Approaching 95-95-95 HIV/AIDS Goals by Focusing on Patients.

12,720

90-count bottles of TLD delivered in Namibia

27,073

90-count bottles of TLD delivered in Botswana

2,759,865

90-count bottles of TLD delivered n Zambia

Eleven-year-old Helvi Isangu collects her ARV medication at the Rundu State Hospital, Kavango East Region, Namibia.  Photo: Salome Nzuma/GHSC-PSM.

For example, GHSC-PSM in Namibia coordinated with the government early to ensure there was a sufficient supply of first-line ARVs to meet patient demand throughout the lockdown. GHSC-PSM’s MMD scale-up in Namibia has likely saved 25,440 trips to the pharmacy, protecting patients and health workers by reducing their exposure.The project also was easing the burden of PLHIV with MMD even before the pandemic. Eleven-year-old Helvi Isangu used to walk about an hour each way to the Rundu State Hospital in Kavango East Region to collect ARVs. She and her aunt would wait patiently in line at the hospital, which sees an average of 160 patients a day. With MMD’s wide implementation in Namibia’s health facilities, missed school days, traveling to the hospital, and spending hours in line to collect medication will be a thing of the past for PLHIV like Helvi.

What we have achieved so far

Before the pandemic, the global health community had made great progress to end AIDS. Between 2008 and 2017, there was a 43 percent reduction in AIDS-related deaths, and the number of PLHIV on treatment also increased, reaching 21.7 million of 36.9 million. With funding from U.S. President’s Emergency Plan for AIDS Relief, GHSC-PSM supports HIV prevention, testing, and treatment, as well as suppression of viral load through data-focused and sustainable supply chain and health system strengthening activities.

GHSC-PSM’s treatment approach focuses on patients’ needs by simplifying treatment to ensure adherence, improving the quality of life for PLHIV, and contributing to 95-95-95 goals to end AIDS. TLD is the preferred first-line ARV. Using TLD for HIV treatment is easier, safer, and more effective for tens of millions of people. Since 2017, when the treatment was developed and widely accepted as preferred, GHSC-PSM has worked to scale-up its transition by delivering 41.7 million bottles of TLD to 23 countries, providing 5.8 million patient-years of HIV treatment over the life of the project. TLD transition has been key to several countries’ reaching HIV/AIDS fast-track targets.

With support from GHSC-PSM, Botswana became one of the first countries to transition to TLD in 2018. The project completed the transition in two phases, overcoming patients’ long wait times while clinicians reviewed and changed prescriptions, fighting misconceptions, and working with patients who wanted to adhere to their previous treatment. Even with these challenges, however, the project’s work with the Ministry of Health and Wellness and clinical implementing partners was key to the transition. TLD is the preferred first-line ARV for treating HIV because it is just one daily pill that is highly effective, safe, and proven to rapidly suppress viral load in adult and adolescent patients with HIV.

Harrison Nzima happily holds his antiretroviral treatment, TLD
Harrison Nzima happily holds his antiretroviral treatment, TLD. Photo credit: GHSC-PSM

In Zambia, GHSC-PSM also helped develop a robust and thoughtful transition strategy to TLD. Harrison Nzima was one of the estimated 1.2 million PLHIV in Zambia who benefitted from switching to TLD. He notes during his hospital visits that TLD is readily available. He has not experienced any side effects, and he is happy with his progress. Now, with improved health, he is ready to work again to earn a living. Harrison is an example of restored hope and a restored quality of life, thanks to the critical commodities that were made available by the global health supply chain.

"People out there should take the medicine
like I am and live long!”

Harrison Nzima

The next generation of care

Although considerable progress has been made, there is still a long way to go for pediatric treatment of HIV. Of the 1.8 million children aged 0 to 14 living with HIV globally, only 53 percent were receiving life-saving ARVs in 2019, and 88 percent of them live in sub-Saharan Africa. With the absence of ARVs, 50 percent of children living with HIV die before their second birthday, and 80 percent die before their fifth. Early initiation of treatment significantly lowers mortality among children, but fewer than half were receiving treatment in 2014.

Pediatric ARV transition to dolutegravir 10mg is the next step toward the 95-95-95 goals and ending AIDS by 2030. If the global health community sticks to fast-tracking, 5.9 million infections among children will be averted by 2030. Children like Helvi can live a healthy life if they adhere to treatment, which is why making it easier and safer for them to receive and take their medication is vital.

“Helvi is an orphan and has been living with HIV since she was born,” said Mpareko Kasova, Helvi’s aunt. “She lost both her parents to AIDS, and she has been living under my care, but it wasn’t until 2016 that her HIV status became known to her.” GHSC-PSM works tirelessly to ensure that a resilient, adaptable, and sustainable HIV/AIDS global supply chain reaches Helvi and 1.8 million children living with HIV, and that these children have continuous access to the latest advances in pediatric HIV treatment for the foreseeable future.

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