Previously people initiated on ART took a cocktail of drugs – three separate tablets, e.g. nevirapine, lamuvidine, zidovudine. The three tablets were all to be taken in the morning and in the evening.

Today there is a compacted tablet made up of the three which makes life easier as one has to take only one tablet in the morning and one in the evening at a given time.
Science has not slept on the job, for those being initiated on ART in Zimbabwe currently no longer have to take a tablet in the morning and another in the evening, there is now only one tablet to be taken.

Unfortunately, those initiated on the previous regimen (morning/evening tablet) cannot be moved to the single dose a day as the compositional make-up is different and so it is not recommended.

This has brought a sigh of relief as I have witnessed four deaths in the last two years as patients forgot to take their late evening medication at times.
With the old regimen if one took a tablet at 7 in the morning one had to take another one at 7 in the evening. The morning pill was not a challenge to most people but the late evening one was.

Take for example one who had gone on a short journey and intended to come back before the end of the day failing to come back due to unforeseen circumstance, it meant a tablet missed.

Mrs Jimmy, who has been on ART for seven years now, said she found it difficult to keep track of the evening dose. At times she would be attending a funeral in the neighbourhood and by the time she came back home it was way past her set time.

“I take my tablets at 6am and 6pm every day. I have had no problem with the morning pill, it’s the evening one that I have missed many times.
“It’s either I am attending a funeral wake in the neighbourhood and since it was not my intention to stay late, I always realise that I would have missed the regulated time,” said Mrs Jimmy.

ARVs are meant to be taken at the same regulated time as this makes them more effective. A simple example would be if it takes 30 minutes to an hour for yeast to rise in dough, the same rule applies to medicine use and efficacy in the body.

However, one finds that at the end of a month one would have missed taking five tablets and this compromises the effectiveness of the medication.
This resulted in Mrs Jimmy getting ill despite the fact that she was on ART.

“I got ill for some weeks and it was only the visiting doctor who noticed it. He realised that each month I missed taking three to five tablets and this led me getting ill,” she said.

The doctor asked her to have counselling sessions as moving her to second line without understanding the gravity of defaulting as tragic.
“Today I am on second line ARVs and am feeling well. The doctor pointed out that if I am to default again that would have fatal effects as the clinic does not have third line drugs,” she said.

First line ARVs are used in the first instance that one is initiated on ART. These cocktail of drugs are less expensive as compared to second and third line drugs. For example, Chegutu District Hospital has six ART patients on second line ARVs.

It is imperative that patients adhere to the set regulations. If one defaults and develops complications say tuberculosis, then that person is passing on that specific type of TB. It is therefore not surprising that a new patient fails to respond to medicine when initiated on first line.

This could imply that the patient already has a drug resistant strain they acquired. This results in the patient not doing well despite being on medicine.
This will require them to be put on second line ARVs. Second line ARVs cost around US$150 a month per patient supply as compared to US$15 for first line therapy.

In December 2011 another person I knew to have been on ART died as a result of defaulting.
Zex used to take the morning and evening dose. He adhered when he was ill but by the time he was fully recovered he became complacent and started to drink beer again.

I had talked to him on the dangers of alcohol and he always promised to drink in moderation. The last time I talked to him was a month before he met his maker and he seemed to have reformed.

Zex used to collect his medication from Mabvuku Clinic but when he got very ill he changed centres and moved to his rural area where he introduced himself as a new client.
With ART being distributed on a centre basis and all the data kept at that place it is imperative that data becomes centralised so as to help patients like Zex.

He was tested, counselled and started on first line ARVs. He never told the health workers in Chiweshe that he had been on ART before.
Had he taken his cards they would have known his history and treated him accordingly but this he did not do.

“I hope to get better soon. I have stopped drinking Zed because by evening I would be so sloshed that I miss taking the evening tablet,” said Zex then.
I told him that he needed to take his old cards to his old centre where they would detect that he had defaulted.

There are many patients lost to follow up as in Zex’s case. With the cards handled manually and with a centre taking care of hundreds of patients a day it becomes difficult to track defaulters.

On Christmas Eve in 2011 Zex breathed his last. It was too late when he had finally hauled himself to the centre that first initiated him on ART where they realised that he was so wasted and had full blown Aids then.

He could not be saved as he died the same week he was admitted and put on life support.
Zimbabwe coming up with the use of a single tablet made up of a cocktail of drugs will go a long way in helping those who found it difficult to take medication twice a day.

With the strides in science and medicine, it should be soon that an HIV vaccine is found.

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