As we mark World AIDS Day 2024, we reflect on the progress made in the response to HIV and AIDS and the ongoing efforts to improve the lives of those affected. In this spirit, we had the privilege of speaking with Nelson Otwoma, the Director of NEPHAK (National Network that unites people living with HIV and those affected by tuberculosis and AIDS in Kenya). Nelson shared valuable insights into Kenya’s journey in HIV treatment and the significant milestones achieved.

Nelson Otwoma is a dedicated advocate for people living with HIV in Kenya. As the Director of NEPHAK, he works tirelessly to amplify the voices and visibility of those affected by HIV and AIDS. NEPHAK collaborates closely with the Kenyan Ministry of Health and many other organisations to ensure that the needs and rights of people living with HIV are addressed.

Kenya’s Milestone in HIV Treatment

Kenya has made remarkable strides in HIV treatment since 2004 when the Ministry of Health declared free treatment in public health facilities. The Kenyan government has a test-and-treat approach, ensuring that treatment is readily available for those diagnosed with HIV. This approach has led to a significant increase in the number of people receiving treatment and a reduction in HIV-related deaths. Initially, HIV treatment involved multiple pills, including antibiotics, making adherence challenging. However, the introduction of dolutegravir (DTG) in 2017 as part of the WHO-preferred regimen marked a turning point. TLD (tenofovir/lamivudine/dolutegravir), a fixed-dose combination, requires only one pill daily, easing the treatment burden and improving adherence as previous treatment options had heavy side effects and lower efficacy. This advancement has led to increased uptake of treatment and better health outcomes for people living with HIV.

Impact of Dolutegravir on HIV Treatment

Nelson highlighted the impact of DTG on HIV treatment in Kenya. With 1.4 million people diagnosed with HIV and 1.3 million enrolled in treatment, the majority are now on DTG-based regimens. The introduction of paediatric formulations of DTG has also ensured that children have access to safe and effective treatment. Paediatric ALD (abacavir/lamivudine/dolutegravir dispersible tablet – or pALD), the new fixed-dose combination for children soon to be available in Kenya, will simplify paediatric treatment further. The commitment to treatment optimisation has resulted in increased viral suppression and a better quality of life for people living with HIV. Additionally, adherence to DTG-based treatment has helped reduce the burden of TB, because those who adhere well to DTG based treatment (or any HIV treatment), are less susceptible to TB, further enhancing their overall health.

Overcoming Challenges in HIV Treatment

Before the introduction of DTG, Kenya faced significant challenges in HIV treatment. Initially, DTG was available only from the originator, and it was unaffordable for governments to procure. However, the availability of generic versions through the MPP- ViiV Healthcare voluntary licence on DTGand through partnerships with organisations like the Global Fund and PEPFAR has made DTG-based regimens accessible to a larger population.

The Future of HIV Treatment and Access to Medicines

Looking ahead, Nelson emphasised the importance of continued efforts to increase access to medicines for more people, especially children and vulnerable populations. For him the goal is to develop long-acting treatments that can be administered at home, reducing the burden on healthcare facilities and workers. Multi-month prescribing and better formulations for children, also key areas of focus, have now become a reality. The ultimate aim is to turn HIV into an easily manageable chronic condition, allowing people to live longer, healthier lives without frequent visits to healthcare facilities, leaving no one behind. Additionally, the concept of U=U (Undetectable = Untransmittable) highlights that effective HIV treatment not only benefits people living with HIV (PLHIV) by improving their health but also plays a crucial role in reducing new HIV infections and incidence rates.

The Role of Voluntary Licensing and MPP

Voluntary licensing through MPP has played a crucial role in making HIV treatment more accessible. Nelson acknowledged the efforts of MPP in negotiating with pharmaceutical companies to make generic formulations widely available. This collaborative approach has ensured that millions of people in low- and middle-income countries have access to affordable HIV treatment, with generic DTG-based treatments having been rolled out in 128 countries so far. The success of these initiatives demonstrates the power of advocacy, diplomacy, and partnerships in addressing global health challenges.

Conclusion

As we mark World AIDS Day, it is important to recognise the progress made in the fight against HIV and AIDS and the ongoing efforts to improve access to treatment. Nelson Otwoma’s insights highlight the significant milestones achieved in Kenya and the importance of continued collaboration to ensure that everyone living with HIV has access to optimised medicines. On 1 December, WHO and UNAIDS join partners and communities to commemorate World AIDS Day 2024 under the theme “Take the rights path: My health, my right!”. Together, we can end AIDS as a public health threat by 2030, with human rights at the centre and communities in the lead