Scientists at the Medical Research Council / Uganda Virus Research Institute (MRC/UVRI) and London School of Hygiene and Tropical Medicine(LSHTM) revealed that Uganda’s viral load suppression is less than 90 per cent, implying that the country has not yet reached the UNAIDS target of 95%, which is one of the challenges in the fight against the virus.
UNAIDS developed the 95-95-95 strategy to end the HIV/AIDS pandemic by 2030. That means; 95% of the people who are living with HIV know their HIV status, 95% of the people who know that they are living with HIV are on lifesaving antiretroviral treatment, and 95% of people who are on treatment are being virally suppressed.
Researchers revealed that despite great success so far, challenges still exist in achieving viral load suppression, especially among children and adolescents.
According to Dr. Deo Ssemwanga, the Senior Scientist at MRC/UVRI and LSHTM, currently Uganda has about 1.5 million people living with HIV, of which about 1.3 million people are on treatment and the coverage among those on treatment is a bit high.
“However, it is very unfortunate that among those patients who are not suppressing and those on treatment, when we test for HIV drug resistance, we are seeing over 90 per cent of these individuals with drug resistance,” he said.
Drug resistance refers to a situation where a person on treatment is not controlling the virus instead, the viral load continues to increase. Dr. Ssemwanga attributed the major cause of drug resistance in Uganda to failure to adhere to treatment.
“Over the years, the MRC and partners have been doing a lot of surveillance among the population and we have worked in so many populations most especially in high-risk populations, including sex workers, the fisherfolk communities and the general population”, he noted.
He noted that viral load suppression among sex workers, is not as good as most of the general population. “Most of them are very active in the business, which is a challenge since they are most likely transmitting,” Ssemwanga stated.
With the fishing communities, the researcher highlighted that they have done a lot of work with communities in Masaka, Islands of Lake Victoria, and in Entebbe of which the findings were similar to those of the female sex workers.
“For example, when you ask a fisherman about the number of sex partners they have, the answer is shocking and yet condom use is an issue. This is where we need to engage the Ministry of Health and other partners to ensure that these individuals adhere to treatment and improve on their suppression,” Dr. Ssemwanga appealed.
“While undertaking the studies in Uganda, several countries were also rolling out data, and when the World Health Organisation looked at all the data across the different countries, the findings were very high resistance. So, a decision was eventually made and WHO came up with new treatment guidelines to start using a drug called Ddolutegravir (DTG), which is being used at the moment as first-line treatment,” he revealed.
Dr. Josephine Birungi, a Scientist with MRC emphasized Integrated Management of HIV and non-communicable diseases as recommended across many African countries but evidence of the effectiveness of the model and its effect on HIV outcomes is still lacking.
“We discovered that when you bring patients of Hypertension, HIV and Diabetes together in one clinic, the health facility saves costs in many ways instead of running multiple clinics for different conditions,” she said
She also noted a challenge with the fact that HIV drugs are free while Diabetes and Hypertension drugs are being charged, saying, some diabetes patients wish to have HIV rather than having diabetes.
Dr. Birungi further highlighted that in rural areas 22% and 34% in urban areas potentially suffer from hypertension and as researchers, the only measure they can do is to present evidence to the Ministry of Health so that it finds the possible solutions.
Another Scientist with MRC/UVRI Dr. Yunia Mayanja remarked that adolescent girls and young women between 15 to 24 years are at a high risk for acquiring HIV.
Dr Mayanja also revealed that there are also injections known as injectable PrEP which is recommended by the WHO and also approved by the Ministry of Health in Uganda but is not yet available for use in the country.
According to the three scientists, Prep is 90% effective if taken daily as per the prescription based on trials done within MRC that have looked at the vaginal ring, which is a product that also contains Anti-viral drugs.
“There are also implants that are being developed for young people but what we found out from our study is that all these products had preference but we know the HIV Vaccine had the highest preference in that study followed by the oral and injectable PrEP. The implant had a small proportion preference and only 3 participants out of 280, preferred vaginal rings,” Dr Mayanja concluded.
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