HIV positive patients who take their medication every day keep the HIV virus in their body under control. The amount of virus in their body becomes undetectable, and when the virus is undetectable, it is untransmittable.
This means that the person will not pass on the virus. It also means that the virus will not make the person feel sick or ill. Because of this, patients who keep HIV under control in their body do not need to see a doctor or nurse every time they collect their medicine. If these patients can collect medicine packages that will last them for longer periods, they do not need to visit their local clinic so often.
The Ministry of Health and Social Services currently provides patients who have the HIV virus in their body under control with enough medicine that they can take every day for four months. Providing medicine for one-third of the year is particularly helpful for patients who live far away from a clinic because it saves patients money and time when they do not have to visit the clinic so often. Providing patients with four months of medicine is also helpful for patients who live close to their local clinic but who otherwise have to take time off work to visit the clinic, or who cannot easily visit the clinic for some other reasons, such as childcare, household responsibilities, or another barrier that makes visiting the clinic a challenge.
The Centres for Disease Control and Prevention (CDC) in Namibia and partners are supporting the Ministry of Health and Social Services to help more and more HIV positive patients who have the virus under control receive four-month daily-medication packages. This process has included making sure that there is enough medicine in the country; updating the treatment guidelines to specify how “multi-month dispensing” as it is technically termed, should be achieved; and training healthcare providers on how to implement the process.
Following the global Covid-19 pandemic, the value of four-month medicine packages in keeping patients away from clinics has become even more important. It has helped healthcare providers spend less time seeing healthy patients and more time preparing how to respond to Covid-19 cases – such as by online trainings and updating clinic procedures in line with new regulations for infection control.
One of the partners funded by CDC Namibia through the President’s Emergency Plan Fund for Aids Relief (PEPFAR) to help HIV positive patients access four-month medicine packages is Development Aid from People to People, or DAPP as the organisation is better known. One of the ways DAPP does this is through support of Community Adherence Groups or CAGs. Community Adherence Groups are groups of six-12 HIV positive patients who have their virus under control and who meet regularly in their community to receive their medication. This is because the group chooses one member, or takes it in turns, to visit their local clinic to collect the medicine for all the group members. When they meet, they also receive counselling and support from the DAPP staff member on how to keep taking their medication and how to stay healthy.
“Because it is so important right now to reduce the number of people visiting clinics, we are working harder than ever to establish community adherence groups, and within those groups, to ensure that patients receive four-month medicine packages,” explained Kirsten Moeller Jensen, Country Director for DAPP.
Between March-April 2020, the number of patients supported by DAPP who received four-month medicine packages more than doubled from around 500 to over 1 200 patients. According to one of the leaders of a community adherence group “now I can do my work any time, I do not go to the clinic every month. In the club we help each other and the members support me”.
Providing patients with enough medicine to last them up to six months has always been part of the planning process for Namibia to make long-term HIV care more convenient for patients. Due to the Covid-19 pandemic, the implementation of this process has been rapidly accelerated to benefit more patients in a shorter than planned period of time, starting with the four-month packages.
This has been achieved through the dedication and hard work of the Ministry of Health and Social Services and DAPP staff. “I am so impressed by the hard work of the healthcare workers who have started community adherence groups and supported patients to receive four-month medicine packages. This has given facilities more time to prepare for Covid-19 cases and it is just one of the small steps that has helped Namibia to be in a stronger position to deal with Covid. Importantly, it will have long-term benefits for HIV positive patients and clinics beyond the challenges we are currently experiencing with the Covid-19 outbreak,” said CDC Namibia Country Director, Dr Eric Dziuban. “This is a great example of how existing programmes have been accelerated during the Covid-19 pandemic to strengthen the healthcare system response to the outbreak. It is not just time that has been saved through four-month medicine packages, these packages also contribute towards saving lives”.