Youths stop taking ARVs months after starting treatment — MoH

A large number of youths who are placed on HIV medicines immediately after they test positive stop taking the drugs within one year, a new survey shows.

Kenya initiated the test and treat programme in 2016, where those who test positive are placed on treatment same day but preferably within two weeks.

Clinical studies that supported this approach showed newly-diagnosed people would not only accept the drugs, but would continue to faithfully take them.

Their viral load would drop to an undetectable level in six months or less, which means their chances of spreading HIV was nil, as long as they remained on treatment.

However, an assessment by the Ministry of Health and its partners shows about 23 per cent of Kenyans on the ‘test and treat’ approach – majority of them youths – stopped taking ARVs just a few months after initiation.

“Our findings from a routine HIV programme setting demonstrate the opposite. We observed that the earlier an individual initiated cART (early combination antiretroviral therapy), the higher the rate of non-retention,” the assessment, published in the Plos One journal, says.

Non-retention refers to individuals who are either reported dead or determined lost-to-follow-up,  which means they missed clinic visits more than three months after their last clinic appointment date.

“Our findings are consistent with those observed from another routine setting in Nigeria which reported high rates of lost to follow-up, poor viral load monitoring and low levels of virologic suppression amongst individuals starting ART within 14 days of HIV diagnosis,” the Kenya study shows.

The Nigerian study reported a 34 per cent lost-to-follow-up at 12-months after initiating treatment.

The report on Kenya is titled Uptake and effect of universal test-and-treat on twelve months retention and initial virologic suppression in routine HIV program in Kenya.

It was authored by officials of the National Aids and STI Control Programme, Kemri Wellcome Trust Research Programme, US Centres for Disease Control and Prevention, Usaid, US President's Emergency Plan for Aids Relief, US Military HIV Research Programme and consultants Palladium Group.

Beforehand, individuals were only put on treatment if their viral load went below a certain amount of the virus in a drop of blood.

The same-day HIV diagnosis and ART initiation increased the number of Kenyans on life-saving drugs from about 500,000 to 1.1 million today.

However, no comprehensive study had shown the effectiveness of this policy in Kenya, on adherence to treatment and sustained virologic suppression.

The authors analysed data from HIV-infected adults aged 15 years and above between July 2015 and June 2018.  All individuals were followed up for 12 months after ARV initiation.

The data was extracted from the repository of HIV programme data at the Nascop in Nairobi.

Results show that same-day HIV diagnosis and ARV initiation increased from 15.3 per cent in 2015 to 52.2 per cent in 2018.

Those initiated on drugs on the same day of an HIV diagnosis had the highest rate of non-retention, followed by one–14 days, 15–90 days and more than 91 days, respectively.

“While young adults (15–24 years) had the highest odds of early cART (combination antiretroviral therapy) uptake, they were also associated with the highest rates of non-retention and highest odds of initial viral non-suppression,” the authors said.

Kenya estimates suggest that youth and young adults contribute up to 40 per cent of all new HIV infections in Kenya.

The findings suggest while the youth are initially ready to start taking drugs immediately after HIV diagnosis, many drop due to denial, inadequate preparedness for early treatment, stigma and disclosure.

“These findings point to the need for a customised universal test and treat package of care that will also address youth-specific challenge,” the authors said.

The World Health Organisation asked countries to introduce the test and treat approach in 2016 to cut HIV transmission by suppressing the virus in those carrying it, which decreases their likelihood of passing it on to others.

However, evidence from ‘real life’ setting continues to show the opposite.

This difference seen may largely be attributed to multiple interventions in controlled studies, experts said.

They said research settings offer early ARV initiation as part of a package to facilitate early uptake, enhance retention, support adherence and achieve virologic suppression.

“These multi-pronged interventions include service providers training, condensed accelerated counselling protocols, intensified early visits schedule, short message service reminders, point-of-care diagnostics, educational packages, non-cash financial incentives and monetary incentives,” they said.

The Kenyan authors suggested this package should also be given to people starting ARVs on the same day they test positive.