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When the Ministry of Health began piloting test and treat practice, in 2014 and eventually adopted it as a policy in 2016, AIDS related deaths were mounting at an alarming rate.

Six years on there is consensus among HIV/AIDS experts and activists that the policy has registered tremendous achievements with noticeable reduction in AIDS related deaths and offers Uganda’s best chance to eliminate AIDS by 2030.

AIDS, the acquired immunodeficiency syndrome is the state of weakened immunity caused by the killing of the type of white blood cells known as the CD4 by the Human Immunodeficiency Virus (HIV).

This state of weakened immunity provides avenue for opportunistic infections to attack and kill the HIV patient.

Based on these facts, HIV/AIDS activists and experts agreed during a weekend health Café organized by the Health Journalists Network in Uganda (HEJNU) that test and treat was the right approach to limit the damage caused by HIV but the approach needs some tweaking to work better.

The panelists were Dr Stephen Watiti, a retired clinician, Moses a.k.a Supercharger, an HIV activist and Winifred Iklai, the coordinator of the National Forum for people living with HIV/AIDS in Uganda.

Managing the HIV/AIDS Scourge

The previous practice of managing the HIV/AIDS scourge in Uganda was that a person was not initiated on Antiretroviral therapy (ART) until the CD4 count fell to 200 per mm3  of blood or less, the level at which AIDS sets in.

Dr Stephen Watiti

Dr Watiti says when he first tested for HIV in 1986, he waited for the results in vain. That was because of the poor testing capacity at the time.

He waited until 1993 when tested again and was found HIV positive but never put on treatment.

It was in 1999 when he fell ill of AIDS and was at the verge of dying of Tuberculosis and cancer that Dr Watiti was taken to Mulago hospital where he was admitted and initiated on ART.

And when put on ART, Dr Watiti was made to swallow 18 bitter tablets every day unlike today where HIV/AIDS patients take one tablet daily.

“Test and treat is meant to reduce mortality, sickness and community viral load,” he commented.

While explaining test and treat policy, Dr Watit said it is a practice whereby “when you test positive for HIV, you are not let to go home but you are counseled and initiated to treatment.”

People who take antiretroviral medicines consistently and feed well have more or less the same life span like those without HIV, he said.

It is estimated that 1.4 million Ugandans are living with HIV/AIDS and the national target is to ensure that by 2030 all HIV positive people do not develop AIDS.

Uganda has been making progress towards universal access to HIV test and treat which involves providing lifesaving ART to people living with HIV irrespective of the CD4 count.

The government through an integrated AIDS Control Programme, has implemented a test and treat policy targeting all children, pregnant mothers, breast feeding women, HIV positive people with associated TB and Hepatitis B and couples in sero-discordant relationships.

What Test and Treat has Achieved

The results have been a marked decline in the rate of transmission of HIV across all age groups and in all regions.

Kalangala Islands has the highest prevalence rate at 18 while Nabilatuk in Karamoja region has the lowest transmission rate at only 0.2.

The panelists said that it is possible to stop a HIV positive person from developing AIDS through testing and early initiation of treatment.

Ministry of health records indicate that AIDS related deaths have also declined noticeably. In 2010, ministry of health registered 56,000 total AIDS related deaths which reduced to 32,000 in 2015 after the test and treat concept had undergone pilot trials. Last year (2020) show total recorded AIDS related deaths reducing to 22,000.

The news of reductions in the number of deaths was even sweeter among children aged 0-14. Ministry of health says 17,000 children died of AIDS related infections in 2010 and 4,300 in 2020.

Moses alias Supercharger, an HIV activist who was one of the panelists on the virtual Café contented that when implemented properly, test and treat can reduce the viral load to undetectable levels and limit transmission of the virus through sexual contact.

His assertion rhymes with the ministry of health fact sheet which shows that new infections have declined by 60% from 94,000 in 2010 to 38,000 in 2020, averaging 730 infections per week.

Towards elimination by 2030 target

It is a move towards the realization of the national target to eradicate AIDS by 2030 by ensuring that 90% of people living with HIV/AIDS are identified and tested, 90% of those tested are put on ART to achieve 90 percent suppression of viral load annually.

Ministry of health claims Uganda hit the 90-90-90 target in 2020 alongside Eswatin, Switzerland, Rwanda, Qatar, and Botswana, Slovenia and Malawi but a look at its figures shows that it was a close call.

Limitations to test and treat

The panelists identified a number of constraints affecting the test and treat policy, thereby derailing the pace of progress.

These include wide spread stigma which forces people to go to far away ART centres in order to get their pills so as not to be spotted by a neighbor or community member.

There is also ART fatigue caused by the persistent daily taking of the drugs prompting them to abandon medication.

While at the ART centres the panelists report lack of HIV competent counselors which hamper psycho-social support to the positive living people.

To address these challenges, they recommended a raft of measures to be taken including training HIV positive people as peer educators and counselors to talk to their colleagues at the ART clinics and calling on the media to publish and broadcast stories of hope about HIV/AIDS to drive down stigma.

Ikilai in particular called on the public to embrace the “beyond my pills” campaign aimed at encouraging the fight against stigma, and improving the quality of counseling which affects clients preparation and adherence to treatment.

To those recommendations, the ministry of health has added abstinence, being faithful to marriage partner and consistent use of condoms to reinforce test and treat.

It is hoped that with the full implementation of these recommendations, and test and treat practice, HIV might still be sticking around but there will be no AIDS by 2030 in Uganda.

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