Namibia hailed as leader in HIV response

JANA-MARI SMITH



Namibia is leading the race towards reaching epidemic control of HIV in Africa and the government’s robust commitment to end the epidemic through a flexible and partnership-driven attitude has been hailed as a model for success.

To help the country reach the last steps towards epidemic control, the United States has increased its funding from US$72 million this year to US$82 million for next year.

The total investment by the United States President’s Emergency Plan for Aids Relief (Pepfar) since 2005 is nearly US$1.2 billion, US ambassador Lisa Johnson said last week.

Johnson highlighted Namibia’s success in achieving near epidemic control by reaching and surpassing the global 90-90-90 targets before the deadline of 2020.

By the beginning of 2019, 94% of adults living with HIV in Namibia knew their status; 96% of those who know their HIV status were on treatment; and 95% of those on treatment were virally suppressed (94-96-95).

To achieve epidemic control the number of new infections must dip below the number of deaths from HIV each year.

New infections have dropped by half over the past five years, to just below 5 000 each year, compared to a rate of 25 000 new infections between 1996 and 1998.

Currently, it is estimated that nearly 13% of Namibians live with HIV and that 4 000 will die from the disease this year, meaning that it remains the number one cause of death in the country.

By September 2019, nearly 204 000 people living with HIV will be on antiretroviral medication.

Tipping point

Carey Spear, Pepfar Namibia’s country coordinator, said the 94-96-95 achievement shows “Namibia is doing so well it can export lessons to the rest of the world, including the United States”, which is currently at 86-64-82 in terms of global targets.

Ambassador Johnson said Namibia’s globally recognised success can be attributed to the government’s commitment and political will to end the epidemic.

She said Pepfar applies a strong data-driven approach to help formulate strategies and shift programming in agile ways when and where necessary.

She praised Namibia’s government, particularly the health ministry, for its willingness to adapt quickly to evidence-based approaches, which has helped to address problem hotspots.

“They are able to take decisions quickly and implement them nationwide. And I think that has been a model of success.”

Spear said Namibia “at a political level” has the will to roll out necessary programmes and policies quickly, without hesitation, whereas these are potential obstacles in other countries.

Dr Eric Dziuban, country director for the US Centers for Disease Control and Prevention (CDC) in Namibia, added that Namibia’s client-driven approach has been crucial to ensure that programmes are framed around what is best for the client.

He added that political commitment is the number one factor that has influenced Namibia’s success. “We have all been impressed with that.”

Dr Randy Kolstad, the US Agency for International Development (USAID) country representative in Namibia, said while a number of factors have played a role in Namibia’s success, the government’s commitment to collaboration and jointly addressing the problem has been key.

Tipping point

Maintaining undetectable viral loads ensures people cannot sexually transmit HIV to their partners, and forms part of a strategy called U=U, or ‘Undetectable is Untransmittable’.

Five urgent target programmes in line with this form part of the multitude of strategies in place to end the epidemic in Namibia.

Spear said the key to reaching epidemic control is to locate, test and treat people across the country as quickly as possible. “We cannot reach epidemic control if we do not continue to find people living with HIV.”

She said the last-mile efforts to achieve epidemic control are often the hardest and costliest and will involve honing in on most at-risk populations, as well as addressing challenges such as the high rate of tuberculosis among people living with HIV.

Tuberculosis is the leading cause of death in people living with HIV and “chips away at the HIV programmes’ benefit for the population,” she explained.

Another key action is the roll-out of a new first-line antiretroviral drug, TLD, which is starting in October and is expected to be completed by June 2020.

This medication has fewer side-effects and helps to push the viral load lower more quickly than the current first-line medicine, TLE.

Other important activities include ensuring available stock of HIV medicines at all times, rolling out a new simple cervical cancer screening technique, and focusing on key and priority groups most at risk of HIV infection, including people in prisons and mines, sex workers, transgender people and men who have sex with other men. These groups are 13 to 28 times more at risk of being infected.