SOUTH AFRICA – South Africa is set to introduce a new treatment plan that includes the antiretroviral (ARV) drug, dolutegravir for HIV-positive children from as young as four weeks and as old as 10 years.

The treatment, which was approved by the South African Health Products Regulatory Authority (Sahpra) in June last year, will replace the syrup currently being administered at private and State hospitals.

The syrup allegedly tastes bad, and anecdotal evidence suggests it has often resulted in children not getting the full dose of medication because their tendency is to spit it out.

The child-friendly treatment is a four-in-one capsule with strawberry-flavoured granules.

The new capsule can be opened and the granules dissolved in water or sprinkled over soft food, and need only be taken once a day.

Nurses will be given directives on the new medication, its side effects, and how to administer it. These directives are outlined in a set of proposed 2023 treatment guidelines that the Southern African HIV Clinicians Society previewed and unpacked in a Bhekisisa webinar.

“The guidelines are about making sure that we have documents that are evidence-based, that help us to manage any disease in a standardised way,” Juliet Houghton, chief executive officer of the Southern African HIV Clinicians Society.

“We look at all the research that’s available, we capture the best evidence and then collaboratively produce guidelines that basically inform how we provide care to patients living with HIV.

“The other element of guidelines is that we’re able to educate not only the health workers that are going to administer them, but also wider communities and organisations so that everybody knows what’s available, what’s best practice and what we can do within any setting.”

More people to switch to TLD

Jeremy Nel, president of the Infectious Diseases Society of South Africa, said that the reason for the Southern African HIV Clinicians Society updating its guidelines is that they want more people (living with HIV) to be switching to TLD – a fixed-dose combination of tenofovir, disoproxil, lamivudine and dolutegravir.

This means that adults, along with children who are HIV positive, will have access to the new medication.

Nel added that because the public and private healthcare sectors cater for different markets, they each have their own guidelines, but despite this, patients can be assured they will get standardised care across facilities.

“The roll out of TLD across both private and State hospitals will be a milestone achievement in improving health outcomes for all living with HIV,” he said.

“TLD is the best tolerated medication anywhere in the world and is affordable.”

From next year, SAHCS will recommend dolutegravir not only for patients who start taking ARVs for the first time, but also for second- and third-line treatment.

That dolutegravir will remain a component of the new treatment plan for HIV going forward, has been applauded by those in the industry.

The health department started to gradually phase dolutegravir in December of 2019. Dolutegravir is currently one of the ARV drugs in a three-in-one pill for first-line treatment. The other two drugs in the pill are tenofovir and lamivudine.

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