TLD (Tenofovir + Lamivudine + Dolutegravir) regiment is the best solution for people living with TB, HIV

Johannesburg, 22 May 2020

SANAC Civil Society Forum, a constituent member of the Community Constituency Covid19 Front (CCCF) in responding to the statement by the Gauteng Health Department on Tuesday, 19 May 2020 that over 11 thousand of TB and HIV-positive patients have failed to collect their medication since the start of the lockdown on 27 March 2020 is an issue that requires a combination of treatment literacy and ongoing social mobilisation for those infected, their families and communities. Adherence to treatment is the bedrock of gains made in South Africa’s response to HIV and TB as outlined in the National Strategic Plan on HIV, TB & STIs.

Huge stride have been done by civil society to get many people to test and get to know their HIV status, enrol for anti-retroviral treatment (ART) and adherence clubs for their support. These strides include addressing stigma or discrimination. The rise in numbers of those defaulting is as a result of poor communications and inadequate treatment literacy that was supposed to accompany the introduction of the TLD ART regiment for HIV positive patients. The lockdown which curtailed movement of people only worsened the situation.

SANAC Civil Society Forum through its various sectors will double the efforts to ensure that the current situation is reversed. “We will go to the frontlines to educate HIV positive patients switch to TLD in a way that will ensure smooth transition. This we will do by joining hands with the health facilities. We dare not fail” said Steve Letsike, Chairperson of SANAC Civil Society Forum. TLD is recommended by the World Health Organization for first-line treatment of HIV. It can also be used in second-line treatment of HIV.

Currently most PLHIV are on the TEE (Tenofovir + Emtricitabine + Efavirenz) regiment and there are guidelines on switching to TLD (Tenofovir + Lamivudine + Dolutegravir) regiment for stable patients. TLD is a new HIV Treatment – One pill, once a day. It is that simple. This new TLD regiment should be given to PLHIV who have their viral load suppressed or strengthened immune system. TLD has rapid viral suppression, rapid barrier to resistance, does not have interaction with hormonal contraception and has mild side effects if any. What makes it more effective is that it a smaller pill and you will be given a three months’ supply of TLD.

This means people will find it easy to remain in care and adhere to treatment. We were never ready for Covid19 and its impact has disrupted lives, movement and livelihoods of people including contribution to the steep rise of over 11 thousand defaulters in Gauteng. Mabalane Mfundisi, the Co-Convener of the Community Constituency Covid19 Front states that “While we do not have data supporting risk of contracting Covid19 by People living with HIV (PLHIV) we cannot accept defaulting of HIV & TB treatment which will be an additional burden to an already overwhelmed health system”.

The majority of people who are on ART are women, and we have every reason to believe that they constitute a great number of these reported defaulters. Women who are pregnant or want to fall pregnant must have the side effects told them so that they are able to make informed decision. Letsike concludes by saying “Our responsibility as civil society is to ensure that we empower South Africans, especially women to know of their reproductive health rights so that they can select TLD at the right time in their lives in order to give them the best chance in having the family that they rightfully deserve.”

The World Health Organisation (WHO) warns that PLHIV not on antiretroviral therapy (ART) or who do not have a suppressed viral load are likely to have a compromised immune system and may be more vulnerable to opportunistic infection and disease progression. TLD provides a great opportunity to reach out to those not already in treatment to start their treatment and enjoy the benefits that come with this regiment.

With the rising number of cases of COVID-19 in South Africa, measures must be taken not only to contain the pandemic, but to ensure that other health services continue unhindered. Whilst there is not a considerable body of evidence available about increased risk of acquiring Covid19, suffering more serious outcomes and having higher levels of transmissions, people living with HIV with unsuppressed viral load and lower CD4 levels and people with active TB might be at an increased risk.

The current state of affairs has potentially set us back from our goal as a country to add an additional 2 million PLHIV on ART by December 2020 and we cannot afford a regression on the gains we have made. We will aggressively drive the TLD Treatment Literary Programme during the lockdown and beyond.

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For interviews with Josiah Ntsibande, Policy In Action Host Organisation Lethukukhanay Health or Mr Thabo Majuja, SANAC Civil Society Forum, Acting Chairperson: Law & Human Rights Sector or for more information, contact:
Palesa Komane
Operations & Communications Manager
+27 81 373 3109