The Botswana Government through the Ministry of Health in Partnership with Botswana Harvard AIDS Institute recently conducted a workshop for nurses and other health officials as the country is moving to earlier HIV treatment from its current CD4 count cut-off from 350 and adopting a CD4 count of 500 cut-off. It is understood that the latest development is in line with World Health Organisation (WHO) recommendation and the idea is to get more people on treatment faster and save more lives.
In 2013, WHO issued new HIV treatment guidelines recommending countries start HIV patients on antiretrovirals (ARVs) sooner ÔÇô when their CD4 counts, a measure of the immune system’s strength fell below 500. Reports indicate that the guidelines drew in part from studies that showed that HIV-positive people who started ARVs at higher CD4 counts were about 96 percent less likely to transmit the virus.
Responding to Sunday Standard queries Ministry of Health spokesperson Doreen Motshegwa said “the Ministry of Health and Botswana Harvard AIDS Institute have not conducted (workshop) but the ministry is currently consulting with key stake holders on the benefits of moving to CD4 500 cut off.” Sources within the Ministry say that if Botswana moves to earlier HIV treatment it should expect increase in costs. It is not yet clear whether Botswana has secured funds for the initiative or intends to share to the costs with Harvard AIDS Institute. Motshegwa said her Ministry is at this stage unable able to share “this information as the ministry is still in the process of forecasting and costing the anticipated number of patients, drugs and related laboratory and drug costs.”
It is understood that at the workshop, concerns were raised that health officials are likely to be overstretched as at least three officers from each District across the country attended the workshop in preparation for the country’s move to earlier HIV treatment. Motshegwa said the ministry of health is committed to providing quality health services to the nation even in spite of the current challenges facing the Ministry.
On some of the benefits that are likely to be realised as result of the impending development Motshegwa said starting people early will reduce the morbidity and mortality and will also reduce the rate of new infections. Quality of life will also improve. “When prevention is strengthened few people will get infected hence the Government will spend less on treatment,” she said. On the challenges she said “there will be more patients coming in thereby increasing workload, shortage of Human resource; there will be increase in the drugs and laboratory test costs.” She added that as people will be started on treatment early while they are still healthy, adherence to treatment might be a challenge (pill fatigue). “Once adherence is compromised we are likely to experience increased patients failing 1st line treatment hence spending more funds on 2nd or 3rd line drugs,” she said.