Response to HIV/AIDS in Togo: Interview with Pr Vincent Palokinam Pitché, National Coordinator of SP/CNLS-IST)

---

Extract from the article: The commemoration of WDD 2024 will be centred around the theme: ‘follow the path of rights’. Togo will be commemorating the day under the banner of this global theme, which sends out a strong message about promoting human rights in order to put an en

---

« Togo is well on the way to achieving the 95-95-95 target set by UNAIDS. The country has achieved 86% treatment coverage. As the target date of 2030 approaches, Togo is making tangibleprogress, but there is still a long way to go »

The commemoration of WDD 2024 will be centred around the theme: ‘follow the path of rights’. Togo will be commemorating the day under the banner of this global theme, which sends out a strong message about promoting human rights in order to put an end to AIDS by 2030, as clearly emphasised by UNAIDS in its report ‘The Path that Ends AIDS’ 2024.On the strength of the progress made in recent years in the fight against HIV/AIDS, Togo is determined to build on its achievements.With the support of its technical and financial partners, the country has begun drawing up a roadmap to intensify its response between now and 2030.  What is the current state of the HIV response in Togo? What are the current HIV challenges? Answers in this interview with Professor Vincent Palokinam Pitché, National Coordinator of the Permanent Secretariat of the National Council for the Fight against AIDS and Sexually Transmitted Infections (SP/CNLS-IST).

Health-Education: Can HIV/AIDS be cured?

Pr Vincent Pitché: HIV/AIDS is treated.HIV and AIDS are not yet cured.Currently, 30.7 million people (out of 39.9 million) worldwide are on antiretroviral treatment.A person living with HIV who starts antiretroviral treatment today will have the same life expectancy as an HIV-negative person of the same age.Antiretroviral treatment works best when it is started very soon after HIV infection, rather than delaying it until symptoms appear.Antiretroviral treatment prevents HIV-related illness and disability and saves lives. The current protocol is simple, with a single daily tablet taken with new molecules that are increasingly effective.

What is the current state of the HIV epidemic in Togo?

There are data and trends that allow us to assess the current evolution of the HIV epidemic in Togo.We currently have a prevalence rate of 1.6%, with a significant reduction of more than 65% in the number of new infections, and a 65% reduction in the number of deaths between 2010 and 2023.

In terms of international targets, Togo has adopted the 95-95-95 strategy.This strategy is designed to ensure that by 2030, 95% of people living with HIV know their serostatus, 95% have access to antiretroviral (ARV) treatment and 95% of patients on treatment have an undetectable viral load.By the end of 2023, Togo will have reached 86% for the first 95 and 85% for the second 95 (more than 8 out of 10 PLHIV were on ARV treatment in our country).Over 90% of PLHIV on treatment had their viral load suppressed, demonstrating the effectiveness of the drugs.The treatment of TB/HIV co-infection is performing well, with more than 99% of TB patients identified as HIV-positive and put on treatment.

What is the state of play as regards women and children?

As far as prevention of mother-to-child transmission (PMTCT) of HIV is concerned, we are still not doing very well.Coverage of PMTCT services has increased, reaching over 83% both geographically and in terms of target populations (but this rate is far from the 95% target set at national level).

While the treatment coverage rate for adults is 87%, the rate for children is 68%, which shows the poor performance of treatment for children.

One of the major challenges in the fight against HIV and AIDS in Togo is the triple elimination of mother-to-child transmission of HIV, syphilis and viral hepatitis B.  To prevent the transmission of these viruses from mother to child, free early screening services are systematically offered during the first prenatal consultation, as contamination can occur from mother to child during pregnancy, childbirth and breastfeeding.The Prevention of Mother-to-Child Transmission (PMTCT) protocol is implemented when an expectant mother is found to be HIV-positive. ARV treatment drastically reduces mother-to-child transmission of the virus, provided that the treatment is adhered to by both the pregnant woman and the mother-to-be. If she follows the advice of her healthcare providers and continues to treat her child at home, the viral load is drastically reduced.We still have a high rate of people lost to follow-up after childbirth.There are bottlenecks in the follow-up of mother-child pairs from PMTCT sites.This is why health facilities are working in partnership with community players to improve the continuum of care, significantly reduce the number of people lost to follow-up and link children and their mothers to health facilities.

What strategies are in place to promote prevention, care and improved access to treatment for the most vulnerable groups, particularly young people?

We need to give young people the means to protect themselves against HIV in Togo.Everyone is aware that if we want to have an AIDS-free generation, if we want to put an end to the AIDS epidemic by 2030, there must be no new infections among young people.Hence the need to involve young people in this fight.According to some surveys, around 1/3 of young people aged between 15 and 24 have sufficient and complete knowledge of HIV prevention. That's why we need to continue raising awareness among our young people about HIV and sexually transmitted infections.Better still, we need to encourage young people to play an important role in HIV prevention through their involvement in defining the policies and interventions that concern them in practice.

The country has youth centres offering services tailored to young people. There are youth associations and networks involved in the fight against HIV. Intervention strategies are adapted to the needs of young people (messages via social networks, toll-free numbers, web radio, youth clubs, etc.).

For several years now, the ministries responsible for education have been including comprehensive sexual health, including HIV prevention, in the curricula of students and training schools. This means that young people can be made aware of the problem of sexually transmitted infections and unwanted pregnancies at a very early age.

As far as out-of-school young people are concerned, peer educators can reach most categories of young people.We are fortunate in Togo to have a civil society with very dynamic associations with good expertise in working with young people in and out of school in all regions.The CNLS is counting on this broad network of associations to have an impact on the social and geographical diversity of young people.

Can Togo achieve the 95-95-95 target set by UNAIDS for 2030?

Togo is well on the way to achieving the 95-95-95 target set by UNAIDS. The country achieved 86% treatment coverage in 2023.As the 2030 deadline approaches, Togo is making tangible progress, but there's still a long way to go. We have 7 years to get there, first and foremost for the well-being of our people.That's why we've drawn up an acceleration plan to speed up the implementation of all interventions in the areas of prevention, care and treatment, the fight against stigma and discrimination, and the mobilisation of resources. Achieving the 3x95 targets is a prerequisite for ending the AIDS epidemic as a public health threat by 2030 (sustainable development goal 3).

It is with this in mind that, with the support of our partners and the leadership of the government across all the sectors involved in this response, we are mobilising all our energies and resources in the hope of achieving the 3x95 targets in the medium term.

What are the main challenges ahead?

As you have noted, despite the progress made by Togo, our level of performance is not optimal because of a number of bottlenecks.One of the challenges is to accelerate the intensification of screening interventions so that all PLWHA in Togo know their status and are put on antiretroviral treatment, with the aim of achieving 95% coverage in the medium term.

The second challenge is the triple elimination of mother-to-child transmission.No child should be born with HIV in Togo by 2030.Transmission of HIV from mother to child is the main mode of infection for children. To break the link between mother and child, children need to be screened early at birth, and mother and child need to be linked up to healthcare structures for optimal follow-up.

The problems of stigmatisation and discrimination still remain a challenge. HIV-related stigma and discrimination have a negative impact on access to prevention and care services for those affected.Most acts of stigmatisation are linked to ignorance of ways of avoiding contamination.

Are the financing opportunities to achieve these results real?

Yes, in the medium term up to 2026.In addition to the government budget, Togo receives funding from international partners such as the Global Fund to Fight AIDS, Tuberculosis and Malaria and the US President's Emergency Plan for AIDS Relief (PEPFAR).  But funding is still inadequate, as the budgets for interventions increase every year, with a major emphasis on financing medical inputs.  This is because HIV infection has become a chronic condition requiring ongoing, long-term care.Not only do we need to guarantee continuity of treatment (no shortage of drugs) for all former patients, but we also need to ensure that new cases that test positive have access to drugs.The same applies to offering viral load tests to all patients undergoing treatment, to ensure that they are effective.

In the long term, resources need to be mobilised to ensure that interventions and services are sustainable.Universal health insurance is one way of funding healthcare programmes in our country.

I would like to thank your newspaper for its work in raising public awareness of the health issues facing our country.

Interview by Abel OZIH