• A six-month disruption of antiretroviral therapy could lead to at least 500,000 more deaths.
• This would mean setting the clock on HIV-related deaths back to where they were in 2008.
Image: JACK OWUOR
Gains made in preventing mother-to-child HIV transmission could be reversed due to interruptions caused by Covid-19.
New infection in children is expected to go up by 104 per cent.
Since 2010, HIV infection among children in Sub-Saharan Africa has declined by 43 per cent, from 250,000 in 2010 to 140,000 in 2018.
A new projection by a group of five teams convened by the World Health Organization and UNAIDS shows an urgent need to strategise to mitigate and overcome interruptions in health services during the Covid-19 crisis.
A six-month disruption of antiretroviral therapy could lead to at least 500,000 more deaths from Aids-related illnesses in sub-Saharan Africa between 2020 and 2021.
This would mean setting the clock on HIV-related deaths back to where they were in 2008. During the year, more than 950,000 Aids-related deaths were recorded in the sub-Saharan region.
According to WHO, an estimated 470,000 people died of Aids-related illnesses in the region in 2018.
People living with HIV are likely to get seriously sick if they contract the coronavirus when their immune system is compromised.
The projection estimates that failure to take urgent action could lead to more deaths for another five years.
“The terrible prospect of half a million more people in Africa dying of Aids-related illnesses is like stepping back into history,” WHO Director General Tedros Adhanom Ghebreyesus said.
“We must read this as a wake-up call to countries to identify ways to sustain all vital health services.”
The WHO boss commended countries already taking steps such as ensuring that people can collect bulk packs of treatment and other essential commodities, including self-testing kits from drop-off points.
“This relieves pressure on health services and the health workforce. We must also ensure that global supplies of tests and treatment continue to flow to the countries that need them,” Ghebreyesus said.
Kenya is among the countries that have allowed people living with HIV to get bulk stocks of ARVs that last them three months.
Health facilities in Nairobi have already implemented the directive, and some are dispensing drugs that can last up to six months.
Previously, only a few individuals with stable immunity were allowed to pick up enough drugs to last more than one month.
"To reduce clinic attendance and drug pickup frequencies, up to three-month multi-month dispensing of ARVs should be considered for all people living with HIV regardless of age and viral status," Nascop head Dr Catherine Ngugi said in a circular to all county executives for health.
It is estimated that in 2018, 25.7 million people were living with HIV and 16.4 million (around 64 per cent) in sub-Saharan Africa were undergoing antiretroviral therapy.
But according to the WHO, they are now at risk of having their treatment interrupted either because of the closure of HIV services, lack of ARVs caused by disruptions in the supply chain or overwhelmed services due to competing needs to support the Covid-19 response.
The research teams used different mathematical models to analyse the effects of possible disruptions to HIV testing, prevention and treatment services caused by Covid-19 in three or six months on Aids mortality and HIV incidence in Sub-Saharan Africa.
From the projection, a six-month disruption shows that Aids-related deaths in one year will range from 471,000 to 673,000.
This means that it will be inevitable for the world to miss the global 2020 target of fewer than 500,000 Aids-related deaths worldwide.
More sporadic interruptions of ART supply could lead to drug resistance, with long-term consequences for future treatment success in the region.
UNAIDS executive director Winnie Byanyima has warned against using Covid-19 as an excuse to divert investments meant to go towards HIV programmes.
“There is a risk that the hard-earned gains of the AIDS response will be sacrificed to the fight against Covid-19, but the right to health means that no one disease should be fought at the expense of the other,” Byanyima said.
“Every death is a tragedy. We cannot sit and allow hundreds of thousands of people, many of them young, to die needless deaths.”