One-step pill pop

Dr Kay Mahomed's office is full. Nine women, some sitting, some standing, are quietly waiting to answer my questions. All of them are HIV-positive, and two only recently received their test results.

These new patients will be prescribed one antiretroviral pill a day, as opposed to three, following the government's roll-out of a new medication last Monday.

The pill, described by Health Minister Aaron Motsoaledi as a "fixed-dose combination", consists of the same three drugs previously doled out in separate tablets.

"The patients are living in a good time," says Mahomed, who works for Right to Care, an NGO that provides clinical services at Helen Joseph Hospital in Johannesburg and other clinics around the country for those who have HIV.

"Now it's one tablet every day for the rest of your life," she says.

Roll-out of the pill will be relatively slow, however, to ensure the government does not run out of stock. New patients will receive the combination tablet first. Of the 1.7 million South Africans already on ARV treatment, a fraction will receive the new pill. Pregnant and breastfeeding patients will be prioritised. Men and women who have tuberculosis, or other illnesses, will also be prioritised.

Yolanda Veli*, 30, was diagnosed with HIV in April 2008. She was prescribed a five-pills-a-day regimen until she started experiencing side effects. "My boobs were getting huge, but my hips were disappearing," she says. Her doctor changed the prescription to three pills, and Veli took these for the next five years.

Today, Veli is hoping to be prescribed only one tablet. "No one will ask why you are taking so many pills. One pill. Pop." Because of its convenience, and the ease with which it can be hidden, the new pill is bound to increase patients' adherence to treatment.

Lindiwe Seitei, 45, is a new patient who will be prescribed the combination pill. Though doctors urged her to go on medication last year, she did not feel ready to start treatment until this month. As a result, she is fortunate enough to qualify as a new patient.

"I was praying all the time that there would only be one pill to take, not those three," she says. "I am going to take it every day."

The fixed dose combination has fewer side effects and also helps patients feel thatscientists are closer to finding a cure for HIV.

"It goes to show there is a light. Something has been done," says Veli, wringing her hands. "That's what you want to believe, that eventually there will be a cure."

Though the pill burden is smaller for patients taking the combined dose, it is also less cumbersome psychologically. A patient who describes herself as very religious says she is often embarrassed to take her medication at church duty, which she attends with her friends. "They hear the pills in my bag. It exposes me, and I don't want people to know," she says. "With one pill, I will be 100% free."

Mahomed agrees, commending the government for introducing the new combination pill to the public sector. The health department has only recently negotiated a deal with pharmaceutical companies, at a cost of R89 for a month's worth of pills. A spin-off of having a low-cost pill is that the government can spend its R8.1-billion budget on more patients.

Mahomed says South Africans shouldn't "let bureaucracy hold us down. We should allow everyone to have the one tablet".

She says hospitals will now have more storage space for medication, and patients will no longer have to suffer the consequences if one of their three pills is out of stock.

"I read a sign somewhere that said 'a tablet a day keeps HIV at bay'," says Mahomed. "I thought: 'Wow. That is exactly what it is.'"

* Name has been changed