- The researchers used the HIV synthesis model to assess the effects of making PEP available without a prescription
- In over 20 years, HIV incidence will decline by 31 per cent and HIV prevalence will fall by 27 per cent
Image: FILE
Some researchers have suggested HIV prevention pills, post-exposure prophylaxis be distributed freely through condom dispensers.
They said they will be easy to collect and no prescription will be needed.
PEP drugs are taken within 72 hours after risky sexual encounters and daily for the next four weeks to prevent HIV infection.
In Kenya they are offered only in health facilities because users first need to be counselled and tested for HIV.
Authors of a study published in The Lancet Global Health suggest making the PEP drug widely available without a prescription, could reduce HIV acquisition by 31 per cent over 20 years in African countries.
They proposed that pilot implementation studies should be done, examining a policy of having packs of PEP (a combination of tenofovir, lamivudine and dolutegravir – TLD drugs) available like condom access in public places, along with free self-test kits and post-coital contraception.
“TLD has a shelf-life of 36 months and does not require refrigeration,” they said.
“One hurdle will be to ensure TLD PEP can be made available without prescription and regulatory support will be required for this move,” the authors said.
Their study is titled, “Potential cost-effectiveness of community availability of tenofovir, lamivudine and dolutegravir for HIV prevention and treatment in east, central, southern and West Africa: a modelling analysis.”
The researchers used the HIV synthesis model to assess the effects of making PEP available without a prescription.
In over 20 years, HIV incidence will decline by 31 per cent and HIV prevalence will fall by 27 per cent.
Dr Sarah Johnson, lead author of the study, said, "Our findings suggest that widening access to PEP within communities could be a game-changer in the fight against HIV.
"By making TLD readily available and removing barriers to access, we have the potential to save lives and reduce the burden of HIV in Africa."
However, a team of African researchers faulted the analysis in a rejoinder published by the Lancet.
They said it was highly likely the PEP drugs would be diverted to other uses.
“Insecticide-treated bed nets, for instance, were often repurposed for catching fish after their distribution as part of malaria control campaigns, where some families valued the immediate benefit of supplemental protein more than an intangible threat of disease,” they said.
Their letter is titled, “Unrestricted access to tenofovir, lamivudine, and dolutegravir as pre-exposure or post-exposure prophylaxis in community settings.”
They said normal ARVs for people living with HIV are also sometimes diverted for recreational drug use by mixing them with other drugs.
Some Kenyan farmers also use ARVs to promote rapid growth and control diseases in pigs and broiler hens.
“We consider the misuse of community TLD to be a distinct possibility, given a declining HIV prevalence and harsh economic climate across the region,” the authors, HIV researchers Lynda Stranix-Chibanda and Tsungai Mhembere said.
Making PEP freely available will also be impractical in Kenya, where the government is already fighting its abuse by young people.
Early this month, the National Syndemic Diseases Control Council raised concern over the high number of young people who requested for PEP during the Safari Rally in Naivasha.
Head of the NSDCC Dr Ruth Laibon-Masha said the high demand could lead to abuse.
“When you see such a high demand of PEP, it means the risk has already happened. All they said is that they were using condoms, which burst, or were drunk when having sex,” she said.
Although more than 200,000 condoms were being distributed in Naivasha, officials were alarmed that many young people were also seeking PEP tablets.
The high demand for PEP indicates successful awareness about its benefits and possible misuse. Masha said health workers cannot allow people to abuse the post-exposure drugs because they should be taken only in emergency situations.
They are also not 100 per cent effective and if misused, can cause users to develop drug resistance in the case of future HIV infection.
The first dose of PEP should ideally be administered within two hours of an exposure and no later than 72 hours after an exposure.
“Last year, we had 117 people turning positive even after taking PEP because they came late,” Dr Masha said.
She also noted PEP drugs do not prevent pregnancy and other sexually transmitted infections, which are on the rise.