Tuesday, March 21, 2017

Government can cheaply full fill girls pads pledge

By Esther Nakkazi

When he was campaigning for re-election of Uganda’s top job in 2015, candidate Yoweri Museveni promised free sanitary pads for all school girls under the Universal Primary and Secondary Education (UPE/USE) programs that were started by his party, the National Resistance Movement (NRM).

It was an election pledge he made while on his forth leg of the campaign trail in northern Uganda. “Girls should not have to run away from school because they are embarrassed. We will get them what to use,” said Museveni.

He was re-elected in 2016 and he named his wife Janet Kataaha Museveni on the new cabinet as the minister of education and sports who in her capacity is supposed to make this happen.

But now a year later, Mrs. Museveni stunned the nation while speaking to the parliament education committee when she honestly said there are no funds to provide free sanitary pads.

I think the incident would have largely passed as any parliament news item until Dr. Stella Nyanzi  put out a provocative post that rocketed around the internet.

Nyanzi said her own mother provided her with ‘Lilia’ pads to protect her dignity and hygiene meanwhile of Mrs. Museveni who asked parliamentarians to understand that there is no funding, she   dismissed as ‘no mother to the nation’.

“I should visit her without protection during my next menstruation period, sit in her spotless sofas and arise after staining her soul with my menstrual blood! That will be my peaceful demonstration in solidarity with Uganda’s poor adolescent girls,” Stella wrote.

Her demonstration continued with setting up a ‘gofundme’ and an online campaign for free pads. In the schools were she has been girls received free pads while singing and dancing to Stella’s self composed ‘pad lyrics’ which goes like “I have a pad.… I put it here.. I pepeya.”

The Ministry of education has since put out a circular not to allow Nyanzi and activists into government aided schools. Private schools are also monitored.

In my opinion, Nyanzi has given menstrual hygiene visibility. Many people may not like her choice of words but at least the message was sent home and hopefully government will full-fill its pledge.

It is true that candidates may make promises to the public to win over votes but in his case, Museveni was an incumbent and knew that forking out Ush16bn annually to provide free pads was unsustainable but a promise is a promise so let him manoeuvre.

Well, menstrual hygiene management was our topic of discussion at the 18th science café organised by the Health Journalists Network in Uganda (HEJNU) in partnership with Reach A Hand and supported by UNFPA Uganda.

In our discussion at the café we talked about the need to emphasise hygiene while talking about menstruation. I like what Nyanzi wrote; “My mother provided pads in order to protect my dignity and hygiene. I excelled at school although I was a menstruating girl.”

To emphasise it further, Dr Edson Muhwezi, the country Assistant Representative UNFPA said it should not only be the aspect of the pad but also the soap, availability of water and education.

A typical girl without access to modern pads lives in a rural setting, sleeps on the floor, for her it is a taboo to talk about pads in public, she uses a cloth which she washes and cannot even dry in direct sunlight. So it dries but not thoroughly and thus has moulds which cause candida and itching. That is unhygienic.

She is also afraid to go to school and will be absent. Studies have shown that early pregnancy and menstrual hygiene are leading causes of school dropout for girls. A study conducted by IRC and SNV in 2012 estimated that close to 4 million Ugandan girls live without proper sanitary care. As a result, 1 out of 10 girls skips school or drops out entirely due to a lack of menstrual hygiene.

Godfrey Walakira from the youth organisation, Straight Talk Foundation told journalists at the café that it was important to make boys and fathers part of the menstrual hygiene conversation. For isn’t it boys who tease the girls and also make it impossible for them to go to school? While fathers buy pads for their daughters.

Another idea Walakira proposed was to include pads as a mandatory on school items for all girls. After all they ask for all sorts of things; cement, brooms, razor blades, beds, basins.. This should be in the short term as Museveni manoeuvres to fullfill his pledge.

When girls have sanitary wear they are empowered psychologically and they gain self confidence said Sophia Grinvalds, the Founder and Director, AFRIpads (U) Ltd.

They also create equal opportunities for the girls. Let us do the maths. A school term has three months, for each month a girl experiences menstruation for one week. Without pads the girl will miss school for 3 weeks in a term totalling a month of the school term. How then do you expect her to compete with boys?

Even if the government does not offer expensive pads there are cheap alternatives like the Ugandan-made Makapads and AFRIpads which are also reusable and their deluxe kit of 4 pads which costs Ushs 16,000 can be used for a year and the test kit of two pads costs 6,500.

The Afripads are thus durable, cost effective, logistically easy to distribute, ultra absorbent and made of fabric so no burning or itching effect, eco-friendly since they do not require regular disposal and a perfect solution for menstrual hygiene, explained Grinvalds. Many girls are using these in refugee settlements.

So since there are cheaper alternatives which are sustainable surely government can full fill its pledge. It is a good gesture that translates to democracy too. Dr. Muhwezi said non profits shall continue to do their part because at the moment UNFPA has partnered with AFRIpads and Straight Talk Foundation to distribute free pads but it is a concerted effort.

With government as a player in menstrual hygiene, better, broader and faster outcomes for the girl child will be realised. Menstrual hygiene management will be a priority and institutionalised in Uganda. That is not so difficult come on!

Thursday, March 9, 2017

African Media Can Move Beyond Risk in Biotech Reporting

By Esther Nakkazi

An image of an injection into a juicy tomato 'tomato syringe' or a huge cabbage with an elephant body are the most common illustrations used by the media on biotechnology stories.

Its dramatic, catchy, appealing and all about ‘hey-stop-pay-attention’ but can also be the opposite.

So the cabbage can have an elephant gene, yes it can because basically biotechnology involves movement of genes of interest.

These illustrations depicting biotechnology were first published in 2000 and have persisted much to the frustration of scientists, science communicators and not-for-profit organisations like ISAAA or the International Service for the Acquisition of Agri-Biotech Application which continuously tracks such stories and images.

“It gives the impression that scientists are injecting things into crops which creates fear, anxiety, outage and mistrust,” said Dr. Margaret Karembu an environmental scientists from ISAAA who said they have even written to the media houses that continue to use these illustrations to no avail.

She was speaking to media practitioners at a COMESA/ACTESA communication training on biotechnology and biosafety held in Addis Ababa, Ethiopia from 7th to 9th March 2017.

I can best describe it as the media wanting to keep biotech dramatic pictures, illustrations and stories while scientists want facts only. The India suicide story of BT cotton still continues to make rounds alarming people in African and not much is done to explain that these happened due to borrowers failing to pay their debts and it was thoroughly investigated.

The groups on either side of the debate are not very helpful as each feed exaggerated messages to the media that is not well trained. But Dr. Karembu maintains that even those pulling these technologies downward or disagree should argue from an informed point of view.

For the African media, of course minus South Africa, which is ahead of the pack in biotechnology, this reporting might be inevitable. After all, uptake of the technology is at snail-speed. The media can only move in tandem with upcoming laws and research as well skeptics seem to override the contest with the limited public knowledge.

But Dr. Karembu is still unhappy that the African media still depicts biotech as a foreign technology, that those illustrations show monsters trying to dump things in Africa yet more and more African scientists have been trained on biotechnology.

With this pool of trained African scientists, however, a few try to preach the biotech gospel some get disappointed after spending long hours with reporters only to get foot notes in controversial stories.

Biotech stories have to compete and if not relegated to science pages or publications are used as fillers in daily media. Writing them as ‘she-said-he-said’ without much analysis and investigation does not make them popular either.

ISAAA has noted that the African media continues to hype the risk factor alarming publics and not explaining the technology enough. I must say going beyond portraying biotech as a myth, mystery, superstition will take a while for the African media just as interchanging the terms GMOs and biotechnology continues.

Dr. Getachew Belay a plant breeder from COMESA/ACTESA says the word ‘hazard’ makes him uncomfortable in African biotech stories but how risk is overplayed and perpetually communicated remains bizarre to him. All technologies have risks and benefits - the balancing of the two sides alludes the media.

Biotechnology may be used in various industries including pharmaceuticals, but it is particularly controversial in agriculture because it is what we eat. That not withstanding it is a highly regulated technology with rigorous safety assessment.

It does not help that biotech terminologies have no local language translations yet community radios keep mushrooming everywhere in Africa and the farmers tune. But ISAAA has scientists who have been trying to define and find local dialect meaning for biotech terms.

But this it is not as fast as how science is developing and whose work is it anyway? “ You need a strategic approach,” said Dr. Karembu who links these stories to the African victim mentality, which delays grabbing of opportunity and fails to separate politics from technical issues.

“Encourage more of dialogue than debate. Shed off that mentality so you are not victims of the technology,” she said but it easier said than done and especially with writing biotech.

Nixon Ngang’a a science editor at Citizen Television and biotech media trainer said he would still use the illustrations to catch the attention of a six year old and his grandmother. Isn’t that what communication is all about anyway - visual attraction.

But he is quick to defend using these images. ‘It is not malicious. We want to catch attention of the audience,” he said.

I must also say that the narrative is changing albeit gradually. The African media has come a long way in reporting biotech. It is improving as some journalists exclusively becoming science journalists like me but the biotech trainings remain are far in between and some scientists remain media shy.

But we shall get there as the pool of more African journalists and trained on biotech and better pictures and illustrations are made available.

Thursday, February 23, 2017

From Village to Community Health Workers Uganda hopes to achieve health SDGs

By Esther Nakkazi

Uganda had an outbreak of Ebola Hemorrhagic Fever in 2000, there were deaths but it was also largely contained. At the time the Director General at the Ministry of Health was Prof Francis Omaswa.

Using this example at the first international symposium on community health workers ongoing in Kampala, Omaswa said what helped to not turn the outbreak into a catastrophic event like what happened in west Africa was among others village health workers.

Communities listened to village health workers who helped to disseminate information but the most important ingredient here was trust.

For 16 years now, Uganda has engaged Village Health Teams (VHTs) but it will this financial year 2016/ ending June 2017 switch to Community Health Extension Workers or the CHEW strategy.

The symposium is convened by Makerere University College of Health Sciences, School of Public Health, Uganda in partnership with Nottingham Trent University, UK and Ministry of Health, Uganda. Dr. David Musoke is the symposium chair and its theme is community health workers and  their contribution towards Sustainable Development Goals (SDGs).

Switch from VHT to CHEW strategy;

There is no doubt as to the positive contribution towards promotion of health, community mobilisation and helping to contain disease outbreaks made by VHTs in Uganda. But 16 years after their existence, 75% of the disease burden in Uganda, which is preventable persists and the top 10 killers are still the same.

So could it be that the VHTs strategy is wrong, was it a 'cut and paste' or it just needs an overhaul? Well, the government is now moving to the CHEW strategy. This does not mean that VHTs will disappear, no they won’t.

VHTs will remain with their role of community mobilisation and some will be absorbed into the CHEW system said Dr. Christopher Oleke at the health workers symposium.

Currently, Uganda has 180,000 VHTs working as volunteers but only 60,000 have been trained. With lack of monitoring, supervision and accountability these have been engaged in an unharmonised and uncoordinated structure.

One of the challenges with VHTs has been the supporting partners who have been messy as each trains their own VHT. Imagine this scenario; in one parish a partner trains a VHT to distribute bednets and check for malaria, another one is trained to preach nutritious feeding, one looks out for pregnancy problems, another is trained to encourage delivery in health centres etc.

So the interventions are not bad and by the way they have produced some visible results as in the case of Kanungu district in south Western Uganda where they have improved maternal and new born health outcomes but the governance and lack of leadership among supporting partners has created chaos rather than progress.

You cannot blame partners entirely, the voluntary role can carry only so much responsibilities. But some VHTs are working 7 days a week for long hours and are untrained.

So Uganda wants to fix it. The CHEW strategy will engage only 15,000 health workers. They have to be between 18-35 years and with a minimum education to qualify. They will be paid a salary by the government and get regular training. Their roles will be defined among them conducting baseline and other important surveys.

As Prof Francis Omaswa put it, ‘they should not be the big doctors in the villages’, anymore so they will be monitored, supervised and supported through a proper governance structure. “They should not be left in isolation,” he cautioned.

But most importantly, the CHEWs will 'reorient' the minds of Ugandans towards healthy living. How? According to Dr. Oleke many Ugandans think that having medicines in health facilities and doctors equals to good health.

The CHEWs will focus on the household as a totality promoting good hygiene, standard health practices like immunisation and most of all promote the use of less alcohol which is causing Ugandans numerous health issues said Dr. Oleke.

They will also play an important role of registering all pregnant women and new borns electronically who will be followed through the system - that way Uganda hopes to improve the mother and new- born well being.

The CHEW strategy will have a strong monitoring, supervisory, accountability and will be under a harmonised structure said Dr. Oleke.

Innovative financing for health workers;

But there are cautionary voices and suggestions before the roll out begins this financial year. Dr. Elizabeth Ekirapa from the School of Public Health warned this should not create a parallel administrative structure instead they should be integrated within the national health care system.

Ekirapa also said the CHEW strategy should be sustainable and be home grown or customised to Uganda. It copies a lot from Ghana and Ethiopia CHEWs.

Dr. Patrick Kadama from ACHEST was concerned about the financing structure, which if not well thought out might distort equity. It comes amidst Uganda trying to create a national social health care insurance scheme and other tax based systems.

Dr. Kadama also thinks the CHEW strategy implementers should ensure good returns on the investment thus a specific investment case should be done before roll out. They should also ensure that the CHEWs boost primary health care.

Concurring with everyone else he said the CHEWs should work in tandem and in sync within a defined national health care system - read - ‘not in isolation’ and the roll out should be gradual. Talk about the best of the best but let us wait for implementation. 


Tuesday, February 21, 2017

Who should try accused health workers?

By Esther Nakkazi

Ugandan health workers are fighting back. As cases of what the public view as health workers negligence build up, most of them end up detained in police cells and tried by public courts.

Today the Executive Director for African Centre for Global Health and Social Transformation (ACHEST) Prof. Francis Omaswa said enough of the police officers interference and trials in public courts for Uganda health workers.

“It is wrong to arrest health workers and detain them at police stations,” Omaswa said to which we got a loud applause at the first International symposium on community health workers held in Kampala, Uganda.

The theme is contribution of community health workers in attainment of the Sustainable Development Goals (SDGs) convened by Makerere University College of Health Sciences, School of Public Health, Uganda in partnership with Nottingham Trent University, UK and Ministry of Health, Uganda.

He said doctors and nurses who commit offences should be tried by their respective professional governing bodies.

In this case the Uganda Medical and Dental Practitioners Council (UMDPC) responsible for licensing, monitoring and regulating the practice of medicine and dentistry for doctors and the Uganda Nurses and Midwives Council (UNMC).

Omaswa has a point after all armed forces accused of offences are court-martialled. Justice is dispensed by their own.

The reasoning could be that people who have no knowledge of the challenges and proceedings in an operation theatre have no business questioning and detaining an accused doctor whose patient has died on the table.

These cases now have a trend in Uganda. Usually, a patient whose case will be viewed as ‘non fatal’ by the concerned parties, such as a pregnancy will report to a health facility. The health workers will demand a fee, a pricey drug not available at the facility or even tell the patients to wait for a senior doctor.

Time is of the essence here. While demands are being made, the patient needs attention and by the time whatever is demanded is availed and the patient is taken to theatre or given treatment, it is the apex of an emergency. A life or two are lost.

With the health system clearly lacking some health workers find themselves in a tight corner inspite of every effort they put in to save lives. So the larger thinking would be to blame the system.

“The best way to manage a system is not to blame an individual,” said Omaswa. Quoting the law, Omaswa who is celebrated as the most efficient Director General at Uganda's Ministry of Health and is remembered for the phrase 'health is made at home and repaired in hospitals' said the Ministry should be led by a technical person and it should not have both a director general and a permanent secretary because it duplicates roles and wastes resources.

While Prof. Omaswa clearly makes a valid point, the larger public has no knowledge of the authorities in charge of accused health workers nor the governing bodies, UMDPC and UNMC, so their immediate action is to go to police.

It also does not help if in some cases the health workers put money ahead of saving lives to which they swear the hippocratic oath. To show that justice is attainable, the health workers governing bodies need to create awareness and show that they can indeed punish those found guilty.

There is a proverb in Uganda which says a person does not just die. The translation is that there is always someone to be blamed for a death.

The public will never understand the system nor medicine but if they for sure suspect that a life could have been saved their only option will be to turn to police for justice!

Tuesday, February 14, 2017

Abortions decline in Uganda; it could cut maternal deaths

By Esther Nakkazi

Uganda is gaining positive results in saving the mother with a decline in the rate of abortions a new  study by U.S based Guttmacher Institute and Makerere University indicates.

Over a decade, the number of women aged 15–49 years who carried out abortions in Uganda declined to 39 abortions per 1,000 women in 2013 from 51 in 2003. This in tandem reduced the annual hospitalisation rate for complications in the same age group to 12 per 1,000 women from 15 over the same period.

Naturally, less abortions would translate to less maternal deaths in Uganda, which are caused by four major preventable factors; unsafe abortions, haemorrhage, hypertension and sepsis.

According to a press release from the Institute, the study also found that 93,300 women were treated across the country for complications from unsafe procedures. Abortion is illegal in Uganda but the law allows it to save a woman’s life.

The 2012 National Policy Guidelines and Service Standards for Sexual and Reproductive Health and Rights permit abortion under additional circumstances—including in cases of fetal anomaly, rape and incest, or if the woman is HIV positive—in practice, legal abortion is both difficult to obtain and to provide.

The country’s abortion laws and policies are inconsistently interpreted by law enforcement officials and the judicial system, and many providers and women remain unaware of the circumstances under which abortion is legal. As a result, most abortions in Uganda are clandestine procedures, which are often unsafe.

“Close to one third of Ugandan women who have abortions each year are treated in health facilities for complications resulting from unsafe procedures, and many other women who experience complications do not get the care they need,” says Elena Prada, consultant with the Guttmacher Institute and the study’s lead author.

“Notwithstanding the Ugandan government’s efforts to improve postabortion care services, stigma and fear of mistreatment are significant barriers for many women in need of these services.”

Over 50% Ugandan women still have unintended pregnancies:

The study also produced new pregnancy estimates, finding that 52% of all pregnancies in Uganda in 2013 were unintended and about a quarter of these unintended pregnancies nationally ended in abortion.

Given that most abortions result from unintended pregnancies, improving family planning services is critical to reducing the incidence of unsafe abortion.

The high proportion of unintended pregnancies reflects the finding that among women of reproductive age, 38% of married women and 45% of unmarried sexually active women had an unmet need for modern contraception in 2011.

“Despite some gains in modern contraceptive use over the past decade, unmet need for contraception in Uganda remains high and must be addressed by improved family planning services,” says Professor Christopher Garimoi Orach, head of the department of community health at Makerere University’s School of Public Health and a study coauthor.

“For example, integrating comprehensive contraceptive counseling into all postabortion care visits can be a powerful intervention to help women avoid future unintended pregnancies.”

The study’s authors recommend efforts to expand existing postabortion care services to ensure that all women with abortion complications are able to get the care they need, particularly in rural areas.

In particular, contraceptive counseling should be strengthened to address high rates of method discontinuation and women’s concerns about side effects. The authors emphasize that counseling must acknowledge the challenges women experience and provide accurate information on the side effects of different methods.

Further, they recommend that family planning services provide a full range of modern contraceptive methods, including long-acting reversible methods such as IUDs and implants, so women can choose whichever method works best for them.

Finally, the researchers suggest clarifying and raising awareness of existing laws and policies on abortion in Uganda among the medical community, the judicial system and women.

Every woman who meets the criteria for a legal abortion should be able to obtain a safe procedure at an affordable cost from a trained health care provider.

Wednesday, January 11, 2017

Zika re-enters Africa as encroachers take over its forest habitat in Uganda

By Esther Nakkazi

The Zika virus has re-surfaced in Africa through Angola. As we all know, Zika was first discovered in Uganda in 1947.

Unfortunately, as it resurfaces in Africa, the Zika forest where it was first identified in Africa is just a few decimals, most of it destroyed by encroachers who feel high rise buildings are much more important than a habitat for mosquitoes species and wildlife.

According to Angolan health officials the country's first two cases of the Zika virus, a French tourist and a resident in the capital Luanda, says AFP.

Since 2015, when the outbreak started more than 1.5 million people have been infected with Zika, mainly in Brazil, and more than 1,600 babies have been born with microcephaly, according to the World Health Organisation.

But in Uganda, the Zika virus, which takes its name from ‘Ziika' - the name has always been misspelt - a forest on the shores of one of Africa’s biggest fresh water lakes, Lake Victoria, where researchers caught the mosquito, isolated the disease and have since kept surveillance, the forest is almost gone.

We can say the researchers at the Uganda Virus Research Institute (UVRI) did a good job and continue to do so. They continue to do research, experiments and monitor the mosquito species in the Zika forest and the whole country.

Continuous monitoring and surveillance means Uganda, which is a biodiversity hotspot with some of the world's most virulent pathogenesis on top of its game of controlling diseases.  

Only to be let down by environmentalists who are oblivious of its importance and thus do not advocate for its conservation and the Wakiso land board who continue to sell part of the zika forest land to big shots with no care at all.

UVRI as a research entity was given a piece of the forest (30 acres) for research but from it 10 acres has been allocated to ‘developers’ by the Wakiso Land board, which of course is under the larger Uganda Ministry of Lands, Housing and Urban development.

The researchers efforts to keep the land for its rightful use has fallen on deaf ears.

Recently, Madame Stephanie Rivoal, the French Ambassador to Uganda visited the Ziika forest and almost cried. She thought Ugandans have not heard of the term ‘conservation’ as she saw hundreds of cut trees, numerous construction sites and encroachers.

By the end of her walk thorough the forest reserve accompanied by Erik Orsenna, -also the ambassador of the Pasteur Research Institute in France-a politician, novelist and Nobel Peace Prize contender their energy and enthusiasm was deflated by the depletion.

The Zika forest still houses wildlife especially monkeys and a number of mosquito species like the Aedes Aegypti and Africanus in the forest.

Dr. Julius Lutwama, who heads emerging and re-emerging infections at UVRI warned that if this wildlife habitat is destroyed the mosquitoes could also have capacity to mutate and adapt. What would we expect anyway if there usual prey is eliminated?

Friday, December 30, 2016

Injectable anti-HIV drugs could be available in 2017

By Esther Nakkazi

Science is moving HIV treatment and prevention forward from oral to injections. Instead of taking a daily pill for anti retroviral therapy it will switch to an injection lasting three months at most.

Scientists believe, especially women, who are also the most affected by HIV will easily adapt to the use of these long lasting injectables because of their familiarity with injections through contraception.

Almost one in four new HIV infections in sub-Saharan Africa are in young people aged 15-24 years, and two thirds of these are among girls who are also users of contraceptives and injectables are favourites.

“When you think about young women in particular being very adapted to getting injections for contraception this could be a very nice natural next step,” said Jeanne Marrazzo, the director of University of Alabama at Birmingham school of Medicine Division of Infectious Diseases.

Scientists also believe the injectables will reduce stigma and daily adherence, which are still a challenge to people taking anti-HIV drugs daily and they will also give users a choice.

“Young people sometimes forget to take the pill so if we give them formulations where they do not have to worry it will probably work better,” Thomas Hope, a Professor of Cell and Molecular Biology at the NorthWestern University, Evanston at the biennial HIV Research For Prevention conference (HIVR4P 2016) held 17-21 October in Chicago, USA.

The injectables under development will be used for therapy and for Post Exposure Prophylaxis (PrEP). Two different drugs, Rilpivirine by Janssen Pharmaceutical Companies of Johnson & Johnson and Cabotegravir by ViiV Healthcare, a global specialist HIV company with GSK, Pfizer Inc. and Shionogi Limited as shareholders are collaborating.

For treatment two injections of Cabotegravir and Rilpivirine will be given in the butt at the same time. While for PrEP, only one injection of Cabotegravir - a new drug to users - will be administered.

“The treatment work is well advanced but prevention is still early,” said Joe Romano, President of NWJ Group, LLC.

Although treatment may be an easy sell to users it will be a challenge for PrEP which communities are less aware about.

“PrEP is more like a contraceptive. It is a product you give to healthy people. Overall, individuals are aware of pregnancy risk all the time and less about HIV risk, which comes on and off,” said Nelly R. Mugo, a gynaecologist and a principal research scientist at the Kenya Medical Research Institute (KEMRI).

But although injections for ARVs may be acceptable there are many technical issues yet to be addressed. Men are still naive in this field and most importantly how long can someone go between the injections, explained Romano.

Scientists are looking at injectables with drugs 3-4 millilitres and for it to last for 1-3 months.

“Men have no experience. Healthy men typically do not get an injection normally every three months,” said Romano.

Then variations in the human body around metabolism, drug absorption are also key as well as being cautious that when an injection goes in it cannot come out!

However, the most pressing issue for injectables for ARVs is the so called ‘tail’, which basically means if the drug is injected in an individual at what point does its concentration go down so that they are not at risk before the next dose. If the drug levels are down what happens if infections with a bit of drug in the background?

“I think 3 months is good but if it starts to get less than that and you have to go every month to the clinic that is still a hustle,” said Lynn Morris the head of the HIV Virology laboratories at the National Institute for Communicable Diseases (NICD) in South Africa.