HIV made the news because yet another vaccine failed. The real story is the impact of COVID on HIV and in turn on COVID. Roll out of a new med worldwide, dolutegravir, delayed. Many missed appointments, refills, doses. Others weren't diagnosed.
This impacts not just HIV but COVID
The cascade of HIV care - learning diagnosis, starting treatment, returning for appointments and viral load testing, adherence, HIV viral suppression - has had interruptions over the past 1.5 years worldwide.
Worldwide we have seen drop offs in service delivery along this cascade of care. theglobalfight.org/covid-aids-tb-…
This means people are missing their diagnosis, their meds, their control of the virus, and the chance to be healthy and also non-infectious
In San Francisco, California, we have seen a drop off in testing for viral load (ie used to document control of the virus in those on treatment, which adherence concerns and resistance can undermine)
The goal of the cascade of care is to have everyone diagnosed, on treatment, and virally suppressed (ie the virus can't be detected, keeping the individual healthy and also no-infectious).
We aim for 90-90-90
90-90-90 is:
90% of those infected tested and know their diagnosis
90% of those who know their diagnosis are on treatment
90% on treatment are virally suppressed
This means actually 90-81-72
It's hard, but countries around the world have surpassed this.
COVID makes it harder. SF:
On a global scale, COVID and all its interruptions and reprioritizations has made it harder for folks to be tested, access treatment and stay on treatment unaids.org/en/resources/p…
In those who are severely immunocompromised, including those with uncontrolled advanced HIV (not on meds, not on meds consistently, or have resistance) there is the risk of prolonged infection with SARS-CoV2.
We have even seen real time development of a new SARS-CoV2 variant in someone with HIV who needed dolutegravir, as was failing an efavirenz based regimen, and persistently was infected with SARS-CoV2 until starting dolutegravir and controlling HIV krisp.org.za/publications.p…
Starting in September, Germany will offer another dose of Pfizer or Moderna to older people, residents of care homes, and people with compromised immune systems — and also to anyone who was already fully vaccinated with the 2-dose AZ or single-dose J&J nytimes.com/2021/08/02/wor…
This is important, not just for Uganda, which was hit early by Delta, but also in best preparing for Delta in nearby countries, as the variant has been more recently forming surges elsewhere in East Africa.
Cote d'Ivoire has never been part a human Ebola epidemic. August 2021 has suddenly put Cote d'Ivoire in the middle of multiple contact tracing investigations. 1/n
In August 2021, a case was found in a traveler to Abidjan from Guinea, leading to investigation of contacts along route and in city. A new case is suspected in Burkina Faso and linked to an area as far as possible from Abidjan on northern Mali border
Hopefully the case in Burkina Faso is simply a suspected case which tests negative. This is quite possible. There are not enough characters to list here all the diagnoses that can look like Ebola - yellow fever, malaria, Lassa etc
Vaccine equity is not just about ensuring more doses. It's about more doses into more arms
Vaccines don't inject themselves. Funding for distribution and vaccination crucial
Vaccines that arrive free just before expiration will be feared to be a dump of what others do not want
Some areas where vaccination rates are the lowest are also those where substandard excess have been dumped as donations in the past. The protective response has long been jettisoning anything close to the expiration date.
Malawi has already incinerated 20K doses of thee vaccine that arrived less than 3 wks before expiry. WHO and AU had encouraged keeping doses as considered fine until July