Drug
resistance to the first line HIV treatment is on the rise in Uganda, according
to a report published by the World Health Organization-WHO.
Findings from a survey carried out between 2014-2018 show increasing resistance
to Efavirenz and Nevirapine, the fine line HIV treatment. The survey shows that
in the last four years, the level of resistance in 12 countries in the world
including Uganda has increased.
The study shows that the level of drug resistance in Uganda among adults is
higher than 10 percent. Resistance in women stands at 16 percent while that of
men stands at 14 percent. This means that more people will be enrolled on
the second line treatment, which is more expensive compared to the first line
treatment. Second lint treatment consists of Efavirenz, Nevirapine and
Lamivudine.
The report looks at drug resistance in 24 low and middle income countries. It
examined the level of drug resistance among persons who were enrolled on ARVs
during that time period. The study randomly selected data from clinics in 18
countries. Uganda was ranked sixth following Papua New Guinea in fifth
position and Nicaragua in forth position. South Africa was ranked third coming
after Cuba and Honduras in first position.
In 2018, Uganda announced the move to Dolutegravir as a first line HIV
drug in line with WHO guidelines. The drug was supposed to replace the use of
Efavirenz and nevirapine as first line drugs. It is estimated that 400,000
patients have so far been switched to the new drug.
A 2018 report released by the Uganda Virus Research Institute showed that an
estimated two people in every ten living with HIV suffered from drug
resistance. The study showed resistance was high among women and children
enrolled on ARVs. Dr. Nelson Musoba, the Director General of Uganda AIDS
Commission, says ART resistance in Uganda is due to mutating viruses and poor
drug adherence.
“ART drug resistance is normally seen in cases where patients do not
adhere to treatment or when the virus mutates and stops being affected by the
drugs. In such cases, we have no option but to push people on the next line of
drugs.” Data from the Ministry of Health shows that an estimated 1.2
million people are living with HIV and are currently on ARVs.
96 percent are on first line regimen and less than 4 percent on second line.
300,000 are estimated to be on third line drugs. Dr. Joshua Musinguzi, the
Programs Manager AIDS Control Programme, says the findings are not good.
“Such figures are worrying but they are caused by many people failing to
adhere to treatment. They need to be dealt with because if they don’t, they can
affect our 90:90:90 goal,” he said.
Dr. Musinguzi says they need to improve their programs to reduce drop outs and
improve retention. He says one of the measures the ministry is coming up with
to maintain retention is partner involvement to ensure that people comply with
drug regimens. “We want HIV treatment to be attached to partners.
This way, a partner will remind their fellow partner to take the drugs,”
he said.
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