Here is why adherence to ARVs is important

People counting ARV drugs. A patient must take their ARVs as prescribed and directed by a doctor.  PHOTO/FILE

What you need to know:

  • Caution. Failure to take ARVs the proper way can cause uncontrolled and rapid multiplication of the virus in one's body, leading to rapid destruction of the immune system.

Every year on December 1, the world commemorates World Aids Day, which serves as a reminder of the global struggle to end HIV-related stigma. It is also an opportunity to honour those who have died of the disease and commit ourselves towards reducing this public health threat.  This year, the day will be celebrated under the theme, “Remember and Commit.”

For a long time, the disease has been a public health threat in many countries across the globe, with Uganda being one of those countries badly affected by it. After some collective efforts, there was a great improvement. 

However, currently, the disease is a serious health threat, with about 10 percent acquired HIV infection via mother-to-child transmission.

The statistics
There is a stagnation in the number of cases of HIV/Aids and condom use in Uganda according to the Uganda Aids Commission (UAC). 

Data from the UAC reveals that more than 1,440,000 people are living with HIV in Uganda (500,000 men, 860,000 women and 80,000 children). 

According to the Annual Joint Aids Review Report for the year 2022/2023, the number of new infections for the financial year 2022/2023 is 51,516 which is contrary to the government target of reducing this number to at least 20,000 new infections.  The number of deaths related to HIV in the same year are as high as 17,337 compared to the targeted 10,000. 

Dr Daniel Byabakama, the head of prevention at UAC, says such figures are a setback to the country’s goal of ending the disease by 2030. 

“The rate of reduction in the number of new HIV infections is not good enough for us to attain the commitment of ending the disease as a public health threat by 2030,” he says.

Dr Byabakama blames the high rates of the disease on risky behaviour such as having multiple sexual partners and refusal of some people living with the disease to take their Antiretroviral drugs (ARVs). 

“We notice high risk behaviour such as one having multiple sexual partners with a significant number of men leaving their spouses to have affairs with several other women. Also, a number of young people initiate sexual activity as early as 15 years,” he says. 

Condom use in Uganda has also declined from 189 million in 2022 to 141million in 2023 according to UAC. Dr Byabakama says there is urgent need for all the citizens to engage in the fight, calling on citizens not to neglect their responsibilities. 

The way out
Before the introduction of ARVs, the ABC strategy worked. This meant that people had to abstain until they got the right partner and got married. Those that are married were supposed to be faithful to their sexual partners and if not, they had to use condoms in order to prevent the spread of HIV/Aids and other sexually transmitted diseases.

According to Dr Andrew Kazibwe, the head of medical services at The Aids Support Organisation (TASO) in Entebbe, “These strategies can still work if we collectively put our efforts into it. People should not neglect their responsibilities. There are also preventive Post-exposure Prophylaxis (PEP) and pre-exposure prophylaxis (PrEP), which when used the right way could reduce the risk of new infections.”

He emphasises that PEP is not intended to replace regular use of other HIV prevention methods such as consistent use of condoms during sexual intercourse or (PrEP). PrEP is different from PEP in that people at risk for HIV take a specific HIV medicine daily to prevent getting HIV.

Another strategy that has worked in the previous years is the fact that as many as 90 percent of people know their HIV status, 94 percent of the people who have HIV are receiving Antiretroviral Therapy (ART) and 94 percent are virally suppressed. 

“Knowing your HIV status is key in the fight. When you realise you have the disease, start taking ARVs as prescribed so that your viral load is suppressed. With a suppressed viral load, one is not able to spread the disease to other people,” says Dr Kazibwe.

Why adherence is important
 Proper adherence to ARVs, according to Dr Kazibwe is one’s ability to take the correct dose of the drugs at the same time, every day; with the right conditions (after food, without alcohol).

To ensure proper adherence, some health system actions have to be put in place. 
“Friendly drug formulations (fixed dose combinations, palatable, reduced frequency of dosing, durable packaging), patient treatment literacy such as sensitisation of client on drugs, dose, timing, expected side effects, how to report side effects are given,” he says.

Individual patients, family and community should all come up and support.  Actions such as using treatment reminders, having a treatment supporter, safe storage of drugs, and treatment charts are very vital in ensuring proper adherence. 

Non-adherence to ARVs can cause several complications and is one of the leading causes of HIV-related deaths. Some diseases and infections that are related to HIV include tuberclosis, Kaposi sarcoma, cryptococcal meningitis. Unsuppressed HIV can also lead to dilated cardiomyopathy which leads to impaired contraction of the ventricles of the heart due to volume overload.

“Failure to take ARVs the proper way can cause uncontrolled and rapid multiplication of the virus in one's body, leading to rapid destruction of the immune system. This results in increased hospitalisation from opportunistic infections such as tuberculosis (TB), early development of cancer-like cervical cancer, rapid ageing and premature death,” he says.

Other complications of non-adherence include the development of HIV drug resistance, which requires more complex and expensive drugs to prevent the above complications.
With poor adherence, it is hard to suppress the viral load due to rapid multiplication of the virus. 

“Failure to suppress viral load results in increased chances of spreading the virus to loved ones, especially through mother-to-child transmission during childbirth and breastfeeding if HIV positive mothers are not taking their ARVs correctly. Chances of HIV transmission to sexual and injecting needle partners increase more than 100-fold when the infected partner is not taking their ARVs correctly,” Dr Kazibwe warns.  

Is it okay to skip a dose?
When you take HIV medicine in pill form, it is important to take it every day, exactly as prescribed. That is important because skipping doses makes it easier for HIV to change form, causing your medication to stop working, which is referred to as drug resistance. HIV can become resistant to your medication and to similar medications that you have not yet taken. This limits your options for successful HIV treatment. Drug-resistant strains of HIV can be transmitted to others, too.

Taking your HIV medicine every day, exactly the way your health care provider tells you to, will help keep your viral load low and your CD4 cell count (a count of white blood cells that fight infection) high. If you skip doses, even now and then, you give HIV the chance to multiply rapidly. This could weaken your immune system, and you could become sick.

Talk to your health care provider if you miss a dose. In most cases, if you realise you missed a dose, take the medicines as soon as you can, then take the next dose at your usual scheduled time (unless your pharmacist or health care provider has told you something different). When your HIV treatment is in injectable form, it is also very important follow the dosing schedule your doctor provides. Setting a consistent injection date can help you stay on track.