Major success in meeting HIV/AIDS 90-90-90 targets – Chief Medical Officer

…more will be done to eliminate challenges posed to viral suppression
By Kristen Macklingam

The Human Immunodeficiency Virus (HIV) continues to be a major global public health issue that claims the lives of millions of infected persons annually despite interventions by relevant authorities.

Here in Guyana, even with recent successes in the treatment of HIV patients and their prolonged lifespans, this deadly disease remains high on the agenda for the Public Health Ministry and other stakeholders.
This is according to Chief Medical Officer (CMO), Dr Shamdeo Persaud, who during an exclusive interview with Guyana Times, stated that although the country was on the right trajectory in achieving the goals set to minimise and eventually eradicate the transmission and prevalence of HIV, much more work needs to be done.
“We have seen some changes in the occurrences in HIV. We really would like to solicit not only the patients – I know the patients do make a great effort to comply with treatment – but we need support from our general population. HIV is not any longer that stigmatised disease that we label people, and we call them names or anything, they are human beings like you and I, who need to access this treatment, lifesaving treatment, and to ensure that they comply with all of the requirements,” the CMO said.

He stated that Guyana has now almost transitioned to “full country support” of the procurement of necessary medication as well as local involvement in the execution process and implementation programme of the country’s HIV programme.

Notable successes
According to the CMO, Guyana continues to forge ahead with achieving the United Nations Programme on HIV/AIDS (UNAIDS) “90-90-90 target”, which seeks to have 90 per cent of people living with HIV become aware of their infection, 90 per cent of the people diagnosed with HIV linked to antiretroviral treatment (ART) and 90 per cent of those on ART adhering and having undetectable levels of HIV in their blood.
Dr Persaud posited that in Guyana, there have been significant improvements in the 90-90-90 programme, but there were a few challenges that the Public Health Ministry continues to battle with in order to successfully achieve this goal.
“The first 90 is the proportion of persons who are sexually active who know their status and that is the greatest increase in the numbers that we have seen.

“Secondly, the placement of persons who are tested positive on treatment. On this front, we are now able to, first of all, identify all those people who need to be on treatment, and, of course, once you are tested positive, there are some confirmation that needs to be done and treatment starts.”
He explained that there were varied treatments available for those who tested positive since not every pill would work effectively on every individual.
“So, once those details are attended to at any one of the family health clinics that we operate, the HIV treatment centres across the country, and we have some Private Sector centres too, so we allow for persons to obtain their treatment. They are free of cost, of course. Those numbers have been increasing. We are not fully at the 90 yet but we are getting closer there.”

Viral suppression and challenges with HIV treatment pills
With regard to the third 90 of the UNAIDS 90-90-90 target, Dr Persaud elaborated that this was where the country aimed to demonstrate that there was viral suppression since this would mean that the treatment was working. However, this area is where the Public Health Ministry faces the greatest challenges.
“Particularly with the laboratory components, and, you know, it is quite a daunting task to have to sample and to test everyone who is on treatment periodically throughout treatment to demonstrate that they are now undetected virally or that there is viral suppression. But on that front, we have been improving, so this is the one we need to work a little more on. The pills do have some challenges intermittently, and the clinicians at the care and treatment centres are working along with persons to ensure that they address those challenges as they go along.”
Nonetheless, the CMO noted that by the end of this year (2019) the public health sector will have “more significant improvements” as it fills its next Global AIDS programme report.
“So, all in all, I think we are standing on better ground. For our testing programme, I must give kudos to all those persons working – the National AIDS Programme Secretariat (NAPS) and more importantly, our partners, both in the Private Sector. Also, the Non-Governmental Organisation (NGO) sector and the civil society that has been really coordinating with us to reach out to everyone.”
Recent statistics from the Education Ministry revealed that Guyana has a higher percentage of its HIV+ population on treatment than the total percentage of the Caribbean Region. Last year, of the 8369 persons estimated to be infected in Guyana, 66 per cent (5557) were successfully put on treatment.