South Africa has 8.2 million HIV+ people. This makes it the country with the highest HIV+ population in the world. Prior to the pandemic, serious strides were made in reaching the UNAIDS’ targets. Now, it’s essential to get testing and treatment back on track, while vaccinating as many people as possible against the current pandemic.
Dr Marion Morkel, Chief Medical Officer at Sanlam, says this Word Aids Day is a moment of reflection to consider progress made, Covid-19 learnings, and what needs to happen next.
Listed below are some recent innovations that are empowering HIV+ people to live ‘normal’ lives.
Advances in testing:
- The World Health Organisation (WHO) approved HIV self-testing (HIVST) kits in 2016. These are meant to specifically target at-risk outlier groups. Multiple trials of self-testing kits in South Africa have been conducted with good results. For example, they proved very effective in reaching men in one rural region, where previously, they tended not to get tested.
- Notably, self-testing kits can now be oral as well as finger-prick blood tests. The OraQuick HIV1/2 oral test was the first to be pre-qualified for HIVST by WHO, and over a million tests have been distributed in South Africa.
- Digitising testing kits has also proved very successful in ensuring those that test positive receive timeous follow-ups and referrals. About two-thirds of HIV+ people initiate ART, but additional strategies are needed to ‘link’ those that don’t with treatment and care.
Advances in HIV management:
- Globally, large proportions of HIV-positive populations live in cities; this is true for South Africa as well. The Fast-Track Cities Project aims to fight the HIV pandemic by increasing the speed and effectiveness of the city response. This project uses a well-established HIV transmission model to estimate how close the country’s five largest metropolitan districts are to achieving the UNAIDS 95-95-95 targets for 2025. (Diagnosing 95% of people living with HIV, getting 95% of those diagnosed on ART, and achieving 95% viral suppression of those on ART.)
- In 2021, the five South African cities’ – Cape Town, Ekurhuleni, eThekwini, Johannesburg and Tshwane – ‘scores’ ranged from 56-73%, with 86% average for the entire country. The metros were making excellent progress to reach diagnosis targets (with the exception of Ekurhuleni) prior to the pandemic. Covid-19 has meant fewer people are getting tested and treated and is likely to impact 95-95-95 targets.
Advances in treatment:
- Injectable PrEP: There is a new injectable prophylaxis to prevent HIV infection after unprotected sexual exposure. Research conducted in seven African countries revealed that women taking long-acting injections of cabotegravir had 89% fewer HIV infections than women prescribed daily PrEP. While HIV oral pills are effective, compliance to the daily pills have been difficult for patients, so this injectable is promising.
- Monthly injections for HIV patients: The U.S. Food and Drug Administration (FDA) approved an injectable Cabenuva drug is administered monthly and could replace the copious daily tablets that some HIV+ individuals must take.
A silver lining from Covid-19?
Dr Morkel says that while the HIV and Covid-19 pandemics have had many parallels, the most striking difference between the responses is the time to authorisation and rollout of preventative vaccines. “In under a year, emergency use authorisation of initial vaccines against Covid-19 was granted by the FDA and European Medicines Agency. After over 30 years of research, only six efficacy trials of candidate HIV vaccines have been completed.
“The reasons for this are multifaceted and complex*. However, the Covid-19 response shows what’s possible when there’s collective buy-in and commitment from global nations, scientists, and society at large. WHO is currently exploring how to leverage these processes to accelerate the final vaccine rollout for HIV.”
Dr Morkel says evidence has shown that HIV+ individuals are more vulnerable to severe illness if infected with Covid-19, which means Covid-19 vaccination status will be considered for insurance underwriting. HIV is treated like any other chronic disorder, with the severity of the disease, treatment compliance, markers indicating the level of disease control, and co-morbidities all considered.
Going forwards, she urges all HIV+ people to get vaccinated as soon as possible. She also encourages all South Africans to get tested for HIV regularly. “An HIV+ diagnosis doesn’t mean what it used to. Advancements mean that people that test positive can live fulfilled lives. It’s critical to know your status and use new tools to adhere to treatment regimens. It’s also vital to be honest and upfront with an insurer about your status.”