communities where civil society contributes, improving civil society organisations’ operations, and enhancing connections between civil society organisations with their stakeholders and beneficiaries.
About the Community Constituency Covid-19 Front
The Community Constituency Covid-19 Front was established as a formal advisory body to facilitate the participation of civil society sectors and networks, including those represented in the national response and implementations of Community-Based Measures in response to the novel Coronavirus (Covid-19). The Community Constituency Covid-19 Front promotes an inclusive, competent and responsive civil society that effectively serves the needs of communities by linking and diversifying civil society actors, expanding the sector’s response and ensuring better coordination, thus improving operations, and enhancing connections between civil society organisations with government, business labour, their stakeholders and beneficiaries.
The Covid-19 Front aims to provide a hub of information and contacts for distribution and engagement through our members across the country.