Growing concerns about adherence as rollout expands

Nearly half of Kenyans in need of life-prolonging antiretroviral (ARV) drugs, are now accessing them. But a growing concern for healthcare workers is ensuring that these people stick to the medication.

According to Dr James Nyikal, Kenya's Director of Medical Services, the number of people living positively with the virus is escalating. Addressing a national conference on prevention in Nairobi recently, Nyikal said the roll out of the national treatment programme had restored hope among HIV-positive people.

Take 41-year-old Henry Okumu for example, who was diagnosed with HIV in 2001, and today uses his own experiences to encourage others to seek treatment.

"I was sickly and frequently in and out of hospital fighting to contain a myriad of opportunistic infections," he said. "I had been reluctant to accept the results of the diagnosis until my wife died in 2004 and I was faced with the reality of bringing up three children."

Through the Dandora Community Support Organisation, where he serves as secretary, the plump and bubbly father of three tells HIV-positive people living in the slum of Dandora, in the Kenyan capital, Nairobi: "There is hope for every HIV patient in Kenya now. Get up and look for antiretroviral treatment."

Okumu told IRIN PlusNews: "Whenever I tell people that I have the virus they don't believe it because the impression inscribed in their mind is one of a patient who is bedridden, emaciated. The community I live in has come to appreciate that when you are positive you can still lead a normal life just like malaria, cholera or cancer patients."

Nearly 140,000 - or 50 percent - of people in need of treatment are now on ARVs. But nurse and counsellor Rosemary Okwiri warned that the success of the ARV programme had its downside.

Adherence key to ART success

We are standing on the precipice of massive drug resistance

Okwiri, who works at Nairobi's Special Treatment Centre for resistant sexually transmitted infections, said two to three of every 10 of the clinic's patients defaulted on their medication.

"From scarcity of drugs two years ago due to exorbitant costs, we are nearing an avalanche [of patients]," she told delegates attending the conference. "We are facing an emerging challenge of abuse of the medicine."

Strict adherence to ARV regimens is crucial to preventing the HI-virus becoming resistant to the medication, which results in patients being put on more expensive second-and third-line treatment.

Okwiri said the new lease of life that ARVs give patients tempts some of them back into risky sexual behaviour and substance abuse, putting their drug regimens at risk and increasing their chances of re-infection.

"There should be effective counselling and monitoring of the patients to ensure 100 percent adherence," she said. "We're at the initial stage of multi-drug HIV resistance in Kenya; the new challenge requires attention or else we are standing on the precipice of massive drug resistance."

An estimated 10,000 patients per month are being enrolled on the national treatment programme, and the government aims to treat 180,000 people by 2008.

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