Recently it was reported patients in Homa Bay are throwing away their HIV medication. But this group in no way reflects the behaviour of the majority of people living with HIV in Homa Bay.
The success of an HIV programme is determined by the number of patients on treatment and the number of people the programme has reached out of the total population living with HIV – commonly referred to as the ART coverage.
Viral load, a test that shows the amount of HIV in the blood, is the only way to truly know if a patient is adhering to medication. Patients diagnosed with HIV are typically tested six months after their initial treatment and thereafter annually to make sure their medications are working effectively.
Data from the national Early Infant Diagnosis and Viral Load Database shows that out of 5,771 adults tested for viral load between January 2014 to May 2015, 5,070 suppressed the virus to undetectable levels in the Homa Bay Referral Hospital. This represents 88 per cent compared to the national average of 84 per cent.
Homa Bay has achieved high HIV suppression rates because we have recognised the sociocultural and economic issues necessary to help our programmes succeed. We have, together with partners, invested in initiatives that integrate facility and community-based psychosocial support programmes in the HIV response. These include peer educators, who, as persons taking antiretrovirals themselves, offer peer to peer support to patients and counsellors to provide psychosocial support.
At the referral hospital alone, there are seven psychosocial support groups of patients that meet every month to provide support to each other and share stigma reduction strategies to cope with the challenges of living with HIV.
ART adherence counselling is conducted by a trained counsellor and treatment is given only when the client confirms he or she is ready to take the medication. In the referral hospital alone, there are five professional counsellors specifically attached to the HIV clinic. These counselling services will enable us understand the needs of all patients in care so that we can tailor-make services for them.
Every person with HIV and on treatment should take their ARV medication. Studies have shown that taking antiretroviral treatment slows disease progression and also transmission. I also encourage everyone living with HIV to avoid alcohol. Taking alcohol while on ART impairs one’s judgement and inhibits absorption of the drug reducing its effectiveness. Patients with alcohol abuse problems are supported by trained counsellors to overcome the challenge and live healthy, productive lives.
Our work is not without challenges. For instance, data from the District Health Information System and 2013 National HIV estimates show that out of 146,200 people living with HIV in Homa Bay, 68,393 are on life-long ART. This represents ART coverage of 47 per cent, one per cent below the national coverage.
For one to be initiated on ART, they must know their HIV status. To close the gap between those who have HIV and do not know their status, the county government and its partners are supporting free HIV testing and counselling in all government, faith-based and private facilities.
Homa Bay has also expanded access to ART to dispensary level, rolled out ART for all pregnant and lactating women, support voluntary medical male circumcision and patient empowerment strategies, including peer support, adherence counselling and psychosocial support.
The Homa Bay HIV response just like any other HIV program in the Country and globally faces the challenges of stigma and discrimination, disclosure of HIV status to partners and adherence to treatment especially among the youths and adolescents.
But as a county, our work isn’t complete until the last person with HIV knows their status, the last person with HIV is provided with treatment and the last person on treatment suppresses the virus to undetectable levels. This is the reason we are deeply concerned about the small, but important number throwing away their medication as our work will not be complete without understanding their needs and addressing them fully.
Dr Lawrence Oteng is Homa Bay Health executive.