Kenyans could, before the end of this year, have access to a drug that protects them from HIV infection in what is being seen as a major breakthrough in the fight against the disease.
About 1,000 commercial sex workers are already using the newly-approved HIV/Aids combination therapy drug Truvada (emtricitabine and tenofovir), ahead of its rollout scheduled for later this year.
Known as pre-exposure prophylaxis (PrEP) and used as an antiretroviral drug, Truvada works by inhibiting the key enzyme, reverse transcriptase, which the HIV virus needs to infect host cells, effectively blocking infection.
Pre-exposure prophylaxis means the drug is taken before exposure to risk of infection. Once taken, the drug is effective for eight hours.
Kenya approved the drug last year, becoming the second country in Africa, after South Africa, to allow its use.
Following the approval, three organisations are conducting demonstration trials on the drug for one year in Nairobi, Kisumu and Homa Bay. The Sex Worker Outreach Programme (SWOP) provides male and female sex workers with daily doses of Truvada in Nairobi and Kisumu; Liverpool VCT Care and Treatment (LVCT) is conducting its demonstration trials in Nairobi, Kisumu and Homa Bay, and the US Centres for Disease Control is conducting trials in Homa Bay.
The Kenya National Aids and STIs Control Programme (NASCOP) is working with the three organisations to conduct a one year demonstration trials on PrEP to determine if the drug Truvada is as effective as the initial trials indicated and if it can be rolled out into the market.
'Combine with safe sex practices'
Last year, the Kenya Pharmacy and Poisons Board approved the use of Truvada as PrEP in combination with safe sex practices to help reduce the risk of sexually acquired HIV infection.
"This means that the drug can now be used as both a preventive and treatment drug for HIV," said Kipkerich Koskei, the chief pharmacist and registrar at the board.
"PrEP is safe and works to prevent HIV infection, but only if taken effectively as directed by the health service provider," said Wanjiru Mukoma, executive director of Kenya's LVCT. "The public needs to get as much information as possible prior to using the drug. Those taking the drug need to be HIV-negative," she added.
MUKOMA: Approval of Truvada a game changer in anti-HIV/Aids effort
According to Jordan Kyombo, the LVCT research manager, the sex workers undergo medical screening before they are enrolled in the demonstration trials. They are then given pills to last them a month.
"The pills are packed in a white can with a memory cap -- Mem's Cap -- to remind the sex worker to take the drug," said Mr Kyombo.
After a month, those on the drug undergo further screening to check the drug levels in their blood and confirm if they contracted HIV while on the drug. "Once the trials are complete, research will be conducted to look into the concerns being raised by the sex workers, including the side effects, infrastructure issues, and the cost of rolling out PrEP across the country," he added.
Mr Kyombo said it is recommended that the drug be used in conjunction with other safe sex practices, like condoms.
"Many sex workers use PrEP as an emergency drug after indulging in unprotected sex, and this is not the best way to go about it," he said. "It would be better for them to take a type of antiretroviral designed to be taken before exposure to HIV."
"The government is looking for partnerships to effectively roll out the PrEP programme. The Melinda Gates Foundation has already pledged to fund the programme on large scale, and we are hopeful that more partners will come in," said Dr Nelly Mugo, the principal research scientist at the Kenya Medical Research Institute and the principal researcher on the PrEP efficacy trials conducted in Kenya.
Currently, the drug is only available for use on prescription. "If a non-infected person takes PrEP, then the virus is killed if it enters their body. This means it doesn't have a chance to hide in reservoirs, and so it is harder for that person to become infected, said Dr Mugo. However PrEP is only for specific populations at high risk of infection like young women, sero-discordant couples and sex workers.
Mombo Ngua and Mary Wanjiku, both sex workers in Nairobi, are using the drug.
Mr Ngua, a gay sex worker, says he started using PrEP last October and it has worked well. "Since I started using the pill, there are times I have had sex without protection and I test negative for HIV. This has helped me, especially when I get clients who do not want to use a condom," said Mr Ngua.
"PrEP is a good idea for people like us who have multiple partners, because some will accept condoms and others will not," he added.
However, he said, the drug makes him drowsy. "Now I have switched to taking the drug at 2pm so that I can sleep before going out. I also feel bloated after taking the pill," he said.
Under the Liverpool demonstration programme, two men in Nairobi are using PrEP.
Mr Ngua said his colleague complained that the pill has broadened his shoulders. "If these challenges are addressed, we will have no problem using it daily," he said.
Ms Wanjiku says she has been taking the PrEP pill since January. Although the pill is working well for her, she is concerned about its blue colour.
"I carry my PrEP pill in my bag, and when I am going into the club at night and my bag is searched, the bouncers stop me at the entrance because they immediately conclude that I am HIV-positive and fear that I will infect their clients," she said, adding that her children too get concerned when they see the pills.
"The colour should be white instead of blue. The pills should also be put in something small like a key ring to avoid them being noticed by everyone."
Caroline Njoroge, another sex worker in Nairobi and an advocate the use of PrEP under the Kenya Sex Workers Alliance, encourages her colleagues to use the drug daily even though they experience challenges.
"This is a new drug, and like any other such drug some people will experience side effects. Some say that after seven days of consistent use the side effects disappear," said Ms Njoroge.