Government’s programme to place everyone who tests positive for HIV on antiretroviral treatment immediately – regardless of their CD4 cell count, as per new World Health Organisation (WHO) standards, could be implemented this year provided funds are availed.
Last year, WHO recommended that anyone infected with HIV should begin antiretroviral treatment as soon after diagnosis as possible. With its “treat-all” recommendation, WHO removes all limitations on eligibility for antiretroviral therapy (ART) among people living with HIV; all populations and age groups are now eligible for treatment.
According to the Namibia AIDS Response Report for 2013-2014 issued in March 2015, there are over 130 000 Namibians on ARV therapy, representing over 90 percent coverage of people needing ART.
The report also said that based on projected HIV estimates of 2015, about 260 000 people now live with HIV while it is estimated that 11 000 new HIV infections occurred in 2014. An estimated 5 100 people died from AIDS-related illness in 2014.
The expanded use of antiretroviral treatment is supported by recent findings from clinical trials confirming that early use of ART keeps people living with HIV alive, healthier and reduces the risk of transmitting the virus to partners.
This new recommendation builds on 2014 WHO recommendation to offer a combination of antiretroviral drugs to prevent HIV acquisition, pre-exposure prophylaxis (PrEP), for men who have sex with men.
However, despite the Ministry of Health and Social Services’ push to implement the programme in the shortest possible time, financing it is an uphill task.
Health minister, Dr Bernhard Haufiku, says the programme is currently in its pilot phase but cautions that without sufficient funds it will be a challenge to run the programme.
The programme is expected to prompt an influx of new patients at public health facilities, which could severely strain the budget of the health ministry.
“The pilot phase is underway and we hope to start the programme by the end of the year. The biggest constraint, however, is the money. We do not want to have a situation whereby we start the programme and then we have to stop it halfway through because we cannot fund it,” said Haufiku this week.
Haufiku said his ministry is already in talks with Treasury, seeking funds to kick-start the programme.
“First, we must be assured that the supply system is sustainable and that donors such as Global Fund also provide assistance,” he said.
In fact, when the guidelines were released last year, Haufiku already at the time warned that the only implication [when it comes to implementing the programme] is that there will be more people on treatment, therefore, more funds will be needed.
Based on the new recommendations, the number of people eligible for antiretroviral treatment has increased from 28 million to all 37 million people, who currently live with HIV globally. Expanding access to treatment is at the heart of a new set of targets for 2020 with the aim to end the AIDS pandemic by 2030.
These targets include 90 percent of people living with HIV being aware of their HIV infection, 90 percent of those receiving antiretroviral treatment, and 90 percent of people on ART having no detectable virus in their blood.
Namibia is one of the African countries enjoying remarkable coverage of life-saving antiretroviral (ARV) treatment, with about 90 percent of Namibians living with HIV and AIDS receiving ARVs from the state.
According to the WHO 2013 global update on HIV treatment, Namibia is ranked among the top African countries in ARV delivery.
The prevalence of HIV in Namibia is among the highest in the world. Since 1996, HIV has been the leading cause of death in the country.
Unofficial statistics indicate that close to 17 percent of the country’s children under the age of 18 are orphaned by at least one parent – mostly due to HIV.
WHO also recommended that people at “substantial” risk of HIV infection should be offered preventive antiretroviral treatment, following further evidence of the effectiveness and acceptability of PrEP.
The UN health agency has now broadened this recommendation to support the offer of PrEP to other population groups at significant HIV risk. PrEP should be seen as an additional prevention choice based on a comprehensive package of services, including HIV testing, counselling and support, and access to condoms and safe injection equipment.
The guidelines stress that in order to effectively implement the recommendations, countries will need to ensure that testing and treatment for HIV infection are readily available and that those undergoing treatment are supported to adhere to recommended regimens and are retained in care. According to UNAIDS estimates, expanding ART to all people living with HIV and expanding prevention choices can help avert 21 million AIDS-related deaths and 28 million new infections by 2030.