his month (April), some public sector AIDSpatients started taking simplied ARVtreatment o just one pill a day to managetheir inection. The South Arican NationalAIDS Council (SANAC) welcomes this change intreatment protocols by the Department o Health.“On behal o men in South Arica and organisationsworking with men and boys, we welcome the goodnews by the Minister o Health that the national HealthDepartment is introducing xed dose combination(FDC) anti-retroviral (ARV) treatment. In the processo rolling out the once a day ARV tablet, whichcontains a combination o three vital ARVs - Tenoovir,Eavirenz and Emtricitabine - the ARV programmeshould improve through increased compliance andmaintenance o patients on ARVs, including theintroduction o new patients to ARVs”.“Instead o taking several pills at dierent times o the day, the FDC allows or patients to take one pillonce a day, which will improve adherence. We haveto make sure that those who are still taking severalpills remain in the system and stay motivated, saidRev Baana Khumalo, the national chairperson o the men’s sector o the South Arican National AIDSCouncil (SANAC). The People Living with HIV sector believes that FDCtherapy will improve and strengthen adherence totreatment.“There are many reasons why people do not adhereto their medication. Amongst them are issues o highdosages or too many pills to take (which is also knownas pill burden) and side-eects. Too many people,about 70% in South Arica, have HIV and TB at the sametime and in most cases they have to take treatment orboth illnesses simultaneously. This means many o ustake ar too many pills and that discourages some notto take them. We need more simplied treatment toinuence adherence. The introduction o xed dosecombination therapy is a very progressive step towardsimproving and reducing actors that contribute topoor adherence”, says Vuyiseka Dubula, an executivemember o SANAC’s sector o people living with HIV.Fixed dose combination therapy will also applyto pregnant women, thus replacing the dualcombination therapy consisting o Nevirapine andAZT. All HIV-positive pregnant women in South Arica,during pregnancy and throughout the breast-eedingperiod, will be on xed dose combination therapyregardless o their CD 4 count. This will continue evenater breast-eeding i their CD 4 count alls below 350.In act, pregnant women are a priority group and arethe rst in line to receive FDC therapy as the HealthDepartment begins phasing in this treatment model.“This is exciting news indeed that we are startingto see a breakthrough and shit or the signicantimprovement o health and well-being or all peopleliving with HIV, especially mothers and children”, saidan executive committee member o SANAC’s children’ssector, Anthony Ambrose.“This is simpliying the way patients have becomeused to taking ARV treatment. Patients will nowtake one pill a day. This pill is an all-in-one packageo all three anti-retrovirals (Tenoovir, Eavirenzand Emtricitabine) that a patient needs or optimaltreatment. And they will take it once a day as opposedto taking a combination o pills three times a day”, saysDr Fareed Abdullah, chie executive ofcer (CEO) o the South Arican National AIDS Council (SANAC).“We have come a very long way since the advent o anti-retrovirals. At one point, patients used to take upto 16 pills a day”, Dr Abdullah adds.“This simplication o treatment makes takingAIDS treatment convenient. We hope that it will resultin patients complying with and adhering to theirtreatment. We hope that this will enable many morepatients to take their medication everywhere andanywhere they may be”, he says.Proessor Ashra Coovadia, chairperson o SANAC’schildren’s sector, advises that “it is important to inormthe public that whilst government will be rolling outthe new PMTCT programme with FDCs, the currentPMTCT programme which utilises AZT & Nevirapine tomothers and Nevirapine to inants is still an eectivestrategy”.According to SANAC CEO, Dr Abdullah, “noteverybody will switch to one pill a day immediately,as the Department will roll this out over the comingmonths. Patients who are on second line treatmentwill not be switched to the one pill a day treatment.Patients should talk to their doctors and nurses to ndout i and when they will switch treatment. There willalways be some exceptions, but by this time next yearthe Health Minister expects that 80% o all patientswill be on the new ormulation”. The rollout o the FDC therapy will be in twophases, with HIV-positive pregnant women, patientsnewly-initiated on ART and those who are co-inected with TB and HIV being prescribed FDCs inApril. Patients who are already taking treatment willbe switched to FDC therapy starting in July/August.Abdullah noted that within SANAC there weresome people who wanted everyone to start at thesame time, but there was an understanding thatthere will be phases to the rollout.“We appreciate the move by our governmentto introduce the FDC. But the government shouldequally put more eorts and ensure that we all getthe same treatment”, said Mluleki Zazini, chairpersono the PLHIV sector.But Zazini moved to make a call to all peopleliving with HIV that are aected by the phasing inapproach to “be patient and continue taking theircurrent treatment, considering that their health willbe compromised i they deault”.“The introduction o xed dose combinationsneeds all o us to do social mobilisation to educatepeople about this change. We also have to make surethat our supply chain management is not interruptedso that we do not have stock-outs o medicines”,added Vuyiseka Dubula, o the PLHIV sector.
SANAC oN fIxEd doSECoMBINATIoNS
The intuctin ie se cmbinatinthea is a veessive ste twasimvin an eucinacts that cntibute t aheence.
a-Rankuwa-based AIDS activist, AndrewMosane, is one o the rst patients toreceive xed dose combination (FDC)anti-retroviral therapy. He says thistreatment will make taking ARVs simple or him.“At the moment I’m taking ve pills every day –two in the morning and three at night”, Mosane says.“Seriously, it was a challenge taking ve pills on aday to day basis. I was taking AZT, 3TC and Eavirenz.FDC is good because it is easy dosage. It is a singlepill. You don’t get drug burdened or get tired whenyou have to take your drugs. It is also good because ithas ewer side-eects”, the 36-year old adds.According to the national Health Department’sguidelines on FDC treatment, pregnant and breast-eeding women, people who are taking anti-retroviraltreatment or the rst time and those co-inectedwith HIV and TB should be prioritised or treatmentwith FDCs. People like Mosane, who do not all underthese categories and are already taking ARVs, willstart switching to FDC therapy in later months. So,having him on FDCs already is an exception to therule.Asked how he got to be on FDC therapy, Mosaneexplained: “I am an activist and I wanted to take thelead in this. I’ve been taking ARVs since 2006 ater Iwas diagnosed with HIV in 2003 and my bloods werechecked or eligibility to switch treatment to anotherset o drugs. It was a right choice or me to take thatstep”.“About two months beore FDCs became availableI insisted on taking blood tests because I wanted tostart taking Truvada and Eavirenz and the resultscame back showing that I can switch my medications.But I did not want to start taking these drugs becauseI knew that the xed dose combination would soonbe available, even though I did not know when”.“By luck, it happened that the acility manager atPhedisong Clinic in Ga-Rankuwa, north o Pretoria,where the national Health Minister Dr AaronMotsoaledi, would launch the FDC therapy wantedsomeone to be on television to speak about their liewith HIV and how FDC therapy will help them. Mostpeople were araid to be on national TV, so I came inand took the opportunity and grabbed it with bothhands. That’s how I managed to switch onto FDCtreatment”.He lamented the act that “there are restrictionsto people who are already on treatment as therestrictions mean that they will have to wait longerbeore they can switch to xed dose combinationtherapy”.However, he believes the country is moving inthe right direction by introducing FDC therapy. “It isgoing to save South Arica some money. But we haveto guard against stock shortages”, Mosane opines.
Takin the ain ut takin ArVs
Andrew Mosane with his pack o FDC ARV supplies