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So taking an HIV test was just to con­firm something she had at the back of her mind.
“I have always known that I am HIV positive since the death of my husband in 2005. He had full-blown Aids and by the time he died I was down with tuberculosis,” she said.
Despite knowing her status, Mbuya Rosy has chosen to seek alternative treatment from herbalists, which she said worked well for some time.
“I have been using herbs because I have been told that once one starts taking ARVs then its for life. I am afraid I do not like taking tablets and if it is going to be a lifetime, then I am better off finding alternative treatment,” she said last week.
Mbuya Rosy had a bout of pneumonia which made breathing very difficult. She was taken to a local hospital where she was admitted. The staff were not amused because she had a file dating back to 2005, but had not called at the hospital as required.
Asking Mbuya Rosy why she avoided the hospital yet her health was on a freefall she said she knew of three rel­atives who had died after being initiated on ART.
“I have a brother, his wife and a niece who all died after being initiated on ARVs so I have been trying to avoid that. I have done that successfully until the recent bout of respiratory inflammation which saw me being admitted in hospital,” she said.
On engaging her, she further noted that she was scared as she had heard that the starter pack knocks one off track.
A starter pack is a packet of ARVs given to a patient and lasts for 14 days before the patient goes for a review.
Patients who start medication when they are bed-rid­den blame the starter pack for even making them worse than before.
The issue here would be that the body is so emaciated that one has difficulty in eating even a fruit, what more with taking a cocktail of drugs?
Some health practitioners would prefer a patient not to be initiated on antiretroviral drugs until they are certain that the patient adheres.
Adherence is the cornerstone to recovery which will make treatment a success.
As in the case of Mbuya Rosy she was fully counselled when she was admitted and initiated on ART when the doctor was satisfied that she understood that ART was for life.
However, Mbuya Rosy got better and was discharged in a week.
The starter pack takes 14 days to complete and on review the patient gets a full month’s supply.
The 14 days’ period is to see if the patient does not react  to the drugs and if  they are compatible, then the same drugs used in the starter pack are prescribed.
A nurse explained that the starter pack is a noble way to measure patient compatibility to the drugs dispensed.
“Health practitioners cannot begin a patient on a full scale ART regime. They have to assess side effects in the first two weeks a patient is initiated on ART. Since one is beginning new medication this is where the name starter pack comes from, if one does not have severe side effects then the same drugs are continued,” explained the nurse who requested anonymity.
When Mbuya Rosy was discharged she did not con­tinue taking the tablets which she claimed made her feel like vomiting.
“I stopped the starter pack because I would vomit at times after taking my medication. I went back to using herbs,” she said.
After the 14 days she went back and did not disclose that she had defaulted. Since she did not report of any severe side effects she was put on the full ART pro­gramme.
The problem with Mbuya Rosy is that she takes the tablets as and when she feels like. This has resulted in her health taking a nosedive. As expected that she would improve, she did not since she was not adhering.
When a patient defaults, the HIV virus mutates which means it replicates and is no longer managed on the same drugs. It therefore needs stronger and expensive doses.
The nurse explained that second line ARVs cost around US$150 as compared to US$10 to US$15 for the first line drugs.
“We find ourselves in very difficult situations. If one defaults then we need to know the reasons for defaulting. If it is mere negligence, then we do not rush to put the patient on the second line drugs which are very expensive we begin counselling sessions again with the patient and make sure that they understand,” said the nurse.
Health practitioners assume that patients do what they are told once they leave the hospital, unfortunately some do not.
Nevertheless, some people taking ARV still struggle to adhere and run the risk of experiencing viral replication, clinical progression or even drug resistance.
Nutritional food is an integral part when one is taking ARVs and health personnel have had cases when one defaults because they cannot take medication on an empty stomach.
“ARVs work best if complemented with a nutritional diet. However, when patients struggle to get food with the discomfort that comes with taking these strong drugs when hungry some find it better to default when they have no food,” said the nurse.
Some patients have defaulted due to the long distances they have to travel to get medication. There have been cases when one has travelled and failed to come back on time and end up running out of drugs.
At present one can only collect ARVs from their centre unless they are in a position to buy from private pharma­cies when such a situation occurs.
An ARV distribution system that would allow patients to pick up drugs from any health facility may help those patients who travel more often.
It is also proven that family plays an important part as they remind one to take their medication.
“As health per­sonnel we urge a patient to at least disclose to family or someone close. We find that people who have disclosed have little failure rate as there is always someone to remind them to take their medicine,” said the nurse.
Generally, ARVs improve one’s heath but there have been cases where one feels discomfort arising from the physiological reactions to the powerful drugs. This can result in a patient calling at health centres to collect med­ication but stocking them at home.
People who are members of support groups in the communities they live find social support and this is rec­ommended as they have low failure adherence rate.
Next week we will look at how masculinity can act as a barrier to ART adherence.
Most men struggle to come to terms with their HIV status and the need to adhere to ART is compromised.
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