After making international headlines for becoming only the second country in the world to achieve the UNAIDS 95-95-95 targets, Botswana could be forgiven for resting on her laurels for a little bit.
After all, achieving the targets is a milestone victory in the four-decade long fight against HIV/AIDS, a battle that has cost thousands of lives and billions of Pula. Announced nearly a decade ago as a way of ending the AIDS epidemic by 2030, the United Nation’s 95-95-95 targets challenge all nations to ensure that by 2025, 95% of all people living with HIV know their status, 95% of those who are diagnosed are on ARVs, and 95% of those who are on ARVs have viral load suppression.
Besides Botswana, only Eswatini and Zimbabwe have achieved the 95-95-95 targets, indicating the difficulties of meeting the UNAIDS’s challenge.
Rather than taking her place on the podium, Botswana is putting her hand to the plough and joining the global push for an HIV cure.
Three studies are in various stages of advancement in the country, involving People Living With HIV (PLWHIV) to search for a permanent solution to the disease.
Kennedy Mupeli, a local long-term HIV activist, says there has been a noticeable uptick in the number of studies for a cure to the disease. After the successful development of ARVs and associated treatments, the global scientific world seemed to slow down a bit on the search for a cure, but of late, the pace has quickened.
“Researchers are not putting their hands down and saying ‘OK we have treatment and people are getting virally supressed and it’s enough.’
“It’s not. We need a cure.
“It’s only recently that HIV cure research studies have proliferated and as activists we are demanding more of them,” he said in an interview this week.
Mupeli, who specialises in HIV treatment literacy, this week kicked off a series of workshops designed to update community members about the different studies taking place all over the world and in Botswana for an HIV cure. Held by the Centre for Youth of Hope (CEYOHO), the first workshop was conducted in Gaborone and others are set for Francistown, Maun and Kasane this month.
For Botswana, participating in the search for an HIV cure is also about the cold, hard facts around maintaining the coveted 95-95-95 achievement. The Ministry of Health estimates that about 330,000 people are living with HIV in the country, with about 2,200 new cases amongst adults each year.
Figures shared last year with Mmegi indicate that government is spending just over P1 billion a year on the HIV effort, a considerable portion of the overall expenditure on broader public health. Particularly concerning to those tracking public health expenditure is that the funds going towards HIV care, come at a time when new, emerging threats, such as Non-Communicable Diseases (NCDs) and long COVID are gripping the nation.
“A cure is the ultimate because we have almost 400,000 Batswana on treatment and this is a huge burden,” Mupeli said.
“Imagine if there is a cure and you manage to heal a substantial number of them.
“Let’s not say because we have treatment, it’s a done deal.
“We need an HIV cure so that when someone is infected, instead of giving them lifelong treatment, they are put on HIV cure treatment.”
Besides the economic burden on treating a large section of the population, Mupeli says there are issues of the toxicity of taking drugs every day for a lifetime, as well as the stigma that PLWHIV have to live with. All these call for renewed energy in the search for a cure.
The most advanced study taking place locally is the Antiretrovirals Combined with Antibodies for HIV-1 Cure In Africa (ACACIA). Coordinated through the Botswana-Harvard AIDS Institute Partnership and different research teams in and outside the country, with the support of the Ministry of Health, ACACIA is a randomised, double-blind, placebo-controlled study combining two long-acting broadly neutralising antibodies.
The study researchers will use the Broadly Neutralising Antibodies (bNAbs) that have shown promising characteristics in pre-clinical and limited clinical studies.
One of the scientists involved in the study, Dr Ayotunde Omoz-Oarhe, previously told Mmegi that besides 30 PLWHIV in Gaborone, the trial would also involve volunteers in Blantyre, Malawi, Durban, Rustenburg, WITS, Soweto, eThekwini all in South Africa and Milton Park in Zimbabwe.
When Mmegi broke news of the study last year, some readers expressed concern, questioning the safety of the research, with others going as far as saying Batswana were being as “guinea-pigs” for international laboratories.
Mupeli said nothing could be farther from the truth.
“What people don’t understand is that HIV is in subtypes and types.
“Some types that are in this part of Africa may not be the type that is prevalent in Europe or North America.
“Being involved in a study is actually a plus because if an intervention or a cure trial is successful here, it means automatically we benefit here.
“It will not need to be retested on us because it was tested on us already.
“I always tell people that even the ARVs that you are swallowing everyday, someone swallowed it as a trial and you are benefiting now.”
He added: “Why don’t you want to go into the forefront?
“It’s like you are in a battle and you say ‘let other soldiers go and fight and when they win they’ll come report to me’.
“No, it’s your battle, go and fight it.”
The veteran activist said HIV cure research trials are amongst the safest in the scientific world, with great care taken in selecting candidates as well as strict monitoring of vitals such as viral loads and the possibility for developing drug resistance.
“For me having gone across the world learning about HIV treatment and cure research, I have learnt that these environments are safe,” he told Mmegi.
“You don’t just say I’m HIV positive, let me jump in.
“It’s about informed consent where they will educate you and say ‘this is what we are trying to do’ and if you agree, you agree and get into the study.
“With studies like analytical treatment interruption, it’s done in the safest environment where they monitor your viral load frequently to see where you are going.
“Immediately you reach a certain threshold that maybe is rising, before it even reaches a level where it can provoke resistance or whatever, before that level, they put you back on treatment.”
CEYOHO’s workshops around the country are designed to update PLWHIV on the various studies taking place for an HIV cure and to prepare those who may want to participate in the trials taking place in the country.
“We want people living with HIV to appreciate the fact that there are some efforts to find a cure,” Mupeli said.
“There’s light at the end of the tunnel. This is just a virus and we remain hopeful.
“I want to encourage people living with HIV to remain steadfast and to continue adhering to their treatment.
“We always say if you are not adhering to your treatment now, when the cure comes, you will not be around.”
