Question
Can fewer doses make my meds last longer as my clinic is closed?
2 February 2025. Related: Access to treatment, All topics.
Hi there, I only have 30 tablets remaining and my clinic has closed.
I don’t know when I will take medicine again if the ART center is closed for 90 days and is then forever closed.
Can I take 1 tablet in 2 days or 3 days? Otherwise after 1 month, 30 tablets will end.
And what about medicine in normal pharma store I purchased privately, like Hepatitis B medicine etc?
How can I manage this problem?
Answer
Thank you for writing back and I am sorry this has been such a difficult and stressful week.
Many people are in the same situation and are also reacting to this news.
Yesterday the US waiver confirmed that PEPFAR medicines will still be provided, at least for a short time. No-one knows how long this will be for, but it should at least be for 90 days.
This is really good news as your meds should still continue – at least in the short term – see:
Trump blocks 20 million people from ART, then issues temporary waiver
It might take clinics in each country a few days to open again but this might still vary in different countries.
Although this is not in guidelines, some people might be able to slowly build up an emergency supply in case this happens again.
If your viral load is undetectable then you could miss one dose every week and still be okay. If your meds are TLD (tenofovir, lamivudine and dolutegravir) or TLE (tenofovir, lamivudine and efavirenz), you could do this every 4 days – i.e. to only take 5 doses a week.
This will slowly build up an emergency supply in case the clinic is late.
Going forwards, it would be good to ask your doctor to help you plan for what to do if treatment is ever stopped.
Even though it is not recommended, most people will continue to feel fine for months or perhaps years. This will depend on your personal history. Over this time many people will be trying to arrange alternative ways to provide your meds.
Please note that I am not a doctor and so please talk to your doctor about this. FOTO studies (Five On Two Off) give us some evidence that viral load can stay undetectable after taking only 5 doses each week.
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