KZN could prove HIV prevention science to world

While KwaZulu-Natal remains hard hit by HIV, a new study by the humanitarian organisation Medicines Sans Frontiers (MSF) may mean the province is turning the tide against the virus.

The HPTN-052 study found that HIV-positive people who started treatment early and had undetectable HIV viral loads were about 96 percent less likely to pass the virus onto partners.

It could also set the scene for KZN to prove to the world that HIV treatment is not only good for patients but for communities.

Presented at recent annual scientific Conference on Retroviruses and Opportunistic Infections in the United States, the MSF study surveyed about 5,650 people in Mbongolwane and Eshowe. As part of the study, people were interviewed and agreed to be tested for HIV. Those that tested positive for HIV also had the level of HIV in their blood, or viral load, measured

The study found that about one quarter of all participants were HIV-positive – a figure about 40 percent higher than the national average, according to UNAIDS.

But this shockingly high figure is only half the story.

The study also found that about 80 percent of those surveyed had been tested for HIV in the past six months and almost an equal percentage of those living with HIV were already on antiretrovirals (ARVs).

Against moderate rates of new infections found in the communities, the area’s continued high HIV prevalence rates are a sign that ARVs are keeping people alive longer, according to Matthew Reid, who coordinates MSF’s Eshowe project.

“Prevalence is like measuring water inside a bucket,” he says. “If there is a hole in the bucket, or people are dying from (HIV), then your bucket doesn’t fill up quickly and prevalence rates are not going to rise dramatically.”

“If you plug the hole and keep people alive on ARVs – which obviously is a good thing – then the level of water in your bucket is going to increase, and prevalence will be higher.”

Treatment is prevention

In 2011, a study conducted in several countries including South Africa found that HIV-positive people who started treatment early and had nearly undetectable levels of the virus in their blood were about 96 percent less likely to pass the virus onto partners. Scientists theorise that earlier HIV treatment and high treatment rates could prevent new infections in communities.

MSF’s Eshowe project is looking to take that theory from mathematical models to the real world. To do that, the KZN Department of Health has allowed MSF to start HIV patients on ARVs sooner than national guidelines recommend.

About 90 percent of the long-time ARV patients surveyed by MSF in KwaZulu-Natal had levels of HIV in their blood that were undetectable, according to Reid.

“Getting on treatment has benefits for the individual, who…will avoid HIV-related diseases,” Reid tells Health-e. “There are also potential benefits of protection of the community because someone with an undetectable viral load is far less likely to transmit the HIV.”

“The fact that the KwaZulu-Natal authorities have accepted to partner with MSF to initiate treatment early is a very encouraging sign of their direction in the fight against HIV,” he added.

To test its theory that high HIV treatment coverage can bring down new infections in Eshowe, MSF plans to conduct another study in several years.

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