27 November 2019 | Press releases

South Africa to introduce state-of-the-art HIV treatment

The country has the largest national HIV programme in the world Unitaid has played a key role in ushering in the new and improved treatment, which works toward ending the HIV epidemic

Johannesburg, South Africa – One in five people in the world on HIV medication will be able to switch to a simpler, more affordable, more effective treatment following an announcement today that the Government of South Africa will roll out a state-of-the-art treatment regime that was introduced with the support of Unitaid.

Because about 20 percent of the people worldwide who have HIV live in South Africa, the introduction of the new treatment there is expected to have a far-reaching impact on the global HIV response, said Lelio Marmora, Unitaid executive director.

“We are pleased that our investments, globally and directly in South Africa, have helped set the stage for this more affordable and effective treatment,” Mr. Marmora said

South Africa also accounts for more than 10 percent of all HIV-related deaths and 15 percent of new infections.

The new regimen, known as TLD, is a three-in-one, fixed-dose combination that includes dolutegravir, lamivudine, and tenofovir disoproxil fumarate. Dolutegravir is already the drug of choice for people living with HIV in high-income countries. It has fewer side effects and is easier to take than other formulations—only one small tablet daily. It also has less negative interaction with other medicines such as those for tuberculosis, a leading cause of people living with HIV.

The new regimen also helps prevent antimicrobial resistance; because it involves fewer pills and side effects, patients are more likely to stick with the treatment. When patients drop treatments, or do not take them correctly, drug-resistant microbes get a chance to develop. Patients must then turn to second-line drugs, which can be up to ten times as expensive.

The South Africa Department of Health will begin the rollout of TLD among people living with HIV on 1 December, which is World AIDS Day. The country has about 4.8 million people on antiretroviral treatment. Scale-up of the new regimen is expected to contribute to reaching the UN’s goals for ending the HIV epidemic by 2030.

Unitaid has invested heavily over the last three years in better antiretrovirals. Efforts include four clinical trials, funding to the Medicines Patent Pool for affordable generics, market-shaping interventions to lower prices, and technical support to the South Africa Department of Health via the Clinton Health Access Initiative.

Those efforts have helped bring about a price drop in dolutegravir-based treatment to a global low of US$ 75 per person per year. Further price reductions are expected, which could save health systems US$ 300 million each year, enough to put an additional 5 million people on treatment.

Through funding to the Medicines Patent Pool, dolutegravir-based regimens were introduced in Kenya, Uganda and Nigeria only three years after they were introduced in the US and Europe. Previous generations of antiretrovirals took up to 10 years to become available.

Coordinator of the African Community Advisory Board Kenly Sikwese, who is living with HIV, said that switching to a dolutegravir-based treatment has allowed him to once again “function as a human being” after suffering from lethargy with other medicines.

“Creating better HIV medicines, tests and prevention methods is one thing, and getting them to people in African countries is another whole process,” said Mr. Sikwese, who is also a Unitaid Executive Board member representing communities living with the disease.

Aiming to make the HIV response more equitable and efficient, Unitaid has involved communities in Africa at all stages of its antiretroviral projects—from designing and conducting clinical trials to review of World Health Organization guidelines.

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