ARV defaulters slow down battle against the spread of Aids

Agnes Akinyi — not her real name — arrives at Jaramogi Oginga Odinga Teaching and Referral Hospital in pain for treatment. She could not walk upright due to lower abdominal pain well as a severe headache.

Ms Akinyi, an anti-retroviral drugs (ARVs) defaulter, had stopped taking her medication and was unwilling to open up about it until after she underwent counselling.

“I was taking my drugs but since my husband was not aware of it, I was afraid that one day he will find out and it might affect our marriage,” she says. Ms Akinyi had been on drugs for a year and stopped in July.

“The drugs not only help keep the immune system healthy, but also lower the risk of transmitting the virus to others,” said Dr Momanyi Ogeto, HIV care and treatment adviser at the referral hospital.

In fact, Ms Akinyi says before she stopped her ARVs, she was very healthy and stable, but became sickly after she stopped taking the drugs and became bedridden last month.

“There are several reasons that can lead to defaulting including a patient feeling unwell, not being able to disclose to a partner one’s status, migrating to another county while others just have issues adhering to medication,” says Dr Ogeto.

According to the records at the hospital, they lose about 30 patients on ARVs a month or 360 in a year, which Dr Ogeto says was worrying.

“When one stops taking drugs, the virus would assume a different shape that becomes difficult to treat, leading to resistant strains that make it difficult for medication to work,” he says.

“I have always advised my patients that once they are placed on drugs, they should be taken as prescribed at the right time, following advice to take with or without food.

“Adherence will make sure that all the drugs are at high enough levels to control HIV for 24 hours a day. If these levels drop too low it increases the risk of resistance.”

National Aids and STI Control Programme head of department Kigen Bartilol says non-adherence to medication was one of the factors hindering effective treatment of HIV.

He says the recent strike by nurses had made Nascop lose track of many patients on ARV treatment because they were not able to get HIV/Aids services.

He said they are encouraging hospitals to adopt differentiated care where patients receive drugs at different times.

“Currently, patients get their drugs on a monthly basis. However, we have started an initiative where they can get them on diverse time including weekly and even a fortnight,” said Dr Bartilol.

“Life doesn’t stop because you have been diagnosed with a disease nor do your responsibilities.

“Whether it’s a disclosure to the partner or chaotic work schedule, the act of getting your medications refilled regularly and taking your medicines consistently should be adhered to.”

He said stopping HIV regimen would result in a return of the HIV virus to pre-treatment levels and a loss in CD4 cells, increasing risks due to low immunity.

Joel Odondi, a researcher at Kenya Medical Research Institute in Kisumu, says counselling HIV patients before anti-retroviral therapy is important.

“When you disclose your status to your family, they tend to accept you and offer moral support.

“Disclosing one’s status helps reduce stigmatisation and discrimination against HIV patients and increases their willingness to adhere to medication and reduce behavioural problems,” he says.