The new HIV fixed-dose combination antiretroviral treatment called tenofovir/lamivudine/dolutegravir, simply known as TLD, was launched last year in a bid to make sticking to treatment schedules easier.  

It has been nearly half a year since people living with HIV were introduced to the new TLD treatment, but reports show that there are increasing numbers of defaulters on the three-in-one HIV pill. 

With the announcement of the national lockdown to curb Covid-19’s spread, a high number of HIV-positive South Africans missed their clinic appointments to collect their medication or missed taking ARVs due to hunger and food insecurity issues.  

Health-e News covered the story, noting that HIV-testing has also decreased, partially as a result of South Africans confusion about what is allowed at each lockdown level. 

Later, the Gauteng Health Department announced that over 11 000 TB and HIV-positive patients have failed to collect their medication since the start of the lockdown.  

 ‘Lives disrupted’ 

Huge strides have been made by civil society to get as many people as possible tested for HIV and enrolled for anti-retroviral treatment (ART). 

However, South African National Aids Council’s (SANAC) Civil Society Forum has noted that the national lockdown has in fact worsened the HIV-treatment defaulting and testing situation, as movement was severely curtailed.  

Speaking to Health-e News, chairperson of SANAC Civil Society Forum, Steve Letsike says “according the nationwide lockdown regulations we had limited rights in order to disrupt the spread of Covid–19 transmission, in order to save the lives of South Africans. This required us to stay and home which disrupted lives as we know it.” 

Letsike says that the government did communicate that you may leave home only for essential services such as visit to seek medical care and buy groceries.  

However, with the excessive policing from the National Defence Force and South African Police Service during level five and level four of the lockdown, a great deal of confusion was created.  

“People were under the impression that movement is only for those who had permit. This means that we never had campaigns that addressed Chapter 2 section 27 of the constitution – right to access health care. South Africans don’t understand the law and how to interpret what is contained in the Bill of Rights. Right to health care is fundamental and that means right to life will never be limited,” she says. 

Halting regressive moves  

The Civil Society Forum, through its various collaborators, says it will double efforts to ensure that the current situation is reversed and that people living with HIV will be on the new TLD regimen. 

“We will go to the frontlines to educate HIV–positive patients to switch to TLD in a way that will ensure a smooth transition. This we will do by joining hands with the health facilities. We dare not fail,” adds Letsike. 

According to SANAC, the current state of affairs has potentially set the country back from the goal of adding an additional two-million people living with HIV on ART by December 2020.  

“We cannot afford a regression on the gains we have made. We will aggressively drive the TLD Treatment Literary Programme during the lockdown and beyond.” 

Second line treatment 

“When TLD was introduced in the country it was meant to be our golden drug. It was intended to be used on treatment naïve patient [person who has not been on ART]. However, due to its virological turn around then it was recommended as both first and second line,” Letsike tells Health-e News. 

Second line regimes are those anti-retroviral treatments taken when the first line regimes have failed in some way – either the patient did not respond well to the first line, or the patient didn’t adhere to the first line treatment. 

She adds that “the rationale behind introduction of TLD as a second line is because the second line pills that are currently in the public health system have their own challenges. We have Aluvia as a second line but that has serious complications, such chronic diarrhoea.”  

Can pregnant women take TLD? 

During the first trimester, Letsike recommends that pregnant women use TEE (tenofofovir/emtricitabine/efavirenz), rather than TLD.  

“The TLD regiment may increase your chances of neural tube defects to the unborn child. The 2019 Tsepamo Botswana study on DTG (Dolutegravir) indicates that women TLD regiment on the first trimester their children were born with these neural tube defects,” Letsike tells Health-e News. 

She adds that majority of people who are on ART are women, and there is every reason to believe that they constitute a great number of these reported defaulters.  

Letsike says that it’s “our responsibility as civil society to ensure that we empower South Africans, especially women to know of their reproductive health rights.” 

“Then, they can select TLD at the right time in their lives, in order to give them the best chance in having the family that they rightfully deserve.” 

TLD myth busting 

According to Letsike, here are some facts about TLD: 

• TLD has minimal side effects that can be easily managed, 

• TDL does not have a side effect which leads to fat redistribution in the body; and, 

• The most common side effect of TLD is insomnia, which occurs when not taking the drug with water.