The test-and-treat policy which was backed up by a study that concluded that an HIV-negative spouse would remain so even if they continued having sex with their positive partner if the partner was on treatment has resulted in significant reductions of new infections in Malawi.
Through the policy, an individual is put on anti-retroviral therapy (ART) immediately after they test positive without looking at the CD-4 count as was initially the case.
The prevention of mother-to-child transmission (PMTC) programme where pregnant women are provided with ART to prevent their infants from acquiring the virus is equally paying dividends.
Counting the economic implications of HIV for poor countries such as Malawi, any investment in research that fights the virus should be worthwhile, experts say.
“The household impacts begin as soon as a member of the household starts to suffer from HIV-related illnesses: loss of income of the patient; household expenditures for medical expenses may increase substantially…,” Lori Bollinger and others state in their paper titled ‘The Economic Impact of Aids in Malawi’ which was produced for The Policy Project many years ago.
They further argue that, in terms of industries, Aids-related illnesses and deaths to employees affect a firm by both increasing expenditures and reducing revenues.
“Expenditures are increased for healthcare costs, burial fees and training and recruitment of replacement employees. Revenues may be decreased because of absenteeism due to illness or attendance at funerals and time spent on training,” the researchers say.
That is why, after the giant strides that are being made in ensuring HIV is no longer a public health threat, scientists are still not sleeping.
Currently, another study is being conducted in Malawi and other countries to see if an antibody can fight HIV before it enters the actual blood stream.
The enquiry, dubbed Antibody Mediated Prevention (AMP), could result in a great breakthrough in as far as strides towards completely annihilating the virus are concerned.
The University of North Carolina (UNC) Project in Malawi is among institutions undertaking the study whose laboratory enquiries already show that the antibodies have been able to block HIV in about 90 percent of blood samples tested.
“In this study, we are giving sexually active heterosexual women who are HIV-negative a drug which we think will prevent them from getting the virus,” UNC Project Study Coordinator for HIV Open-Label Extension, Dr Tchangani Tembo, explains.
The researcher looks back at what various studies have done in fighting the virus and is optimistic that there is room for more.
“We have done a number of studies in line with HIV prevention. We did a study about a vaginal ring to see if it can prevent women from contracting the virus. Other studies are in the pipeline. We are just waiting for approval,” Tembo says.
UNC Project states in one of its notes on the research that the AMP study is a new idea for HIV prevention that is related to what has already been done in HIV vaccine research.
While in traditional HIV vaccine studies participants get a vaccine and researchers wait to see if their bodies will produce antibodies against HIV in response, in the AMP study, that step is being skipped and people are given the ready-made antibodies directly to prevent HIV infection.
“The AMP study is a phase two study testing whether antibodies can prevent HIV infections in people. Antibodies are natural proteins in the body that fight diseases. The VRC01 antibody is able to attach to the outside of the HIV virus and block it from causing an infection,” UNC Project’s AMP study Co-principal Investigator Dr Tinkhani Mbichila says.
According to the institution, the antibody in the AMP study called VRC01 stops HIV from causing an infection by attaching to the virus.
“Broadly neutralising monoclonal VRC01 antibodies are able to fight against many strands of HIV up to 91 percent,” it says.
Additionally, Tembo reveals that UNC Project concluded the first phase of a study where they found that a vaginal ring containing a certain drug can protect women from getting HIV with a probability of 71 percent for those who adhered to treatment.
“Now, we have called back all those women who participated in the clinical trial. Everyone is now getting a ring that has an active product. What we are trying to do is to conduct an open-label clinical trial where everyone is given a ring that contains an active product called Dapivirine,” he says.
The HIV prevention researcher further states that the study is meant to get additional information about the safety profile as they wait for necessary approvals before the product can be rolled out full throttle.
With the research by UNC Project and its partners clearly contributing to reduction of new HIV incidences, Malawi has already nearly achieved the second and wholly achieved the third of the 90-90-90 targets set by UNAIDS.
The first report of the Malawi Population-Based HIV Impact Assessment (Mphia) which was released in November last year stated that 89.6 percent of HIV-positive adults aged 15-64 who know their status reported being on ART.
“91.2 percent of those on ART were virally suppressed. However, achievement in diagnosis is below the first target, with 72.7 percent of HIV-positive persons aged 15-64 reporting being aware of their HIV status,” the report reads in part.
It adds that the achievement of the 90-90- 90 targets is essential not only to prevent HIV-related illnesses and Aids-related deaths among those infected but to prevent transmission and the occurrence of new infections.
Mphia expounds that increasing coverage of diagnosis while sustaining high levels of treatment and viral suppression is key to reducing HIV incidences.
With more successful research being conducted by institutions such as the UNC Project whose discovery that ART prevents heterosexual HIV transmission by 96 percent informed the World Health Organisation guidelines of test-and-treat policy, the virus could be on its way out of existence.
Perhaps, if a pre-exposure drug can successfully attack HIV before it goes into the blood stream, a more advanced one can completely annihilate the virus already in the blood system, leading to the discovery of the virus’ cure.
“That would be a research to be informed by the success of the AMP study. In research, one successful project often informs the next direction,” Tembo says.
Such sentiments are corroborated by Mbichila, who avows that already the progress that is being made in HIV research has the potential of eventually overcoming the virus.
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