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Antiretroviral medications are those that are used to treat HIV/AIDS in humans. Different antiretroviral drugs are needed at different stages of the HIV life cycle. Antiretroviral therapy is characterized as a mixture of antiretroviral medications used to slow the rate at which HIV affects a person. Antiretroviral drug protocols have evolved over the past few decades since they were invented. By 1987, there was no vaccine licensed for the treatment of HIV (Eaton, et al. 15). Generally, health care facilities only treated opportunistic diseases and malignancies. When antiretroviral drugs were discovered, health care experts suggested that all the patients who are HIV positive should be treated when their CD4 counts were so low. However, there were divided opinions as to whether those with high CD4 counts should be treated or not. By early 1995, Merck and the Institute of Allergy and Infectious Diseases recruited patients for trial using various combination of antiretroviral drugs. But later, his method was criticized by those who were claiming that the use of multidrug on patients would make them develop resistance to those drugs and therefore would make them not to respond to treatments (Fairall et al.889). After this method had been abandoned, only patients with advanced risks or those whose CD4 counts were below 350uL were to be subjected to such kind of treatment.
Antiretroviral treatment gained prominence later on due to its effect on transmission HIV. It was discovered that antiretroviral treatment was able to reduce an amount of virus in the blood of the victim and also in genital secretion. The result was a reduced transmission where a partner who has a suppressed viral load in the blood has sex with one who is HIV negative (Johnson 24). World Health Organization then ensured that antiretroviral drugs are accessible even in the poorest world nations. This paper will look at antiretroviral treatment in South Africa.
South Africa is one of the countries that are believed to have the highest rate of HIV infection in the world. The 2007 world report by UNAIDS estimated that about five million people are suffering from HIV/Aids infection in South Africa. He rate in adults’ population is about 18.5%. The number of infected people in South Africa is higher than any single country in the whole world. In the year 2010, about two hundred and eighty South Africans lost their lives due to HIV/Aids-related complications(Johnson 24). The HIV prevalence in South Africa has increased from 10.6% in the year 2008 up to 12.2% four years later, 2012. According to their races, 13.6% of blacks tested HIV positive while only 0.3% of whites tested the same. Lack of education and false beliefs about HIV/Aids among blacks in South Africa were the major contributors of the higher spread of HIV. The belief that HIV/Aids are witchcraft make most of the citizens that have tested positive not to go to the hospitals for treatment but look for traditional medicine men(Johnson 25). The time wasted through this processes are enough to deteriorate the health condition of the patient. Also, there was quite some sexual violence, and attitude towards HIV among the citizens were also significant contributors. Females were reported to have higher infection rates as compared to male. Women who are under forty years of age are the majority of the infected people with a rate of 4 in every five infected people. Among the infected people that are estimated to be over five million, only three million people are under antiretroviral treatment by the end of March 2016. The country is also leading among the nations with the largest antiretroviral treatment programs.
Currently, only those with CD4 counts reading about 500 are qualified to receive antiretroviral treatment. However, the world health organization proposes that as long as one has tested positive for HIV/Aids virus, they should be placed under treatment. Those who start treatment at an early age are at minimal risks of being sick and would live longer with the help of the treatment((Johnson 27). When more people are placed under treatment, they will stop the HIV from replicating and therefore there would be fewer cases of new infections. The minister of health in South Africa, announces this change of policy in 2016 during the budget vote. After this announcement, several researchers agreed with him that this would be a step in the right direction. Fromm this time henceforth, all those who tested positive in South Africa will qualify for the antiretroviral treatment despite their CD4 counts(Fairall et al.889). The move is to make the country HIV/Aids free by the year 2030.
Before the change of the policy, when one tested positive, they would only qualify for treatment when their CD4 count is below 500 or when the health care professionals have established that they are in the stages 3 or 4 of the infection(Fairall et al.889). However, those who were placed under fast-track were the pregnant women, breastfeeding women and those who had TB.
Patients that had cryptococcal meningitis or TB meningitis were to delay their treatment for about four to six weeks. But those who are tested and found to have a CD4 count that is below 50 were to start antiretroviral treatment within two weeks(Fairall et al.889). If the CD4 is more than 50, they were to start antiretroviral therapy within eight weeks.
The quality of antiretroviral treatment is also important. The care used was not to decrease in quality when the number of patients increased. The programs of antiretroviral therapy in South Africa was to find the people who are in need of these treatments and get them to healthcare services and keeping them in care by ensuring that they have taken their medication as prescribed by their doctors(Gupta, et al.196). They had to ensure that people remain on the system.
There is an institution in South Africa that has a responsibility of monitoring the stock of medicine of HIV and TB. The receive information from healthcare workers to make a report on the stock of antiretroviral treatment. They had to get the information on the changes in some those who are under treatment and give the report for the government to order the exact quality needed for these population(Fairall et al.889). Their responsivity s to keep the country supplied with antiretroviral drugs, and thus no stock out that can endanger the lives of the victims. Those who needed this treatment needed it for the rest of their lives, and thus the drugs had to be there throughout. The antiretroviral treatment in South Africa also involved community health workers who would advise patients to keep taking their drug. They had to ensure that patients stay adherent to their treatment every day(Gupta, et al.196). Counseling was also to be offered to patients so that they would have the self-esteem to deal with any stigma that the society might present to them.
South Africa success in expanding its antiretroviral treatment program is attributed the HIV testing and counseling campaigns that were started in 2010. Currently, the country has the largest antiretroviral treatment program in the world. In this program, about 47% of those who tested positive for HIV have been placed under antiretroviral treatment(Gupta, et al.196). Also, the country has kept and used well the guideline that is provided by the World Health Organization in a step that is aimed to ensure that its commitment to ending HIV/Aids epidemic. In the year 2015, World Health Organization gave a recent guideline on the time to which people should start receiving treatment.
Consequently, the UNAIDS visions towards zero rates of HIV as well as zero discrimination are some of the factors that have been used in ensuring a better antiretroviral treatment in South Africa. Pregnant women are closely monitored to make sure that the virus does not pass to their little ones(Gupta, et al.196). When tested positive, they are placed under antiretroviral treatment immediately.
In summary, antiretroviral treatment programs in South Africa have been expanded in the last few decades to care for the largest population of the country that has been infected by the virus. Some of the policies adopted to help manage HIV/Aids in South Africa including the change of the policies regarding who should receive treatment. Initially, only those that had low CD4 County were allowed to start receiving antiretroviral treatment immediately. Currently, the policies have been changed that all those who have tested positive regardless of their CD4 status would be placed under antiretroviral treatment. Also, there are those that have been entrusted with ensuring that the country does not run out of stock of the antiretroviral drugs. All these have been done with an aim that the rate of transmission would be reduced shortly. The WHO has also provided the country with guidelines on using the antiretroviral treatment on their population. This guideline has been kept and followed keenly by the health practitioners of South Africa. With its large population of the infected people, the challenge the country is facing is to ensuring that these people adhere to the treatment rules and take their drugs as recommended.
Eaton, Jeffrey W., et al. "HIV treatment as prevention: systematic comparison of mathematical models of the potential impact of antiretroviral therapy on HIV incidence in South Africa." PLoS medicine 9.7 (2012): e1001245.
Fairall, Lara, et al. "Task shifting of antiretroviral treatment from doctors to primary-care nurses in South Africa (STRETCH): a pragmatic, parallel, cluster-randomised trial." The Lancet 380.9845 (2012): 889-898.
Gupta, Ankur, et al. "Tuberculosis incidence rates during 8 years of follow-up of an antiretroviral treatment cohort in South Africa: comparison with rates in the community." PloS one 7.3 (2012): e34156.
Johnson, Leigh F. "Access to antiretroviral treatment in South Africa, 2004-2011: original article." Southern African Journal of HIV Medicine 13.1 (2012): 22-27.
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