Kenya is now banking on three magic numbers that experts say if achieved, can finally tame the HIV epidemic.
The 90-90-90 plan, unveiled by UNAids, aims to end the spread of HIV by 2020 and eliminate the disease by 2030.
DUAL PURPOSE
This plan was informed by growing clinical evidence showing that when people living with the virus are treated, two goals are achieved simultaneously.
“The infected person is able to live a nearly normal life but also, they become less infectious, making it harder for the virus to spread unchecked,” says Mary Naliaka, a nurse in pediatrics Aids.
“Basically, HIV treatment is also prevention and if 90 per cent of people living with HIV will get on antiretroviral treatment (ART) and reduce viral load by 90 per cent, 90 per cent of new infections will be avoided,” she explains.
Viral load is the amount of HIV in a sample of blood. A high viral load is problematic since it is an indicator that the HIV virus is multiplying fast and attacking the immune system of a person living with HIV.
The Kenya HIV Estimates 2015 showed that 77,000 people were infected with HIV and an estimated 35,822 died from Aids-related complications.
Dr Lucy Matu, the technical services director at the Elizabeth Glaser Pediatric AIDS Foundation in Kenya, says the 90-90-90 initiative is achievable.
“As of April 2014, there were 871,063 HIV patients currently on HIV care, which accounts for about 72 percent of all people living with HIV by the most recent Kenya Aids Indicator Survey estimates,” she says.
She further says that 657,845 of the 871,063 (76 per cent) were on ART by April 2014. This includes adults and children.
Dr Matu explains that what set the stage for the attainment of the 90-90-90 targets was the adoption by government of the 2013 World Health Organisation (WHO) guidelines, which recommended an increase in the CD4 count threshold for initiation of HIV treatment from 350 to 500.
She said that with the 2013 guidelines, the eligibility for ART became broader.
When the guidelines are fully implemented in Kenya, Dr Matu says that “it will push the number of people living with HIV on ART up by at least 250,000, to at least 90 per cent of those in care, and of course, more people will continue being enrolled in care.”
CLINICAL BENEFITS
The 2013 WHO guidelines were also informed by evidence of clinical benefits of earlier HIV treatment initiation.
“If you start people living with HIV on ART when their CD4 count is relatively high, the body is relatively healthy and can remain healthy without the patient experiencing any opportunistic infections,” Dr Matu says.
She explains that when an HIV patient starts treatment when CD4 count is very low, it is difficult to substantially improve response to ART, “which is seen through rising CD4 count”.
Research has shown that some of the clinical benefits of early HIV treatment initiation include reduced risk of acquiring recurrent pneumonia or even AIDS-defining illnesses, such as tuberculosis and meningitis.
But achieving these targets will require an unprecedented financial commitment.
According to the National HIV and Aids estimates 2014 released by the Health ministry, Kenya needs an estimated Sh1.75 trillion by 2030 to prevent at least 1.5 million new HIV infections.
The report further shows that with a budget of Sh11.7 billion per year, “Kenya would reduce the number of new infections by 66 per cent.”
Treasury allocated Sh670 million to the National Aids Control Council in the 2014-15 Budget.
In spite of the uphill task ahead, many are optimistic that 90-90-90 will end Aids and that Kenya is still on the right track, albeit with more financial commitment while aggressively fighting stigma.
“Stigma remains a big challenge because it keeps HIV-positive people away from health centres that offer HIV care for fear of having their status known. This also affects how they take their medication,” Naliaka says.
“If they are not taking ARVs as advised, then we end up with cases of failed treatment and people with a high viral load,” she says.
These challenges notwithstanding, Naliaka says that sooner rather than later, HIV will not be able to withstand the continued onslaught from progressive research and better treatment regime.