Kenya makes final push in eliminating HIV

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By Gatonye Gathura

The biggest push against HIV has just got underway, targeting about 10 million youths, a dozen global celebrities and a small blue pill.

Advocates claim the pill, Truvada, taken once daily by healthy individuals is the ultimate tool to annihilate HIV and pave way for a new HIV-free generation within 15 years.

Trials done in Kenya and elsewhere among sex workers, discordant couples and gays show the pill can reduce new HIV infections by between 92-99 per cent.

“We have largely tamed the scourge but for new infections,” says Cabinet Secretary for Health Dr Cleopa Mailu.

With Truvada now registered in Kenya, user guidelines published recently and funds released by the US, it is time to put the show on the road.

First on stage was President Uhuru Kenyatta in July when he launched the Maisha County Football League that plans to get to 10 million youths from all the 47 counties.

Run under the banner “Kick out HIV stigma” the initiative intends to reach 10 million young people with HIV messages, test three million of them and link one million to treatment by 1st December.

The league, which hosted Victoria Beckam last weekend, is only one of several innovative ways of attracting the youth into the Truvada initiative.

The choice of Mrs Beckam, one of many celebrities lined up, was not accidental with the planners targeting to capture about 4.1 million 15-24 year-old adolescent girls and women.

Planning notes, by the consortium led by the US President’s Emergency Plan for AIDS Relief (PEPFAR) singles out girls because they are four times more likely to get infected than boys.

Other priority groups are 260,000 discordant couples and an unquantified number of prostitutes, gays, prisoners and drug users.

PEFER is funding several innovative ways of mobilizing youth, including interactive social media outlets, business initiatives for youth and other crowd pulling activities.

In July, PEPFAR released more than $85 million for activities that will keep girls in school longer including funding to the University of Washington spearheading the Truvada push in Kenya.

This approach, to meet youth where they congregate, was adopted after Kenyans showed strong opposition to sex education in schools. Some Kenyans have been opposed to a Senate Bill which proposes sex education in schools for 10-year-olds.

“Don’t introduce sex education in schools. It would be catastrophic and likely to escalate early sex,” the Head of Anglican Church of Kenya Jackson ole Sapit warned last week while at St. Paul’s University.

But public hostility is not the worst the planners have to contend with. Stigma might be and specifically targeted at the oval blue pill.

Truvada, an antiretroviral, is used to treat HIV infected persons and recently for prevention among sex workers hence fears that targeted young, healthy and ‘upstanding’ women may not want to be associated with the pill.

“Stigma is a major concern for uptake,” says PEPFAR. The planners anticipate stigma such as usually directed at sex workers or women seeking protective tools like condoms and now Truvada.

To enhance discretion, trials are ongoing in the country to develop a long term injectable formulation as well as a topical microbicide as an alternative to the current oral pill. Such, researchers say will offer more discretion and privacy for users.

The recruitment of 1,500 HIV negative women for the injectable trials is underway in Kisumu, Kenya, Botswana, Malawi, Mozambique, South Africa, Tanzania and Zimbabwe and results anticipated in 2022.

As per the Truvada user guidelines developed by the US Centers for Disease Control and Prevention and endorsed by the Ministry of Health in July, the drugs come in a 30 tablet once-a-month-refillable plastic bottle.

The oral pill is recommended for healthy individuals normally involved in risky sexual behavior. Such would include individuals; with multiple sex partners, involved in buying or selling sex or for discordant couples.

If you are the type to drink and engage in casual sex under the influence, the guidelines indicate you as a possible candidate.

However, unlike condoms where initiation can be made at the spar of the moment, pre-exposure prophylaxis (PrEP) as this is called requires a longer preparatory process.

One has to be initiated by qualified medical personnel, first be tested for HIV, and be willing to adhere to PrEP and to attend follow-up evaluations including repeat HIV testing and monitoring for side effects

For the pill to be effective one is required to take seven doses to achieve adequate levels of concentration in body tissues. This means on initiation one has to take the pill for a week at which time they must not engage in risky sexual activities.

At the same time, if one misses to take the pills for any number of days, the user must compensate for the misses before full protection can be assured.

Truvada, a combination of two medicines works by blocking important pathways that HIV uses to set up an infection. The presence of the medicine in high quantities in the bloodstream often stops HIV from taking hold and spreading.

Before initiation, both the PEPFAR planner and user guidelines indicate one has to under go liver and kidney check-ups and continuous evaluations thereafter due to its side effects.

“Capacity-building will be needed in order to equip delivery outlets with competence to provide liver and kidney testing needed alongside PrEP,” says the PEPAFR planner.

The rollout of Truvada now operationalises what could be Kenya’s most ambitious health campaigns ever: The HIV Prevention Revolution Road Map launched in 2014.

The plan estimated to cost about Sh1.7 trillion has Truvada rollout as a main component and targets at eliminating HIV spread by 2030.

The donor rollout plan does not indicate what the total cost of PrEP. However an estimate prepared for the Government, by the now defunct US-funded Health Policy Project, had put the cost of covering all sex workers at Sh 4 billion annually each at Sh48, 667.

Before the new PrEP initiative the US estimates HIV treatment and prevention efforts in Kenya to cost about US$956 million annually.

The US and UK, the PEPFAR document indicates are responsible for 62 per cent of this budget, Government of Kenya contributing 15 per cent and four per cent coming from non governmental sources.

The US report: Country Situation Analysis Interim Findings: Kenya, indicates initial funding for the PrEP role out will come from the Bill Gates Foundation.

But Kenyans will also have to pick the tab along the way especially through the proposed National HIV Trust Fund and the enhanced National Hospital Insurance Fund.

The bulk of the drugs will be manufactured by the American company Gilead Sciences and supplied in Kenya through their local representatives Philips Pharmaceuticals Limited.

The roll out of Truvada to anywhere near four million people, from the current 900,000 on antiretrovirals could also have serious though unintended environmental consequences.

A comprehensive sampling of the whole Nairobi River Basin, earlier this year confirmed the waters to be dangerously contaminated with antiretrovirals.

Researchers from the University of Jyvaskyla, Finland and Jomo Kenyatta University of Agriculture and Technology, Nairobi, confirmed the chemicals were hurting marine life in the rivers.

They attributed the contamination to untreated domestic wastewater being directed into the rivers especially in heavily populated areas of Nairobi.

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