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AMR, an emerging health threat

By Catherine Murombedzi

“People Living with HIV are more likely to develop infections like tuberculosis, fungal meningitis, and other severe bacterial infections. This is complicated by the threat of Antimicrobial Resistance (AMR), making those infections difficult or impossible to treat”

Antiretroviral therapy (ART) ushered a new lease of life to people living with HIV (PLHIV). A weakened immune system is a playground for opportunistic infections (OIs), thanks to ART.

Zimbabwe has had ART in public health centres since 2004. Then, those severely ill with a CD4 count less than 200 were initiated on ART. Today, there is a test and treat, thanks to the Global Fund, PEPFAR, Melinda and Bill Gates Foundation, EGPAF, and many partners who pool resources to provide the much needed life-long treatment.

Speaking in a virtual pre-ICASA conference recently, Thomas Joseph, Head of Antimicrobial resistance (AMR) Awareness, Advocacy and Campaigns, World Health Organization (WHO), highlighted the threat of resistance to treatment for PLHIV.

“People Living with HIV are more likely to develop infections like tuberculosis, fungal meningitis, and other severe bacterial infections. This is complicated by the threat of Antimicrobial Resistance (AMR), making those infections difficult or impossible to treat,” said Thomas Joseph.

AMR is a problem driven by misuse and overuse of antimicrobial medicines, including antibiotics and antivirals, and it results in critical medicines losing effectiveness to treat infections.

“HIV drug resistance is a big problem, with estimates of 10% of adults having resistance to some of the routinely used first-line treatment. Antiretroviral therapy has saved tens of millions of lives globally, but drug resistance is jeopardizing the efficacy of these medicines and resulting in an increasing number of treatment failures,” he added.

Drug resistance in HIV is primarily driven by misuse and poor adherence to treatment.

AMR is associated with 5 million deaths a year. Besides this, there is a huge burden of morbidity and healthcare expenditure that can affect household welfare severely,” said Joseph.

The World Bank estimates that Global GDP could fall by $1 to $3.4 trillion annually after 2030 due to AMR.
Dr Cleopas Chimbetete, an HIV and Aids clinician at Newlands Clinic, Harare, said poor adherence is the main reason for the majority for resistance to treatment.

“Poor adherence to prescribed treatment is the leading cause of drug resistance in ART. It leads to treatment failure.

“The only other way that one can have treatment failure, yet they have never missed a dose, is when they get re-infected. Cross-infection can cause treatment failure. We urge PLHIV to always use protection. If they get a drug-resistant strain from a partner during sexual intercourse, it means the treatment in force will not work. So always condomize,” advises Dr Chimbetete.

“We need to address the issue of poor adherence. About 90 percent of people on second and third line treatment missed their doses of the first line regimen. Young people struggle to take drugs as prescribed. Substance and drug misuse is also a contributor to lack of adherence.

“With mutoriro (chrystal meth) use, for instance, we notice a rise in young people failing to adhere to treatment,” Dr Chimbetete said.

Paradzai Chimba, a substance use survivor now on third line ART treatment, said he missed doses when he was high.
“I am now on third line treatment, I will never miss doses again. I nearly died. The doctor told me that there is no fourth line treatment. I have stopped taking mutoriro, I would sleep for days. That way, I missed treatment,” said Chimba, who looks gaunt and frail.

The Director of Civil Liberties and Drug Network, Mr Wilson Box advocates for harm reduction. He does not believe in punishing the users, rather, education is required on the dos and don’t.

“Drug use is not a criminal issue but a public health concern. Once you pronounce it as a public health concern, you ought to provide services. Harm.reduction services include naloxone programs, programs for people who use drugs, stabilization programs, condom programming, ART, sexual transmitted infections (STI) screening, etc.There is also need to reform our laws from criminalisation of drug use to decriminalization of drug use with arrests to concentrate on traffickers,” suggested Mr Box.

With AMR an emerging health threat, awareness on causes, risks and what should be done is required.


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