An aggressive campaign for the use of antiretroviral therapy (ART) has helped lower viral load among patients living with HIV in Kenya, reducing the risk of sexual transmission of the disease while improving their health.
Studies show that ART sets the body of an HIV positive person on an immunological recovery, improves the quality of life, reduces HIV-related morbidity and death caused by opportunistic infections.
The latest National Aids and STI Control Programme (Nascop) viral load data shows that in 2017 83.5 per cent of those tested positive and on ART had their viral load suppressed. This year’s figures indicate a slight improvement from 83 per cent recorded in 2016, 82.9 per cent in 2015, and 80.4 per cent in 2014 from the samples collected.
However, despite the positive national data, the viral load statistics also reveal a worrying trend that threatens the campaigns against the spread of HIV virus.
The data shows a percentage non-suppression viral load rates of 41.9, 38, 32.5 and 31.4 in Samburu, Turkana, Mandera and Tana River, respectively. North Horr, Kibish, Turkana South and Samburu East and North are the most affected sub-counties with percentage non-suppression rates of 65, 50, 40, 47 and 42, respectively. This shows that half of the persons living with HIV in these sub-counties were either not adhering to the treatment regimen or are not part of the treatment programme.
“There are three steps to keeping the viral load low, first when a person tests positive they are taken through counselling so that they can accept their status, then they are given drugs to suppress their virus levels.
“The drugs have to be taken as prescribed and without fail otherwise if a person flops to adhere to the prescription this is where the viral load increases paving the way for opportunistic infections and death eventually,” said a Nascop official.
Adults above the age of 20 formed the biggest group of persons living with HIV with non-suppressed rates of 73 per cent, while adolescents and children below the age of 10 were 13.6 per cent and 8.8 per cent.
Females formed the largest group with high viral load of 64 per cent while male account for 34.8 per cent.
Nascop head of department Kigen Bartilol says the main cause of a high viral load is the failure to adhere to the prescribed medication.
“We have a programme for people living with HIV and each is required to regularly go for check-ups. When they do not show up for a check-up and when they fail to replenish their medicine they risk a higher viral load and this weakens their immune system exposing them to opportunistic diseases,” he says.
Dr Bartilol says statistics from arid areas show a high non-suppression rate, meaning that persons living in remote areas fail to adhere to the HIV treatment regimen. Nomadic people are unable to do the regular monthly visits to the hospital due to their lifestyle.
The official says the government has adopted SMS notification to ensure that HIV patients are reminded when their appointments are due.
“We have also embarked on a differentiated care where we can actually tailor drug needs to a person, that instead of them coming every month for the medicine we give them a dosage that can last over a number of months. We also take laboratory tests to determine their viral load and type of treatment,” he says.
Of the pregnant mothers living with HIV only 79.8 per cent had their virus levels suppressed while 85.5 per cent of breastfeeding mothers had a low viral load.
HIV positive mothers on ART lower the risk of passing the virus to the foetus at birth and during breastfeeding. In Kenya, antenatal clinics for pregnant women involve a mandatory HIV test for every expecting mother.
The World Health Organisation (WHO) recommends two antenatal care visits in the first two trimesters and two more during the last three months.
The 2014 Kenya Demographic and Health Survey shows that only 58 per cent of women in Kenya attend the four recommended antenatal care visits.
The Centres for Disease Control (CDC) in September declared that people living with HIV on effective treatment cannot transmit it through sex.
CDC directors Eugene McCray and Jonathan Mermin said scientific advances had shown that ART preserves the health of people living with HIV. “We also have strong evidence of the prevention effectiveness of ART. When ART results in viral suppression, defined as less than 200 copies/ml or undetectable levels, it prevents sexual HIV transmission,” read part of their statement during the National Gay Men’s HIV/Aids Awareness Day.
“Across three different studies, including thousands of couples and many thousand acts of sex without a condom or pre-exposure prophylaxis, no HIV transmissions to an HIV-negative partner were observed when the HIV-positive person was virally suppressed.” About 1.6 million persons in Kenya are infected with HIV and only about one million are on ART, according to the WHO.
Kenya has an estimated 71,034 new HIV infections among adults and about 6,613 new infections among children annually.
Kenya’s campaign to reduce the levels of HIV infection has seen the number of deaths fall over the years.
The 2017 Economic Survey indicates that 9,471 persons died from HIV/Aids in 2016 down from 11,131 in 2015 and 12,235 in 2014.
“We are proud to have put over 1,045,000 people out of the estimated 1.5 million people living with HIV on ART.
“This has led to over 600,000 deaths averted over the last 14 years and reduced new infections,” said Jackson Kioko, director of medical services during the launch of Dolutegravir, a new first-line generic drug that offers better tolerability and fewer side effects, among other benefits.
The government has also launched new products in the war on HIV such as circumcision devices, self-test kits and pre-exposure prophylaxis for people at high risk of HIV.
Arid counties show the highest non suppression rate
Counties with lowest viral load suppression rate
Non-suppression rate %