The ministry of Health has started the process of putting HIV/Aids patients on a new combination of first-line antiretroviral treatment (ART). Patients are being moved to Tenofovir, Lamivudine and Dolutegravir, (TLD), replacing Tenofovir, Lamivudine and Efavirenz (TLE). Dr Joshua Musinguzi, the AIDS Control Programme manager at the ministry, told journalists this week that they are following World Health Organisation advice to replace TLE with TLD, a more effective and preferred first-line treatment combination. Musinguzi said starting this month, September, Dolutegravir (DTG) will start being administered. “We hope that by end of this year, we shall have migrated about 206,000 patients on Dolutegravir and that by 2019, we shall have completed the transition. We shall have put about 560,000 patients who are eligible for first-line on DTG,” Musinguzi announced during a media breakfast meeting. The meeting was held under the theme: ‘Implementing a public health response for HIV pandemic control in Uganda.’ Musinguzi said there is a challenge of dealing with the rising number of patients who are developing resistance to first-line drugs. “DTG [Dolutegravir] has a good amount of viral load suppression significance and it’s less prone to resistance. It has a higher generic barrier with fewer side effects and is easier to swallow,” Musinguzi said. He, however, expressed concern that only about 52% of the populace living with HIV/Aids who are on treatment would be moved to DTG. There are safety issues to be considered, which Musinguzi said make it unsafe for some females and children. The recent advisory from WHO cautioned the ministry against administering the DTG to women of childbearing age. “WHO cautioned us that there was a study which was taking place in Botswana which indicated that DTG in early stages of pregnancy may be harmful to the foetus and it may cause side effects like malformation of the spinal cord; the spine does not close. There was an observation of four cases in that study and they advised us to exclude women in child-bearing category,” Musinguzi said. He said the exclusion of women was a huge drawback since they are persons who need that first-line treatment combination most. “While setting guidelines for the country, public health approach programming is used and you go for the common good. So whereas we know the drug may be beneficial for those outside of that period, it may not be easy to implement within our systems because we are dealing with different levels of health care and we don’t want confusion,” Musinguzi said.
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