“Most people who have switched to dolutegravir are very happy with the switch; many often asking whether it is true they are still on antiretrovirals!”

After studying Medicine at Makerere University in Kampala, Uganda, Dr Watiti was Medical Officer at Kampala’s Rubaga Hospital from 1985-1988. He then practised medicine privately from 1988-2004 at Entebbe Road clinic and JOY Medical Centre Ndeeba, Kampala. From 2004-2013, he worked at Mildmay Uganda, a leading HIV and AIDS service organisation.

An HIV activist and ardent advocate for improved and sustainable health for all, Dr Watiti believes, with hindsight, that he contracted HIV between 1985 and 1986 while working as a junior medical officer. In 2000, he began antiretrovirals (ARVs) after contracting tuberculosis, Kaposi’s sarcoma and meningitis. He has written extensively on HIV for New Vision, Uganda’s leading daily newspaper.

“My advocacy work began after I recovered from AIDS back in 1999. I decided to speak openly about my experience hoping to prevent others from going through what I did. I’d honestly thought I was going to die. I just prayed that God would give me five years so that I could raise my daughter.”

Stephen’s experience of living with HIV and as a medical practitioner means he can talk from different perspectives. “My country, Uganda, has access to dolutegravir (DTG), though it is being rolled out in a phased manner. Many people living with HIV (PLHIV) who are doing well on older regimens, such as tenofovir/lamivudine/efavirenz (TLE600) are reluctant to switch – the devil whom you know is better than the angel you don’t know attitude – but I would strongly recommend DTG to PLHIV because it is a gentler, easier regimen – smaller size, easier to swallow and the patient only needs to take it once a day, with no food restrictions. It also has fewer side effects compared to other ARVs, making adherence to it much easier. Most people who have been switched to DTG are very happy with the switch; many often asking whether it is indeed true they are still on ARVs!

“It is also life-changing for other practical and emotional reasons. The easier regimen and smaller pill size mean fewer trips to health services and, therefore, fewer disruptions to life. This is especially important for those PLHIV who wish to remain anonymous because of the stigma associated with HIV and ARVs. Many PLHIV fear starting on ARVs because of the associated side effects like body changes or being unable to do certain jobs like working at night or going out at night to socialise.

“In the era of test and treat, we need drugs like DTG, so that people don’t have to tolerate the same issues that they have in the past, where, when we started treatment for PLHIV who had suffered from AIDS, an experience so horrendous, that they were motivated to swallow even nasty drugs. Thankfully, we are moving towards more tolerable regimens.”

As a doctor, Stephen also has insight into some of the challenges ahead for Uganda concerning broader access to DTG.

“Uganda’s poor infrastructure and lack of a robust health system means that it may be impossible to ensure that the over 1.3 million[1] PLHIV in the region can have access to the ARVs they need, without stockouts. We also need to look at education which can help ensure people present themselves for testing and, I believe, we need to invest in treatment literacy programmes for all PLHIV, since antiretroviral therapy is, essentially, treatment for life.”

From January 2012 to December 2018, MPP generic manufacturing partners have supplied 158,000 patient-years of DTG and TLD treatment in Uganda[2].

 

Additional biographical information:

The Watiti Foundation

Living with HIV in Uganda – The Guardian, Global Development

Dr Stephen Watiti – A story of HIV/AIDS and hope

 

Notes:

[1] UNAIDS – Uganda country factsheet

[2] More sales have occurred through procurement agencies

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