Name of person responsible /Facilitator: Esther Nakkazi
Café Name/Title: HIV Prevention
Organized: Health Journalists Network in Uganda
- DR. Emmanuel Mugisa HIV TESTING STAFF/ PMTCT Coordinator; Baylor- Uganda
- Kakwezi Henry, Nurse, Kagote Health Center II
- Katusabe Beatrice; User, Kagote Health Center II
Date Cafe held: June 21, 2018
Café objectives (The learning objectives should be tailored for each specific café)
- To enlighten more about Prep and its conditionalities associated with it.
- To understand other prevention methods like PrEP and new technologies being developed by researchers like Multi-Purpose technologies.
HIGHLIGHTS, KEY QUESTIONS /THEMES
DR. EMMANUEL MUGISA, HIV TESTING STAFF/ PMTCT Coordinator, Baylor- Uganda
He states that key strategies to reduce the acquisition of HIV include Post-exposure Prophylaxis (PrEP). PrEP is a tablet (Truvada) swallowed on a daily basis to prevent the client (HIV infected person) from acquiring HIV. PrEP reduces more than 90% chance of HIV acquisition.
“We test HIV and do a urinalysis on clients who have an ongoing risk like discordant couples. Then we counsel them to start on medication. PrEP started in January 2018 at Kibito health center and we have registered 200 clients receiving prep intervention. Majority of the recipients are sex workers and discordant couples,” says Mugisa.
Kagote and Kibito are the first pilot implementation sites for PrEP however plans are underway to extend the service to the regional referral hospital and other centers.
Kakwezi Henry, Nurse at Kagote HC II
He says that PrEP started in March 2018 at Kagote health center II after training in Kibito. There are conditions to be adhered to be given PrEP especially among the eligible persons that include Female Sex Workers (FSW), men that have sex with men, discordant couples, and general population like truck drivers, boda-boda riders, men with multiple partners and drug users that use injections.
“We operate moonlight outreaches in the streets from around 7 pm – 10 pm to provide privacy to the FSWs. We test HIV and kidney functioning, and screen for Sexually Transmitted Infections. In case one is found HIV positive, they are referred to the health centers to start on ARVs.”
Prep is given to any free willed client not hence coerced on anyone. Hence provide forms to those who have consented and we require of their contact details. “We give ARVs after consenting to our process and are assessed monthly, screening is done when the client comes for a refill and test as well.”
For discordant couples, the HIV negative partner starts on PrEP for 6months, screened and tested monthly. PrEP minimizes chances of spreading the virus. HIV infected person is linked to the department to start on ARVs, counseled on the importance of taking ARVs. Proper adherence to ARV leads to viral suppression hence the multiplication of the virus is reduced.
The day outreaches are carried out in busy areas like bus parks. However, for the general population, when one feels they have changed from multiple partners and decided to be committed to one partner, then they can stop treatment of PrEP. There are 257 clients on Prep at Kagote HC II albeit some are faced with abdominal pain as a side effect for a short while.
Katusabe Beatrice, a mother of two, who has been in a discordant relationship for the last 13 years, says, “We went to HC facility at 6 months of my second pregnancy to test HIV and I was confirmed negative but my husband was positive. They gave me a letter and started on PrEP until 6 months. Of course, I got nausea and fever but later on got used to the drugs. All in all, I remained negative and would encourage people to have an HIV test and strive to finish dosage once advised upon”
Questions from the media:
Qn: Do you have dropouts as a problem?
Dropouts wouldn’t want to benefit from PrEP since information is shared with the client before the start of PrEP. Some change their social behaviors /habits to get committed to their partners hence stop coming for PrEP.
Qn: How do you keep trust on information of clients enrolled on services?
We offer pretest counseling in a group or one on one and post-test counseling given in a private setting. It is unethical for a health worker to expose the privacy and confidentiality of a clients’ information. In case of such unprofessionalism, we could locate them, to train and support them on client management.
Qn: Are services for free?
PrEP is free of charge in all Health Center IIs and government hospitals.
Qn: Is there a policy that can extend drugs to shops?
There is no open market for Prep because one needs to undergo testing and they are assessed through the 6 months.
Qn: If PrEP is taken for months what side effect is likely to occur?
Before one starts on Prep, they are counseled emphasizing on adherence to the pill that is taken daily. Non-adherence leads to higher risk of acquisition and the client is asked to come back for assessment in case of any side effects.
Qn: How many times do you have to test to confirm your status?
Ministry of Health set up a testing algorithm in Entebbe at DNA PSR that indicates the first level of testing is done by the determine kit, which tests antibodies in the virus. If they are sensitive, there will be a reaction.
At the second level of testing, once the Stat Pak detects antibodies, then we declare that person HIV free. Also, ensure you’re tested by a certified testing officer who knows how to handle the testing procedure. The officers ought to be of an external quality assurance standard.
Qn: What are some of the challenges of enrolling people on Prep
The public lacks enough explanation of the importance of Prep so that they are more willing to accept the conditions.
Also, the side effects of Prep include vomiting and dizziness which can go away with time go away with time or one can experience for a short time. 90% of clients don’t get side effects. Medications are generally safe and not life-threatening.
There are so many side effects that occur with the drugs so we change regiments to another drug; the body isn’t able to easily convert the regiment. We pick on another regiment after the cold resistant.