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Why AIDS prevention drugs should be as close at hand as fast food

2022-04-30T04:05:58.811Z


In South Africa, the country with the highest number of HIV infections in the world, the number of people using the pill that prevents infection has doubled since the government made it publicly available in 2020


Twenty years ago, little could be done to prevent HIV infection other than not having sex or using condoms every time.

Today, the situation is very different thanks to the fact that researchers have made great advances in so-called biomedical interventions.

In common language, these are means such as pills, injections or vaginal rings that can be used to reduce the probability of HIV entering the body if you have sex without a condom.

Scientists call this class of interventions pre-exposure prophylaxis, or PrEP, because they are used before possible contact with the pathogen and help prevent it from spreading (prophylaxis is preventive treatment).

PrEP for HIV contains antiretroviral drugs (the same ones that doctors use to treat people who carry the virus) that protect the cells of the immune system from infection.

South Africa registers 200,000 new HIV infections each year (about 550 a day), and pills, vaginal rings and injections can help reduce this number dramatically.

In South Africa, there is only one pill (also called oral PrEP) that needs to be taken daily for it to work.

The pill must have entered a person's body at least 30 days before they were exposed to HIV and, if taken correctly, can reduce the chance of getting the virus by 92-98%.

Another possibility is to take two pills before sexual intercourse and a third one a day later (in this case, obviously the person has to know when they are going to have the encounter).

However, this method, called “PrEP on demand,” is recommended only for men who have sex with men, as studies show that when this modality is used, the pill is not as effective for vaginal sex as it is for men. the anal

There is also a silicone ring that women can insert into the vagina, called the dapivirine vaginal ring.

The device can reduce the chances of contracting HIV through sex by 27%.

Its use was approved by the South African Medical Devices Regulatory Authority (SAPHRA) in March, but the National Department of Health has stated that it is still drafting instructions for use and negotiating prices with the manufacturer. so the ring is not yet available.

More than 450,000 people have received the preventive pill in state centers throughout the African country

The most effective PrEP according to studies is an anti-HIV injection called cabotegravir that is given every two months.

The puncture virtually nullifies the chances of getting HIV through sexual intercourse.

One of the reasons why scientists think that a cabotegravir injection works better than a daily pill is that it is much easier to follow the treatment faithfully, since some people have a hard time remembering to take a pill every day, and the less is the frequency with which it is taken, the worse it works.

Cabotegravir recently came onto the market and has not yet been approved for use by SAPHRA, although ViiV Healthcare, the manufacturer of the preparation, has applied for approval.

But even if it is approved, it is likely to be unaffordable considering that, in the United States, it is sold for 54,000 South African rands a dose, about 3,200 euros.

There is no comparison with the 90 rands per month (5.35 euros) that, according to the health department, it costs to provide the HIV preventive pills to one person (3.8 euros corresponds to the cost of the medicine itself and the rest to the costs administration, such as nurses' salaries, blood tests, etc.).

The most effective PrEP according to studies is an anti-HIV injection called cabotegravir that is given every two months.

Experts believe that ViiV Healthcare would have to sell cabotegravir to the health department for no more than 180 rand or 11 euros per injection (i.e. about the same price as a month's supply of pills) to make it feasible to administer it in the public health system.

Given that, in South Africa, eight out of 10 people depend on state clinics and hospitals, that is where the pill would be most needed,

South Africa registers 200,000 new HIV infections each year (about 550 a day), and pills, vaginal rings and injections can help reduce this number dramatically.

At a recent event for South African digital media outlet Bhekisisa held via Twitter Spaces, Linda-Gail Bekker, Director of the Desmond Tutu Center for HIV at the University of Cape Town, stated: “We need fast PrEP, like fast food.

PrEP should be available at many points and in many ways.

In this country, prophylaxis is not a luxury;

HIV prevalence makes it a top priority.”

Where is South Africa in terms of distribution of HIV prevention pills in the public system?

We asked the health department for the most recent numbers (they gave us the data up to the end of December 2021), put together a series of infographics, and asked the agency questions about some of the statistics.

In this link you can consult the figures that they provided us.

1. How many people have received HIV prevention pills in a public center?

Bhekissa

In total, the drug has been administered to 450,606 users of the South African public health system.

How was this figure arrived at?

The country started making the pills available in public health centers in mid-2016, but the drug was introduced in phases, so at first only certain population groups could receive it.

In 2016, it was exclusively sex workers authorized by public clinics and hospitals;

only 771 used the pill that year.

In 2017, men who have sex with men and college students were added to the list of people who could receive the medication.

So the number of oral PrEP users quadrupled.

In 2018, when it was the turn of adolescent girls and young women, 8,593 people took the pill, more than double the number in 2017. In 2019 it was 45.

576 those who started using it (injecting drug users and transsexuals were included that year).

In 2020, anyone who needed oral prophylaxis could receive the pills at a public facility as long as a health professional prescribed them and the facility had them available.

106,402 people used it.

In 2021, this figure multiplied by more than two, reaching 286,068 people.

The health department has not yet released figures for 2022.

2. How many public clinics and hospitals have HIV prevention pills?

Bhekissa

2,700 of the 4,263 public health centers in South Africa (63%) have HIV prevention pills (2,224 are primary care centres, ie clinics where people go before seeking more specialized care).

In addition, 12 university clinics and 47 prison clinics also provide them.

How has this number increased over the years?

In 2016, only 13 hospitals and clinics had oral PrEP (they were pilot projects).

In 2017, the figure multiplied by more than two, up to 27 centers.

In 2018 there were 73, and in 2019, 117. When the pill became accessible to everyone in 2020, the number of centers multiplied by 12, to 1,412.

In 2021 the figure almost doubled, reaching 2,700 centers.

3. Which provinces use pills to prevent HIV the most?

Bhekissa

KwaZulu-Natal is the province with the most people taking oral PrEP, with 158,193 users (remember that this figure includes only those who receive the drug in public hospitals and clinics), and Gauteng is second, with 115,058.

However, the latter has a larger population (15,176,115 inhabitants) than the former (11,289,086 inhabitants), so when the percentage of population reached is considered, in KwalaZulu-Natal (1.4%) it is almost double than in Gauteng (0.8%).

However, the distribution is related to the percentage of people infected with HIV in each province: 18.2% in KwaZulu-Natal and 13% in Gauteng.

Coverage in the other provinces is as follows:

  • Mpumalanga: 62,001 (1.4%)

  • Eastern Cape: 50,103 (0.8%)

  • Free State: 21,531 (0.8%)

  • Western Cape: 21,487 (0.3%)

  • Limpopo: 12,990 (0.2%)

  • Northwest: 9,872 (0.3%)

  • Northern Cape: 371 (0.03%)

Why is coverage in the Northern Cape (0.03%) so much lower than other provinces?

According to the national health department, "PrEP progress was slower than in other provinces" because the Northern Cape has not received donor money to "accelerate distribution of prophylaxis," while others have.

4. What percentage of public primary care centers have oral PrEP by province?

Bhekissa

The health department states that it has 3,465 primary care centers, 2,224 of which (64%) have oral prophylaxis pills.

KwalaZulu-Natal is the province with the best figures: 97% of primary care centers have the drug.

They follow:

  • Mpumalanga: 96%

  • Gauteng: 94%

  • Free State: 94%

  • Eastern Cape: 66%

  • Northwest: 45%

  • Limpopo: 18%

  • Northern Cape: 14%

  • Western Cape: 8%

5. What age groups use PrEP the most (provided by a public center)?

Bhekissa

People between 20 and 24 years old (90,642) are the ones who have accessed HIV prevention pills the most through public clinics and hospitals, followed by the group between 15 and 19 years old (70,995).

This means that 1.5% of the total population of this second group (4,793,213 people according to the statistics of the district health information system used by the national health department) use oral prophylaxis provided by public centers.

In the first group, the proportion is 1.9% (out of a total of 4,824,133 people between 20 and 24 years old).

As age increases, the use of pills decreases, something that is consistent with sexual behaviors: young people tend to take more risks than older people.

Pills for the prevention of HIV infection are not intended to be used permanently, but rather in periods of life in which people are more likely to have sexual relations without condoms with partners at risk, which, in turn, In turn, it increases the chances of getting the virus.

In all age groups except those aged 50 and over, more women than men use the pills.

The difference is especially marked in the younger age groups (between 15 and 34 years).

Figures for HIV infection in South Africa show that adolescent girls and young women between the ages of 15 and 24 are becoming infected at a much faster rate than their male peers, as well as older men and women.

According to the national health department, "demand creation and social mobilization to reach this age group with preventive HIV interventions have increased."

That is why the use of the pills by women between the ages of 15 and 25 is much higher.

6. How is the use of pills distributed by sex in the different provinces?

Bhekissa

In all provinces, pill use is significantly higher among women than men, except in the Western Cape.

The health department says the reason the picture is different in the latter could be a matter of preference.

Thato Mtshaba, director of HIV prevention says “it is not because, in the Western Cape, prophylaxis is offered more regularly to men than to women.

It could simply be because more men prefer it, but we need to look at the data more closely to know for sure."

Article originally published in English in Bhekisisa, a South African health publication.

You can consult the Bhekisisa Center for Health Journalism newsletter here.

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Source: elparis

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