For the last three months according to Nsubuga, Uganda has faced a shortage of the Raltegravir drug which is used by people on third line HIV treatment, and this led to health workers to switch HIV patients to Dolutegravir so as to avoid drug resistance since there is no any other alternative drug.
“It’s now a policy in Uganda, every person enrolled on first-line HIV treatment, has been enrolled on DTG, since it’s very tiny, easy to swallow and it’s the best drug to fight and decrease the amount of HIV in the blood. However, it has the side effect of increasing diabetic levels,” Nsubuga said.
He appealed to government to import more Raltegravir drugs due to increased diabetes after using the DTG treatment. Raltegravir is an expensive drug to most Ugandans living with HIV – a tin for a month costs as high as Shs 300,000 in private pharmacies.
“When you are on third line, you take a combination of four drugs, and one of them is Raltegravir, which is out of stock. Third-line treatment takes a combination of four drugs. And the total cost of all the three drugs, used on the third line treatment is over Shs 800,000, in private pharmacies per month,” added Nsubuga.
He was speaking at the Health Journalist Network offices in Ntinda, during a media briefing about HIV status in Uganda and the commemoration of World Aids Day on December 1.
Nsubuga asked government to push for long-acting therapies like the cabotegravir injection, which is taken once a month, and the rilpivirine HIV jab which is taken twice a year which saves people from the burden of swallowing ARVs.
“Many Africans find a lot of difficulties in taking drugs, so if the long-acting therapy injections come, they will help them,” he says.
Nsubuga says, because of taking his HIV treatment consistently since 1998, his viral load has been suppressed, became undetectable, and he has not transmitted infection to his wife he has lived with for the last 16 years with two children.
Winfred Ikilai, the HIV research activist says, the majority of the people on third-line treatment are below the age of 20 years, but due to stigma especially at school, they fear taking drugs and hence become drug-resistant.
“About 90 per cent of people who fail HIV treatment in Uganda and go for third-line treatment, fail the treatment due to lack of transport to pick drugs, stigma at school and home and other fear to swallow tablets,” she says.
According to Ikilai about 1.2 million Ugandans who are on treatment and take their drugs well can’t spread HIV to their loved ones since their HIV virus has been suppressed in the blood and other fluids in the body.
“We urge people on HIV treatment to swallow their drugs as recommended to suppress the virus to avoid being enrolled on unaffordable third-line treatment,” she says.
Most people on third-line treatment, start to use it after developing resistance to the common first-line drugs and the second-line medicines. Raltegravir is taken in combination with other antiretroviral drugs.
Dr Daniel Byamukama, the head HIV prevention at Uganda AIDS Commission urged Ugandans to stop stigma amongst people living with HIV if they want to end HIV by 2030.
“Stigma will kill us, it’s the reason why some people don’t get treatment which increases the number of infections and deaths. If we want to end HIV pandemic, let’s end stigma. You can’t imagine, because of stigma, people move from Mbarara, Gulu to Kampala where they don’t know them to pick their HIV treatment,” he said.
Byamukama says, about 23,000 people die of HIV/Aids-related illness in Uganda annually.
“We want to end stigma and use words that encourage people to adhere to treatment. People don’t take HIV treatment because of stigma. The words we use against people living with HIV, cause much pain to them and costs the country a lot since they discourage people to enroll on treatment and they end up spreading HIV,” he says.
Byamukama says, UNAIDS targets 95 per cent of people living with HIV in Uganda to be enrolled on treatment by end of 2025, although currently, about 92 per cent of them are already on treatment.
The first and second line treatment can be got at free cost in hospitals across the country while the third-line treatments are only accessed from designated centres like, TASO and Makerere University John-Hopkins University (MUJHU) Research collaboration in Mulago Hospital complex in addition to the Joint Clinical Research Center (JCRC) on Entebbe road.
