Luckyboy Edison Mkhondwane (Lucky) is the National Prevention and Treatment Literacy Training Coordinator at Treatment Action Campaign (TAC) in South Africa.

Lucky identifies as gender-queer and is living openly with HIV. Since his diagnosis in June 2002, Lucky has been an access-to-treatment advocate. He has a great passion for treatment literacy and community education in HIV/AIDS and in tuberculosis treatment. Since joining TAC in 2002, he has worked as a Prevention and Treatment Literacy Trainer and Policy Communication Coordinator and represents South Africa on the CHAI (Clinton Health Access Initiative) Optimal ARV Project. He lives in Johannesburg.

South Africa has the largest HIV epidemic in the world, with 19 percent of the global number of people living with HIV, 15 percent of new infections and 11 percent of AIDS related deaths. South Africa also has the largest treatment programme in the world, accounting for 20 percent of people on antiretroviral therapy globally.

South Africa does not yet have access to dolutegravir (DTG) in the national treatment programme[1] but national roll-out is planned to begin from August 2019 and guidelines are being updated to include DTG as a first-line treatment regimen, replacing efavirenz (EFV) in South African standards of HIV care.

Lucky’s work as an advocate has brought him into direct contact with those PLHIV in other countries who have had access to DTG. He says, “Even though we don’t have DTG yet, the feedback from people in countries that have already transitioned to a DTG-based first-line regimen are very positive. The improved quality of life after experiencing insomnia and the other CNS-related side effects[2] because of EFV has been outstanding.

“I would definitely recommend DTG, the reason being it is more tolerable compared to EFV, has less toxicity and CNS-related side effects. Once DTG is rolled out, it will make things easier for people who work nights as one of the main concerns with EFV has been dizziness or feeling sleepy which is a major concern. And the size of the pill will help to increase the adherence rate.”

On why it is so important that DTG and also tenofovir/lamivudine/dolutegravir (TLD) is available for people in need worldwide, Lucky states, “TLD is important to us because of the low resistance profile of DTG. Considering the number of people who are currently on ART in South Africa, having TLD would mean that fewer people will have to be switched to the second line regimen which is currently more expensive and a very tricky regimen to adhere to.

“It is not yet clear how the country is going to do the transition. The number of people we have on our ART programme also means that we need more suppliers in order to meet the demand. Undoubtedly, the introduction of DTG is going to change lives and make it easy for people to adhere to their treatment.”

From January 2012 to December 2018, MPP generic manufacturing partners have supplied 488,000 patient-years of DTG and TLD treatment in South Africa[3].

Source data and background details:

UNAIDS country stats – South Africa

TAC – https://tac.org.za/

Notes:

[1] It is, however, already being used in private sector healthcare

[2] CNS side effects – more information at HIV i-base

[3] More sales have occurred through procurement agencies