By Scovin Iceta
MOYO-the test and treat police of combating HIV-AIDS is facing resistance in Moyo district, a year after it was rolled out. Introduced last year, the test and treat method was started to reduce the prevalence rate after a spike in new infections rate was detected.
Vicky Mundrua, the coordinator of persons living with HIV/AIDS and senior counselor in Art clinic at Moyo general hospital says the policy is a good one because it is a way of now reducing HIV/AIDS infection. “When you are found positive and you are started on ARVs immediately your viral load will be dormant,” she said.
She said implementing the policy at the health facilities in the district is facing challenges as people are aware that there is still self and external stigma in the Communities. “You know this person is tested positive today and you are told immediately you are going with drugs, this one is real difficult for clients to pick it up and sometimes the clients are tested and sent to us to be counseled to start ARVs. some will straight away tell us no nurse me I’m not ready to start this drugs allow me to go home and make up my mind and some because of the shake they will accept to go with this drug and others will go forever from the facilities,” She said.
Mundrua said the ARVs for starting, is given for one month and clients are expected after this drug gets finished within one month to come back but you will see this client not responding. ”We are saying this test and treat policy is facing challenges because the clients do not follow appointments. This is a day scheduled for the clients to return back at the health facilities for another services and when you follow this client some even relocate their residences,” She said.
Mundrua added that there is serious need for community sensitization. ”Let the community be aware of what is going to take place in case he or she goes to be tested for HIV/AIDS and when found positive, the communities are not aware over this test and treat policy,” she added
She said at Moyo general hospital since the policy was introduced for implementation, less than 20 people were initiated and again most of them have failed to return for their appointment for period of over three months. “Sometime we followed them through phone calls and some said they are in Adjumani or Yumbe district and many other places but me I know that is stigma,”
She appealed to the ministry of health to conduct effective sensitization on the policy because it has not been well perceived. “This policy has been passed and cannot be reversed back. Let the communities be aware and counseling should continue for the clients because there is high level of self and external stigma,” She said.
A Client who preferred anonymity for fear of stigmatization after testing positive complained that the drug has weakened and he cannot continue because he was not ready to start the drug on the first day. “It is scaring people like when I go to the health facility to test and I’m found positive it is bad to start taking this drugs immediately, that is why people are fond of throwing ARVs in the bushes because of fears,” he said
Moyo district focal person for HIV/AIDS, Michael Adrawa said the policy has adopted to test and treat for all People living with HIV irrespective of CD4 count, clinical staging or age. “ARV drug should be initiated within first day of testing for clients,” Adrawa said
He said critical concern is the dire need to appropriately target the remaining increasingly smaller group of HIV positive people with unknown HIV status. “Large numbers of people are increasingly tested with very low yield. Routine HIV Testing Services (HTS) program data shows a stagnating average HIV prevalence of 3.5% among the general population and above 10% among key populations,” he said
He noted that there is need to re-orient and strengthen community and facility HTS delivery approaches; strengthen public and private partnerships; increase uptake of HTS in priority populations; strengthen health system bottlenecks, behavioral change communication and strengthen linkages to care and prevention.
He said in the last quarter of March 2017, only 10.7 percent of the active HIV positive clients on ART were done viral load. ”This is however low because of low demand for viral load by the clients. The viral load suppression (66.8%) is below the target of 90% due to poor adherence, and low retention on ART”
Rationale for Policy Review
According to the Ministry of Health National HIV Testing Services Policy and Implementation Guidelines August 2016 4th Edition reports indicates that by end of 2014, access to HTS in Uganda had improved, with 3,565 HTS outlets spread across the country, and at least 51.4% of the population aged 15-49 knowing their HIV zero-status. While the number of people testing for HIV surpassed annual targets (8million people tested annually), the rate of HIV re-testers was high (40%).