National Aids Commission (NAC) has disclosed that it is taking deliberate stronger measures to increase acceptance and uptake of pre-exposure prophylaxis (PrEP) in an effort to control further spread of HIV in Malawi.
This follows observations made at Area 25 Health Centre in Lilongwe, during a site visit by the NAC Board of Commissioners and executive management.
PrEP is a medicine that reduces people’s chances of getting HIV from high risk behaviours such as sex with an HIV infected partner or with multiple partners. Evidence shows that when taken faithfully as prescribed, PrEP is highly effective for preventing HIV.
But speaking during the site visit, the NAC Chief Executive Officer, Dr. Beatrice Matanje, was dismayed with the low number of people that are retained on the oral PrEP after initiation.
Matanje said, her organization plans to engage the Ministry of Health, through the Department of HIV, STIs and Viral Hepatitis, into a discussion on how best they can integrate PrEP into the routine healthcare system and mitigate the challenge of low retention.
“Our mandate as the NAC is to provide leadership, as well as coordination of the national response to HIV and AIDS, but we do this through various implementing partners and stakeholders. So because PrEP is a biomedical intervention, we will engage with the Ministry of Health through the DHA where we are going to present the policy related issues that we have observed here” she said.
“For example, if within the policy and guidelines, there is no allowance for follow-up of those that have missed appointments or that have defaulted from taking subsequent doses of PrEP, then you’ll find that the implementers on the ground are hand tied to act, yet those people might still be at risk of getting the HIV infection. We know that with injectable PrEP coming up, this will have an implication on resistance. If people go on and off of the medication while still at risk, they will end up increasing the chances of development of resistance to these medications.
“So, since the follow up or tracking guideline is something that a facility cannot change on their own, we need to talk with all the relevant experts (through Prevention Technical Working Group) in order to allow some active follow up of those that have started taking PrEP and to see that they continue if their risk is still significant,” she added.
But Matanje was quick to point out that there has been a significant increase in the PrEP uptake, saying data at the national level show positive results on trends of PrEP coverage.
In a separate interview, NAC Board Chairperson Chipo Kanjo said the main purpose of the visit to the clinics was to appreciate how PrEP program was being implemented on the ground.
Kanjo said the board was impressed with the strides health facilities are making in providing the medicines.
In his presentation, an officer from Partners in Hope, an HIV implementating Partner that supports Area 25 Health Centre with funding from USAID, Frank Nanga, highlighted retention as a huge problem in PrEP administration, with other issues being seasonal variations of people accessing PrEP due to variations in market seasons around the facility, misconception that once one PrEP course (30 tablets) is taken, lifetime protection is acquired and limited space at the facility.
Nanga also bemoaned inadequate trained providers and workload, stressing the need for authorities to address the gaps in order to improve the uptake.
