Experts alarmed at SA patients who stop HIV meds

Efforts to implement same-day treatment for HIV patients have shown success, but experts are worried about the number of patients who quickly stop antiretroviral therapy (ART).

“There is a serious concern regarding the reduced rate of retention among the same-day ART initiators,” said doctors who analysed the treatment of tens of thousands of HIV-positive patients.

Within 10 months of being told in August 2017 to provide HIV-positive people with immediate ART, clinics in Johannesburg and Limpopo were succeeding with more than half of their patients.

But a team from Anova Health Institute in Johannesburg said the same-day initiative decreased the proportion of people who continued with treatment. US backers threatened to cut funding for HIV and Aids programmes in SA after revelations in 2018 that the number of people stopping treatment exceeded those starting it. Writing in the journal PLOS One, Rivka Lilian and colleagues said numerous studies had shown “multiple benefits of rapid [ART] initiation”, including higher rates of viral suppression a year later and reduced risk of death.

But their findings among 34,600 patients in Johannesburg and Giyani showed one in three patients who started taking ART as soon as they were diagnosed had stopped six months later. They were more likely to be young and female.

Only one in five patients who initiated treatment later more likely older and male stopped within six months.

Lilian whose team’s research was funded by the US President’s Emergency Plan for Aids Relief (Pepfar) said the WHO recommended same-day initiation of ART should happen only for patients who had been counselled and were willing. “Interventions to support client readiness for treatment are essential,” she said. “Furthermore, it is important to acknowledge that same-day initiation is not a shortcut for adherence counselling.”

Pepfar has provided SA with billions of dollars of aid since 2004, but a year ago US global Aids co-ordinator Deborah Birx threatened to cut funding due to what she described as the “grossly suboptimal” performance of Pepfar-supported programmes in SA.

She drew particular attention to the fact that more patients had stopped treatment than had started in 2018, undermining efforts to bring SA’s HIV and Aids epidemic under control.

In response, SA instituted measures to improve HIV patients’ retention in care and to encourage more people to be tested for HIV, and aims to have 6.1 million people on treatment by December.

To reach the target, the health department needs to put about 89,000 patients a month on ART, and ensure they keep taking it.