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A lifetime patient

02.04.2020

Worldwide 2.8 million children live with HIV. Many are under therapy. This is not suitable for children. That is why many young people stop taking it and life-threatening resistances threaten.

Zimbabwe With a tense smile, mother Mhlava Makhese sits with her 10-year-old son Ripfumelo in front of the infectious disease clinic of the hospital in Chikombedzi. Only yesterday she received a text message on her mobile phone with the request to visit the HIV clinic in the hospital with her second oldest son as soon as possible. Ripfumelo has been HIV positive since birth and is under therapy.

During the conversation with Dr. Kevin Mawana, the head of infectiology, the smile disappears from the mother's face. Shock and worry spread. The HIV therapy has lost its effect on Ripfumelo. The number of viruses in the blood has risen dramatically in recent months: From 1,532 viruses counted per millilitre of blood to 17,332 at the last measurement a few weeks ago - an alarm signal. The disease AIDS could soon break out. As a result of the immunodeficiency, the boy could fall ill with other serious infections such as pneumonia or tuberculosis.

Ripfumelo Makhese received the virus from his mother, who is also HIV positive. The then 24-year-old woman knew nothing about her infection. As a result, there was an exchange of blood with the baby during birth, which means that Ripfumelo is a carrier of the HIV virus from birth.

The two sisters carry the burden of the HI-Virus. They wanted a watch so that they always know when to take their medication.

Unfortunately, it is not uncommon for children of Ripfumelo' s age to develop resistance to HIV therapy, says Dr. Kevin Mawana. "During puberty, many children no longer take the drugs regularly and mutations in the viruses occur, leading to resistance. In this case, one has to switch to another combination of drugs as quickly as possible.

The hospital in Chikombedzi is located in the southernmost province of Zimbabwe, near the South African border. Far away from the capital Harare. For several years it has been raining too little.

"Ripfumelo urgently needs a change to a so-called second-line therapy", Dr. Kevin Mawana explains to the mother. Unfortunately, this therapy is currently only available at the district hospital in the main town of Chirdezi, which is about 150 km away. Ripfumelo will also receive this treatment free of charge. However, Mhlava Makhese has to pay the costs of the bus ride to the hospital with her son herself. And these 80 Zimbabwean dollars, the equivalent of 20 rappen, are already an existential burden for the single mother of five children.

Unfortunately, it is not uncommon for children of Ripfumelo age to develop resistance to HIV therapy, says Dr. Kevin Mawana. "During puberty, many children no longer take the drugs regularly and mutations in the viruses occur, leading to the development of resistance. In this case, one has to switch to another combination of drugs as quickly as possible. However, this second-line therapy is much more expensive and is therefore often lacking in the health centres and hospitals in the south of the country.

The last mile

Zimbabwe has made great progress in the fight against HIV. But the so-called last mile remains stony in large parts of rural Africa. But that is precisely where HIV is particularly prevalent. SolidarMed therefore focuses on the most remote areas of the country. Thanks to these efforts, HIV therapy is now also available to all those affected in the rural districts of Zaka and Bikita. Pregnant women are tested for the virus as standard and, in the event of infection, are treated immediately. "During pregnancy, they receive the highly effective antiretroviral therapy, whose active ingredients reduce the viral load within a few weeks to such an extent that the viruses are no longer detectable," explains doctor Jochen Ehmer, Managing Director of SolidarMed. This prevents the infection of the child during pregnancy and birth, and later also via the breast milk.

Appointments via SMS

Successful and sustainable HIV treatment requires regular monitoring of those affected. Like Ripfumelo, those affected must be invited to the hospital once a year for a so-called virus load measurement in order to measure the number of viruses in the body and thus the effectiveness of the therapy. If resistance occurs, the patient can quickly switch to other drugs. In Zimbabwe, SolidarMed supports this monitoring of those affected in the Masvingo province. SolidarMed also ensures the training of nursing staff in remote health centres.

Together with local programmers, SolidarMed developed the INYASHA* SMS system. The results of an examination can be transmitted directly to the affected persons by SMS. Or - as in the case of Ripfumelo - invite the patient to the next examination appointment. The virus load measurements, which SolidarMed introduced as a new standard for monitoring the success of therapy, enable all patients, including children, to be tested once a year to monitor the effectiveness of the therapy. Thus, resistance in Ripfumelo was discovered just in time to switch to the second line of therapy, which saves his life.
 

Allowing everyone to benefit from the therapy

In the last three decades, more than 37 million people have died of the immunodeficiency disease AIDS, which is caused by the HIV virus. HIV/AIDS is thus one of the deadliest infectious diseases. Fortunately, effective therapies are widely available today. However, it remains an enormous challenge to reach and support those affected in remote regions of the world. The need for action is very high. SolidarMed will therefore continue to focus strongly on HIV treatment in Southern Africa.