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Could Pre-Exposure Prophylaxis (PrEP) be the panacea for HIV/AIDS? 

The most persistent question among Kenyan public and medical research circles is whether Pre-Exposure Prophylaxis (PrEP) could ultimately be the panacea for HIV/AIDS which has had devastating health and economic impact globally.

Perhaps this explains why majority have remained optimistic that with God’s guidance, ongoing drug trials spearheaded by Kenya Medical Research Institute (KEMRI) in collaboration with Ministry of Health and other partners could be the ‘light at the end of the tunnel’.

Pre-Exposure Prophylaxis, or PrEP, is a way for people who do not have HIV but who are at substantial risk of getting it to prevent HIV infection by taking a pill every day. The pill (brand name Truvada) contains two medicines (tenofovir and emtricitabine) that are used in combination with other medicines to treat HIV.

When someone is exposed to HIV through sex or injection drug use, these medicines could work to keep the virus from establishing a permanent infection.

When taken consistently, PrEP has been shown to reduce the risk of HIV infection in people who were at high risk by up to 92%. PrEP is much less effective if it is not taken consistently.

PrEP is a powerful HIV prevention tool that could be combined with condoms and other prevention methods to provide even greater protection than when used alone. But people who use PrEP must commit to taking the drug every day and seeing their health care provider for follow-up every three months. This is according to Center for Disease Control –CDC Internet site.

Sample this inspirational story of a discordant couple (HIV+ but the partner is HIV-) who have continued to live peacefully over the past 15 years after they ascertained the status by undergoing several tests in renowned health facilities.

Joshua Otieno (59) and his lovely wife, Judith Auma Otieno (35) could be best described as a strong pillar of hope for those unwilling to undertake HIV testing or have already known their status but lost in thought of how best to deal with their situation.

Otieno hails from Kasipul Kabondo (Homa Bay County) while Auma was born in Kano Kabonyo, Nyando in Kisumu County but having come of age, she took the deliberate decision to marry the love of her life with whom they were blessed with six children.

Auma took participants of a three day journalism training on HIV Biomedical Prevention organized by Media for Environment, Science, Health and Agriculture (MESHA) in Kisumu (March 25th -28th 2018) by surprise given the calm demeanor with which she answered questions.

She pointed out that while most victims threatened to or even ended up committing suicide in the area, this lovely couple found solace in each other’s confidence and support while going about breaking the stigma associated with HIV among the community.

“Counseling played magic in our lives by understanding that being HIV+ was not in itself the final nail to consign the infected to an early grave. At first, it was difficult to accept our status and even apportioned blame but with time, we got over it,” she narrated to a hushed audience.

Subsequently, Auma was put on septrin and multi-vitamins for the next two years as approved by the medics who managed her even though she reported having splitting headaches but this did not slow her down as she stayed focused on the strict regimen.

Auma and Otieno then saw it fit them to seek a second opinion thus opted to visit Ramula health facility where her blood was drawn for further testing and it was again confirmed that she was indeed HIV+ which then required that they seek counseling services.

“I then turned to a local Community Based Health Worker (CHW) who was well versed with counseling and this is the person who managed to convince my husband to agree to undergo the HIV testing the following day,” explained Auma.

She revealed that Otieno was found to be HIV- and this confirmed that they were a discordant couple. They were then advised to proceed to Lumumba health center, Kisumu for even more testing just to be sure that they left nothing to chance.

After two years using septrin and multi-vitamin, she explained, the medics saw it fit that Auma be put on Truvada (both as an ARV but mostly as PrEP drug for preventing those not yet infected with HIV against acquiring the disease).

In a captivating narration, Auma told the forum how she went on using her ARVs while the husband was put on Truvada and for the next two and a half years the drugs managed to put the virus to sleep until when she was declared as ‘clean’.

She went on to conceive and thereby realized that HIV/AIDS does not require one to hide from the public due to fear of stigma but rather come out in the open to help the medics sensitize other members of the public to take the bold step and know their HIV status.

While all this was happening, Otieno contemplated divorcing the love of his life but after having experienced untold suffering during his wife’s sickness but chose to remain faithful to Auma and to date they live happily.

The family disclosed to the forum that their first born child was 18 years but the child was born long before they went to Lumumba in 2008. This means that the first three children were actually born before they confirmed their HIV status.

They also confirmed that Mzee Otieno was put on Truvada in 2010 and it almost around the same period when Auma developed enough courage to declare publicly that she was ready to start a new life just like those who stated publicly soon after seeing the light at the end of the tunnel.

This brings the question whether PrEP is safe? That’s where the danger lies. Not taking Truvada for PrEP properly is more serious than just not having protection from HIV infection. On the other hand, Truvada has serious side effects, including kidney damage and bone loss. These risks may be acceptable when a person has HIV or AIDS, but people taking PrEP are healthy (CDC).

Truvada, the PrEP drug, costs between Kshs.800, 000 (US$8,000 and US$14,000) per year. One will also have to figure in the cost of four medical check-ups annually and possible lab tests. It is also imperative for the user to check with your medical insurer to see if PrEP is covered or not.

The Head of Center for Global Health Research, KEMRI Kisumu, Dr. Victor  Mudhune revealed that the facility was established in 1978 through collaboration with Center for Disease Control (CDC) as the main Clinical Research site.

Dr. Mudhune took participants through the complex operations of the state of the art medical laboratory which focuses on ways to control HIV/AIDS, Malaria, and Tuberculosis (TB) alongside lifestyle diseases like diabetes and hypertension.

He stated that HIV prevalence in Kisumu County still stands at 19.9% but quickly added that ongoing vaccine trials at the facility were geared towards preventing clients from acquiring AIDS through the intervention which is more of a research in itself.

“It seeks to reduce the viral load to low levels by laying emphasis on prevention as opposed to treatment. PrEP protects against HI,” he told participants who toured KEMRI Kisumu located at Jaramogi Oginga Odinga Teaching & Referral Hospital (JOOTRH) this week.

Amid all this emerged strong calls to get an alternative to Oral PrEP, vaginal ring and the Injectable Drug Users (IDUs) which were still undergoing research after all the above were found to be safe and effective.

Of importance was the revelation that HIV prevalence was quite high around Lake Victoria; Homa Bay 26%, Siaya 24%, Kisumu 19.9% and Migori18% prompting stakeholders to attribute the shocking trend to cultural and behavioral aspects, stated Dr. Mudhune.

While a section of stakeholders said the high percentages were overstated, those opposed insisted that numbers never lie. Pundits on the other hand believe that the anticipated KENFY survey would help ascertain whether the high percentages were real or far-fetched.

Participants were told that ethical governing bodies of international repute must ensure regulations were strictly followed with Independent Ethical Review Committees composed of professionals from diverse background allowed to review the research protocols.

Clinical research is usually done in phases: 1, 2, 3 and 4 with 1-2 involving small populations while stages 3-4 having large populations. The latter stages 3-4 take as long as 6 months to 5 years or even a lifetime.

Facilitators at the forum observed that there was an inadequate allocation from both the global, national and county governments but most research funding largely emanated from external partners thus sometimes caused unnecessary delays of implementation.

It also came to the fore that it takes between 15 – 20 years for a trial vaccine to go through all phases and reach the end product. This calls for close collaboration and patience on the part of all players.

Among the successful research undertakings done in Kenya and adopted globally as a major successful intervention was the study of Prevention of Mother –to-Child transmission of HIV. The study commenced in 2003 – 2008 when it came full cycle.

Researchers in Kenya have also embarked on Carposis Sarcoma (Skin Cancer) research which was ongoing until when it was stopped for some reasons.

Local researchers also boast of having embarked on Phlebotomy (blood withdrawal for other tests). Apparently this has shown great success considering that KEMRI, Kisumu Research has been declared ISO 15189 by the internationally reputed SANAS laboratories.

KEMRI, Kisumu HIVR Laboratories receive between 15, 000 to 20, 000 blood samples for viral load testing according to Dr. Mudhune who was flanked by a strong team of colleagues; Arthur Ogendo and Phillister Adhyambo who often chipped in at some stages.

The media and researchers alike agreed that great strides could be achieved if the two sides collaborated for the betterment of society as opposed to letting unnecessary suspicion and bloated ego take precedence by keeping them further apart.

By Joseph Ouma – KNA Kisumu

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