Page 128 - HIVMED_v21_i1.indb

Southern African Journal of HIV Medicine
ISSN: (Online) 2078-6751, (Print) 1608-9693
Page 1 of 2 Editorial

COVID-19 crisis effect on HIV service delivery in Egypt:

Hard times or blessings in disguise?

Coronavirus disease 2019 (COVID-19) continues to disrupt the health system globally.
Authors:
Rahma Mohamed 1 Nevertheless, such adversity has urged us to rethink the way healthcare is delivered, based on a
Heba Wanis 2 recommendation and a lesson learnt which we wish to highlight in the following paragraphs.
Sonia Zebachi 3,4
Menna-t-allah El-Kotamy 5
Gamal Esmat 1 In our previous editorial published on 30 July 2020, we recommended the use of locally
Ahmed Cordie 1 manufactured tenofovir disoproxil fumarate (TDF)/lamivudine (3TC) for the treatment of people
living with HIV (PLHIV) in Egypt, as an alternative to the imported originator’s TDF/emtricitabine
Affiliations:
1 Endemic Medicine (TDF/FTC) 2-in-1 combination, the importation of which was hindered by COVID-19 restrictions,
Department, Kasr Alainy making it inaccessible. 1
School of Medicine, Cairo
University Hospitals, Cairo, Available data about the interchangeability between TDF/3TC and TDF/FTC are not limited
Egypt
to their use for treatment only, but include their use for prevention as well. Evidence shows
2 Third World Network, Cairo, similar distribution of 3TC and FTC in cervicovaginal fluid and in semen, with a lack of data
Egypt on 3TC rectal concentration in humans. In the meantime, the human mucosal pharmacokinetic
profile suggests pharmacological equivalence of FTC and 3TC for pre-exposure prophylaxis
3 Clinical Epidemiology and
2
Aging Team (CEpiA), Mondor (PrEP).
Institute for Biomedical
Research (INSERM U955), In 2015, the World Health Organization (WHO) recommended that any person at substantial risk
Créteil, France
of human immunodeficiency virus (HIV) should be offered oral PrEP containing TDF as part of a
3
4 Public Health Services, combination HIV prevention programme. In 2017, the WHO Essential Medicines List was
Henri-Mondor Hospital, updated to include PrEP drugs, specifically TDF, TDF/FTC and TDF/3TC.
4
Assistance Publique-Hôpitaux
de Paris, Paris-Est Créteil
University, Créteil, France In most countries that have adopted PrEP, TDF/FTC is the most commonly recommended PrEP
therapy. Six countries recommend TDF/3TC for PrEP in addition to TDF/FTC, namely, Kenya,
5 Egyptian Patent Office, Namibia, Pakistan, South Sudan, Zambia and Zimbabwe, whilst Lesotho’s guidelines recommend
Academy of Scientific exclusively TDF/3TC.
5
Research and Technology,
Cairo, Egypt
Pre-exposure prophylaxis is a ‘game changer’ for HIV prevention. When taken consistently and
Corresponding author: correctly, it is very effective and reduces the chances of HIV infection to near-zero. Despite this,
6
Ahmed Cordie, the cost of PrEP remains an important limiting factor to its wide use, particularly in low- and
[email protected]
middle-income countries.
How to cite this article:
Mohamed R, Wanis H, Egypt has the fastest growing HIV rate in the Middle East and North Africa region, where the
Zebachi S, El-Kotamy M, epidemic is concentrated in key populations. Case load has increased annually by 25% – 35% for
Esmat G, Cordie A. COVID-19
crisis effect on HIV service the past 10 years, and yet Egypt has not adopted the WHO’s oral PrEP recommendations at this
delivery in Egypt: Hard times time. Both TDF and 3TC are locally manufactured in Egypt and are available at affordable prices
7
or blessings in disguise? S Afr because of the absence of patent protection on either of them.
J HIV Med. 2020;21(1),
a1170. https://doi.
org/10.4102/sajhivmed. The growing evidence on TDF/3TC as an effective PrEP option, availability of locally produced
v21i1.1170 generic TDF/3TC and the urgent need to control the trajectory of the HIV epidemic should all
motivate the Egyptian National AIDS Programme (NAP) to start providing PrEP services and to
recommend its use for prevention within the national guidelines. Such a step will encourage more
generic pharmaceutical companies to join the growing market, increasing competition and thus
further lowering costs.
Read online: During the COVID-19 pandemic, as a mitigation measure to patients’ movement restriction, the
Read online:
Scan this QR
Scan this QR
code with your
code with your NAP implemented multi-month dispensing (MMD) of antiretroviral therapy (ART) covering
smart phone or 2–3 months, which has had a positive impact on the adherence of PLHIV.
smart phone or
mobile device
mobile device
to read online.
to read online.
Copyright: © 2020. The Authors. Licensee: AOSIS. This work is licensed under the Creative Commons Attribution License.
http://www.sajhivmed.org.za 120 Open Access