Tag Archives: PrEP

Include elderly patients in HIV prevention campaigns

Dr Cleophas Chimbetete

BY MUNYARADZI BLESSING DOMA

 

There is need to highlight HIV prevention campaigns in elderly patients, as it has been noted that there is an emerging challenge of increasing number of people aged 50 and above living with the virus, an HIV Clinician has revealed.

Doctor Cleophas Chimbetete revealed this on Tuesday during a media science cafe on “HIV and Ageing”, organised by the Health Communicators Forum and the Humanitarian Information Facilitation Centre.

He revealed that over the years, there seems to have been more focus on the younger generation, whilst a lot of issues concerning the elderly patients were emerging.

“There is a realisation that there is an emerging challenge of more and more elderly patients living with HIV in their old age, so in terms of strategies to address this problem number one; we need to highlight HIV prevention even in elderly patients.

“Those of us who are involved in HIV prevention campaigns such as PrEP (Pre Exposure Prophylaxis), such as circumcision, whatever form of HIV prevention campaigns, let’s include the elderly as well.

“Realizing that they remain at risk of new infections,” said Dr Chimbetete.

He further revealed that as elderly patients visit health institutions for any other medical reasons, personnel should offer HIV testing, so that they (elderly patients) are not left behind.

“Number two; when we see elderly patients coming to our hospitals, facilities, for whatever medical reason; let’s offer HIV testing because we have noticed a delay in HIV diagnosis.

“Because some of the symptoms of HIV infections in this age group, they mimic old age and they are just dismissed as part of the ageing process and we don’t want late diagnosis of HIV in this generation of people.

“We also realise that HIV is a risk factor for a number of other conditions, so people living with HIV in old age are more likely to have other conditions such as hypertension, such as diabetes, mental health issues, such as also being at greater risk of cancers such as cervical cancer.

“So us as care providers we must now offer a holistic approach or comprehensive approach to the care of elderly patients.

“We don’t want OI (Opportunistic Infections) clinics that just look at viral loads, without BP machines, without glucometers to test blood sugar.

“We don’t want health care workers who only understand HIV management and not understand our national guidelines in terms of how we manage hypertension, how we manage diabetes, how we screen for common cancers. “So we want a holistic approach, we are offering free services for HIV clients and these services must also mean that we offer free treatment where possible for these common non communicable conditions,” added Dr Chimbetete.

Dr Trevor Kanyowa

Doctor Trevor Kanyowa, World Health Organisation (WHO) Zimbabwe, Technical Lead Healthier Populations, said the trend of a number of older people living with HIV is being noticed, not only locally but regionally and globally.

“This is mainly because of two reasons; the first reason is that we now have effective anti retroviral medicines of high quality and these medicines are enabling people to live healthier and longer lives.

“So we have people who acquired the HIV virus even before they had aged, managing to grow into the older age groups still living with the virus but living healthy and longer lives.

“The other reason is that whilst we know that even at younger age groups, HIV is still being acquired, we have also noticed that the risk of acquiring it in older ages has also increased, this is for a number of reasons.

“The reasons include the issue of the information that people have, for example there is a general belief that HIV is for younger people so therefore older people are less likely to use protective measures as compared to the other age groups.

“We also notice that for instance, older persons may lose a partner and then may opt to go into a new relationship, they may opt to marry or opt to live with a boyfriend or a girlfriend but there is not that much effort to check one’s status in that age group and as a consequence, they acquire the infections.

In 2022 UNAIDS estimated that 24 percent or 4,2 million of people living with HIV (PLHIV) globally were aged 50 years and older and in Zimbabwe, 22 percent of PLHIV (28 407) are 50 years and older.

“So these are the main things that are making us see that we have HIV rates increasing in the older age groups,” said Dr Kanyowa.

He also revealed that it has been noticed that the figures of young people acquiring HIV are dropping, whilst the population with HIV in the older age group is rising.

“If you then look at it as a proportion, it will appear very much bigger in the older age group.

“This is what we are noticing and these trends are what we need to focus our responses on,” added Dr Kanyowa.

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Dapivirine vaginal ring should be rolled out to the public

…as South Africa orders 16 000

Dr Were

Dapivirine vaginal ring should be rolled out to the general public

 

BY MUNYARADZI BLESSING DOMA

 

The dapivirine vaginal ring which has proved to be an effective HIV prevention tool should be rolled out to the general public so as to give people more options in the fight against the epidemic, a Kenyan Behavioural Scientist and Public Health Expert has revealed.

Doctor Daniel Were revealed this in Nairobi during a recent media symposium with senior health journalists from Kenya, Tanzania, Uganda, Zambia, Malawi and Zimbabwe.

The symposium was hosted by AVAC and MESHA.

Doctor Were said that while countries acted differently when it comes to HIV prevention, it was vital that others learn from those who would have led on such initiatives.

“What we have seen overtime is that there are countries where the governments move very fast, and there are countries where the governments move much slower as far as prevention is concerned.

“The important thing here is how do we use those countries that are on the forefront to try and encourage the others to also go faster,” said Dr Were.

He added, “this is a call to the government but also other donor agencies that work closely with the Kenyan government that how do we fast track the availability of these products to be available to the public.

“When I talk about fast tracking, there are issues around procurement to make sure that the product such as the dapivirine ring are available,” said Dr Were.

He said the dapivirine vaginal ring whose studies had proved 35 percent efficacy, was not yet available to the general public in Kenya but only for trials.

Dr Were also revealed that the dapivirine vaginal ring which is inserted every 28 days, costs US$7 to produce and US$12-US$13 to procure.

Bridget Jjuuko from AVAC, said failure to implement the roll out of the ring could be linked to funding, hence governments had to find other sources of funding.

“We have seen that the ring is not going to be funded by PEPFAR, so if PEPFAR is not going to be funding the ring, who else is going to fund the ring,” quizzed Jjuuko.

Jjuuko also revealed that allocation of resources towards HIV prevention for women and girls was what the Choice Manifesto was all about, which is an initiative on women led HIV prevention interventions which was launched in Uganda in September.

And true to Dr Were’s assertion on how governments respond differently, Zimbabwe, Kenya, Uganda and South Africa who had all given the nod to the dapivirine vaginal ring, were beaten to it by the latter which recently revealed that it was set to start a roll out for use by the general public.

AVAC in its Weekly News Digest of September 29 reported that South Africa, which has the largest epidemic of the virus in the world, was soon going to roll out the vaginal ring.

“The Global Fund to Fight AIDS, Tuberculosis and Malaria said three groups involved in the fight against AIDS in the country have with its support, placed an initial order of 16 000 rings-that are expected to become available in the coming months,” read the report.

While Zimbabwe was one of the countries to have approved the ring, unlike its neighbour South Africa, the HIV prevention option is not yet available to the general public.

Pangea Zimbabwe AIDS Trust (PZAT) Senior Programs Manager, Definate Nhamo told this reporter that in Zimbabwe “the ring is currently not available to the general public.

“It is only available through implementation science studies.”

According to the International Association of Providers of Aids Care, the dapivirine vaginal ring is a flexible vaginal ring made of silicone and slowly releases an antiretroviral (ARV) medication called dapivirine over the course of one month to reduce the risk of HIV infection.

The dapivirine vaginal ring which is a form of Pre-Exposure Prophylaxis (PrEP), is termed a female initiated option to reduce HIV infection.

According to the NHS Inform, pre-exposure means it’s taken before sex and prophylaxis means to prevent disease-in this case, by stopping one from getting HIV if taken correctly.

Speaking further on the dapivirine vaginal ring, Dr Were revealed that it was one of the options for HIV prevention because “available methods have not done enough to slow the epidemic among women and there was need for discreet products that women can use on their own terms.

“No one product will solve the HIV epidemic hence women need multiple prevention options that make sense for their lives.”

He added that from the researches that were done among women on the dapivirine vaginal ring, it was shown that they (women) were comfortable with it, as they did not feel it during any of their daily activities.

Dr Were also revealed that the women said they were willing to use it if effective and it has little or no impact on sexual experience and while on their period.

He also revealed that for men who were with someone putting on the dapivirine vaginal ring; most did not feel it during sex, no impact on sexual pleasure.

Dr Were also revealed that that in preparing for the dapivirine ring introduction, there was a pathway to achieve scale up.

“Regulatory approval; submission of regulatory dossiers for product approval from local national health product bodies.

“Government buy in; in order for a health product to be adopted into government policy, plans for introduction are developed through national technical working group structures and national level committees.

“Prior project projects donor funded sites; prior to large-scale up roll out pilot studies which are often donor funded are conducted across sites and populations to determine feasibility and the most effective implementation strategies.

“Broader scale roll out (government clinics) once pilot studies have demonstrated feasibility and the most effective implementation strategies, these strategies are applied to a broad scale public health roll out,” said Dr Were.

Following South Africa’s giant leap, it now remains to be seen whether other African countries where the ring has been approved, will also make orders for the use by the general public.

 

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