Test and treat policy rekindles hope

Mavuto Mwakihana did not doubt his status when he went for an HIV test. The 35-year-old was not sickly, but just living up to a door-to-door awareness campaign by Malawi Red Cross Society (MRCS) in Karonga last December.

The man who lives in Paramount Chief Kyungu’s territory feels lucky to have started taking life-prolonging drugs soon after being diagnosed with the virus which causes Aids.

“I was devastated when I tested positive, but I am very happy to know my status. I have been counselled on dos and don’ts. I know the importance of good nutrition, how to safeguard my partner and why living positively matters. This is not the end of life.”

He hails the Test and Treat Policy government adopted in August 2016 to ensure universal access to antiretroviral therapy (ART).

The policy is part of the country’s race to achieve 90-90-90 targets by 2020. The global agenda requires United Nations member States to ensure 90 percent of people living with HIV know their status, 90 percent of those tested are receiving treatment and 90 percent of people on ART have a suppressed viral load.

The National Aids Commission estimates that nearly 901 000 Malawians are living with the virus, down from about 1.1 million in 2014. Slightly over half of this population-about 533 027-are on treatment, shows a Global Aids Response Progress Report released in July.

Mwakihana was initiated in August. He is convinced the new policy will help him stay healthy rather than waiting for his immunity to wane before he starts taking drugs.

Health experts back the Test and Treat Initiative to stop further spread of the virus.

Malawi Network of People Living with HIV and Aids (Manet+) executive director Safari Mbewe says there is evidence that if people start treatment earlier, they live longer.

“We thank government for adopting this policy because people living with HIV will live long and boost their chances of enjoying a healthy life as their viral load will be suppressed,” says Mbewe.

However, recent visits to Nkhata Bay and Kasungu exposed some setbacks to the new policy. They include delays to roll out, shortage of trainings for health workers, inadequate drugs, poor monitoring of ART clients and shortage of skilled hands.

Non-compliance

Besides, the 2016 Global Fund report highlighted worrisome non-compliance with the national HIV guidelines, especially skipping of confirmation tests before inducting new people on ART, failure to test HIV-exposed infants and children within recommended deadlines, inadequate monitoring of CD4 counts and viral load testing for HIV patients.

Nkhata Bay’s Chintheche Rural Hospital HTC supervisor Austin Nkhwazi says 44 people tested HIV positive last month, but only 24 have begun ART. The hospital cannot trace the other 20.

“Some just test and disappear without going for ART. The hilly terrain makes follow-ups difficult,” he says, decrying “poor linkage between the HTC and ART sections at the facility whose staff see twice its expected population of 24 968.

About 11 in 100 people in Nkhata Bay are living with HIV. The shoreline district, where tourism, fishing and sex work spur new infections, has not fully rolled out the new strategy.

“Some health workers have not been trained about the new package. However, we help our clients know this arrangement,” says district HIV testing services coordinator Joshua Nyirenda.

In Kasungu, some hospitals have not upgraded.

Family Planning Association of Malawi (Fpam) clinics have registered 37 clients since the cbeginning of the initiative three months ago.

“The programme needs more sensitisation and awareness. We can’t just rush initiating clients before they understand the issues at hand,” says Fpam district manager Limited Mwango.

He bemoaned shortage of staff and drugs, saying the programme will strain ART and health staff when more people are initiated.

Mbewe backs calls for government to train health workers adequately and increase medical supplies.

Minister of Health Peter Kumpalume acknowledged the concerns, but said health system has enough capacity to handle swelling figures of ART clients.

He told Weekend Nation: “If you look at the amount of money we have received and the number of people that we have reached, comparing with other countries who have received more money than us, our programmes have been more significant. I have no doubt that we have got everything in place.” n