26 March 2013

Gauteng ready for single ARV roll-out

The Gauteng health department is ready for the roll-out of the new fixed dose combination (FDC) of antiretrovirals from April 1 this year, MEC Hope Papo said.


The Gauteng health department is ready for the rollout of the new fixed dose combination (FDC) of antiretrovirals from April 1 this year, MEC Hope Papo said on Tuesday.

"Patients will benefit more from FDCs because they simplify treatment, cutting down the number of tablets that a person has to take daily," Papo said.

"They also allow patients to take their medication more discreetly if that is what they prefer to do. With one-pill-a-day FDCs, adhering to your antiretroviral therapy is as simple as taking any other tablet."

Benefits of the new pills

Health Minister Aaron Motsoaledi announced the switch from the three-tablet-a-day regimen in December, saying that besides the convenience of taking fewer tablets a day, it would also cost the government less, and reduce the amount of space required for storage.

The one-pill-a-day FDC contains three different ARV medications --emtricitabine, efavirenz and tenofovir -- and is intended to replace three tablets.

"It is easy to take, highly effective and in no way inferior to taking three individual drugs," said Papo.

He explained that initially the supply of the multiple antiretroviral FDC might be insufficient to provide for all FDC-suitable patients, so patients had been prioritised for the initiation and switch.

First to receive the FDC will be new patients, adults, adolescents and pregnant women who are eligible to start antiretroviral treatment.

The second priority will be all pregnant women needing triple therapy, as well as breastfeeding mothers currently stable on an FDC compatible regimen. The third priority will be those who are virally suppressed currently on first line regimen requiring a switch due to toxicity of, for example, stavudine.

The other priority groups include:

  • people currently stable on an FDC compatible regimen with tuberculosis infection;
  • patients currently stable on an FDC compatible regimen with other illnesses such as hypertension, diabetes mellitus, etc;
  • patients currently stable on a Tenofovir Disoproxil Formulate (TDF)-based regimen and who request a switch to a FDC; and;
  • patients currently stable on a TDF-based regimen who, after counselling, agree to a switch to a FDC.

Most patients initiated on the FDC are not expected to encounter problems, but if they experience any significant side effects, they are urged to consult their healthcare provider.

Although the FDC is a larger tablet, it is not significantly larger than the usual tablets so swallowing should not create problems. There is no liquid FDC formulation currently on the market and crushing or dissolving the FDC undermines bio-equivalence and should be avoided.

Papo said all pharmacists and health care workers had been trained on the fixed dose combination and were able to counsel on the important information they would need.

"We have emphasised the need to counsel all patients, especially the stable ones, who are not included in the priority groups for the FDC so that they understand why they are not being switched to an easier option," said Papo. National health department spokesman Joe Maila said stock deliveries to all provinces were going well and all supplies were expected to be in place by April 1.


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Dr Sindisiwe van Zyl qualified at the University of Pretoria in 2005. She is a patients' rights activist and loves using social media to teach about HIV. She is in private practice in Johannesburg.

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