One pill a day makes all the difference

One pill a day makes all the difference

In April, the Department of Health introduced South Africa’s first three-in-one fixed dose (FDC) antiretroviral (ARV). OurHealth speaks to an FDC veteran about the difference one pill can make.

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Ntombifuthi Shongwe from Ermelo, Mpumalanga was diagnosed HIV-positive in 2005 after she developed active tuberculosis (TB). Thanks to the non-governmental organisation BroadReach Healthcare, funded by the US President’s Emergency Plan for AIDS Relief (PEPFAR), she was able to access FDCs in 2006 much earlier than most South Africans. She talked to OurHealth about how FDCs changed her HIV treatment and her life.

“In 2005, I was diagnosed with TB and I took the treatment for eight months. For the first two months I was in Ermelo hospital. I tested for HIV because I was not recovering from TB and the HIV test results were positive. Immediately after I was diagnosed with HIV, I took a CD4 count test (a measure of the immune systems’ strength) and it came back 32.

“I was referred to Bethal Hospital to start treatment there, a hospital which is 60 km away from Ermelo.

At that time only a few hospitals in Gert Sibande district provided ARVs, and Ermelo was not one of them. This worried me because I knew that I would not be able to afford transport money to Bethal Hospital. I had seen many of my friends defaulting on their treatment because they couldn’t afford the transport fare to Bethal to collect their treatment.

“Fortunately for me, (BroadReach Healthcare) came along to assist the Department of Health in Mpumalanga with access to ARV treatment, especially in the community of Msukaligwa.

“I started my ARVs in October of 2005. For a week I experienced some side effects like coughing and vomiting. My father suggested that I should drink African medicine as well because he said it was stronger than ARVs and that it would boost the treatment I was getting. I didn’t though  because I had been counselled and educated about the importance of adhering to the treatment and not mixing it with any medication not prescribed by a medical doctor.

“I know my father was trying to help me, but people don’t always know that mixing medicines can kill you.

“I fell pregnant in 2006. By then my CD4 count was 168, much better than the previous year when I had started treatment. I knew my pregnancy was at risk and that I could infect my unborn baby. I told my doctor about the pregnancy and was put on the prevention of mother-to-child HIV transmission (PMTCT) programme. Throughout my pregnancy I was monitored by a gynaecologist at the hospital, having been referred by the BroadReach Health Care doctor I was seeing on monthly basis.

“Because I was pregnant the doctor swapped the ARV efavirenz for nevirapine and throughout the pregnancy I was on a triple ARV therapy of lamivudine, stavudine and nevirapine.

“I delivered my baby at seven months. My life completely changed after that. I had a more reasons to live, practise safe sex and eat healthy food. I was not doing it for myself but for my daughter. I had a reason to look after myself.

“In the same year, my treatment was changed to a single-dose tablet a day, thanks to BroadReach, so I started using the FDC in 2006, way before many people in the country even knew that there was such a treatment.

“My daughter was tested for HIV first at six weeks and then at 18 months, and both results were negative.

“Ever since taking the FDC, my adherence level has improved. Taking medication has never been so easy for an HIV-positive person. When I joined the Treatment Action Campaign in 2008, I learned more about FDCs and the importance of South Africa registering one and providing it to HIV patients in public health facilities.

“I celebrated when the Minister of Health announced that an FDC would be available in our clinics. I am currently taking my medication at Emthonjeni Clinic in Wesselton. BroadReach transferred me to a public clinic because the medication I am taking is now available to the public. I understand that now it’s only given to HIV-positive pregnant women, people who are infected with TB and HIV at the same time, and those who are starting treatment for the first time.

“I encourage everyone on treatment other than the FDC to make sure that they switch when that opportunity comes, or even to ask their nurse or doctor to switch them now if they can.”

As of September, about 119,000 HIV patients, including about 5,000 from Mpumalanga, have been placed on the FDC.