Last May, amid much funfair, Kenya launched a pre-exposure prophylaxis drug dubbed PrEP, as well as HIV self-testing, in a bid to reduce new HIV infections by 75 per cent, by 2019.
The HIV-prevention pill Truvada, taken by people who are HIV-negative before exposure to the risk of HIV infection, contains the same antiretrovirals as some of the pills taken by people who are HIV-positive to control the virus in their bodies. Its effects last for eight hours.
When taken as prescribed, PrEP can reduce the risk of catching HIV by up to 90 per cent. “It is taken once daily for the period of potential risk. PrEP is prescribed for one month, must be taken for at least seven days for its effectiveness to kick in, then continued. Studies have shown that, with good adherence, PrEP works miracles,” said Dr Christine Ogolla, a programme director at the Elizabeth Glaser Aids Foundation.
Prior to approval, three organisations were conducting demonstration trials on the drug for one year in Nairobi, Kisumu and Homa Bay.
The Sex Worker Outreach Programme (SWOP) provides male and female sex workers with daily doses of Truvada in Nairobi and Kisumu; Liverpool VCT Care and Treatment Centre (LVCT) is conducting its trials in Nairobi, Kisumu and Homa Bay, and the US Centre for Disease Control is conducting trials in Homa Bay.
“PrEP is not for everyone and it’s not to be taken for life. Individuals who perceive themselves to be at risk should visit a healthcare facility for a HIV test and have a discussion with the healthcare provider,” said Dr Nelly Mugo, the principal research scientist at the Kenya Medical Research Institute and the principal researcher on the PrEP efficacy trials conducted in Kenya.
Currently, the drug is only available for use upon prescription. “If a non-infected person takes PrEP, then the virus is killed if it enters their body. This means it doesn’t have a chance to hide in reservoirs, and so it is harder for that person to become infected,” explained Dr Mugo.
However, PrEP is only meant for specific populations at high risk of infection like young women, serodiscordant couples and sex workers and youth.
The government together with implementing partners rolled out the delivery of PrEP in a few public and faith-based health facilities in the country, but uptake is still very low.
According to Health Cabinet Secretary Dr Cleopa Mailu, the programme rolled out last February is not widely spread since most healthcare providers are yet to be trained on the use of PrEP.
“We still have a long way to go in reaching out to individuals who need PrEP for HIV prevention,” said Dr Mailu. Estimates from the National STI and Control Programme (Nascop) show that 9,800 persons at risk of getting HIV have been put on PrEP to-date.
The Ministry of Health is, however, expected to release comprehensive figures on the impact of PrEP and its usage next month. With 1.5 million people living with HIV in the country, and 77,000 new infections every year, the government is aiming to put more high-risk Kenyans on PrEP, to reduce new infections, especially among adolescents and youth.
However, PrEP is not without challenges, when offered to people at risk of contracting HIV. In November 2015, a large community study of HIV-negative participants who were considered to be at high risk of being infected with HIV, found that when they were offered PrEP to reduce their chances of infection, only 11 per cent started taking the prophylactics within 30 days after getting them.
On the flip side, those who were outside the HIV infection risk score, who were also given a chance to request PrEP, were more likely to start taking the prophylactic immediately, even though they were considered low-risk.
In the low-risk group, nearly 40 per cent of the participants started taking PrEP within 30 days after getting it, meaning that more people who self-referred ended up taking PrEP, than those for whom it was prescribed by health workers after HIV counselling and testing.
Experts however warn that PrEP is not a magic bullet, and must be taken in combination with safe sex practices like use of condoms. Moreover, after a month on PrEP one requires further screening to check levels of the drug in their blood and to check if they contracted HIV while on the drug.
Further, researchers such as Dr Mugo of KEMRI, have raised concerns that people at risk of getting HIV shy away from taking PrEP. One of the main complaints is about the colour, size and even the rattling sound that the tablet makes when being taken out of its container, thus affecting drug adherence.
“Most of them have complained that people think the drug is an antiretroviral drug (because of its size) or that it is Viagra or a drug for mental health (because of its blue colour),” said Dr Mugo.
Other complaints were made about health providers who do not emphasise that PreP should be used as part of a combination of prevention methods and the fact that sometimes it was prescribed by health workers who were not adequately trained on its use.
Dr Ogolla, the programme director at the Elizabeth Glaser Aids Foundation, said that there were talks with manufacturers to consider changing the colour of the drug and the packaging to encourage more people at risk to make use of it as a HIV-prevention measure, even though the changes if accepted, would take time to be adopted.