ARV shortage sets in as Aids funding falls

Unanticipated shortfalls in funding have forced some health-service providers to stop enrolling new HIV patients on life-prolonging drugs, while others are signing up only those “critically ill” rather than all who qualify for the therapy in accordance with global medical standards.

The EastAfrican has learnt that some of the lead providers like the Joint Clinical Research Centre have stopped initiating new patients on anti-retroviral drugs completely, while a civil society network for people living with HIV said that Mildmay Uganda is only enrolling patients whose CD4 cell counts have dropped to 150/mm3 against the recommended 250/mm3 cell count stipulated in World Health Organisation guidelines for administering the therapy.

The management of Mildmay Uganda declined to comment on the issue of signing up only patients with very low cell counts — which lead to drastically weakened natural immunity.

While patients are now sharing the available drugs to a certain degree of sustainability, there is an increased risk of people dying from the disease because they cannot access drugs at all, or do so too late.

Already, the government is investigating 17 recent deaths of HIV-positive patients in Apac district that have been linked to shortage of anti-retroviral drugs.

“Investigations are still going on. I am waiting for the report to confirm if it was a result of lack of anti-retroviral drugs,” said Dr Zainab Akol, head of HIV programmes at the Uganda Ministry of Health.

The HIV treatment crisis has come at a time when Uganda’s HIV prevalence rate has risen to 6.4 per cent from the record low of 5 per cent achieved by 2000, down from 30 per cent in the 1980s.

The Uganda Aids Commission, the lead government agency on Aids control programmes, anticipated funding of $646 million this financial year to fund activities in prevention, social support, care and treatment.

The Ministry of Health was subsequently shocked to learn that the Geneva-based Global Fund approved just $4.2 million from the $70.2 million the government had applied for to fund Aids control programmes.

This is about 6 per cent of the money the government expected to use to buy anti-retroviral drugs that prolong life for people living with HIV, carry out outreach services like voluntary counselling and testing (VCT) and so on.

The reality is that donors hold the power of life and death over people living with HIV in Uganda , since 90 per cent of life-prolonging drugs made available to the 180,000 people using them in the country are procured with the financial support of the Global Fund, the UK’s Department for International Development (DfID) and United States’ President’s Emergency Plan for Aids Funding (Pepfar).

Now Pepfar has asked the Joint Clinical Research Centre to stop enrolling new patients who will need new lines of ARVs, while DfID, which funds a third of the Uganda Aids Commission’s budget has not yet committed to renewing that support, which ended in June.

Last financial year, the Ugandan government for the first time put aside Ush60 billion ($3 million) for ART and malaria drugs, although this is a small portion of what is needed to sustainably provide life-prolonging drugs to all people who need them.

“We are not enrolling any new patients on treatment because Pepfar stopped us. The greatest dilemma we have now is turning away pregnant women, which is morally and ethically wrong,” said Prof Peter Mugyenyi of the Joint Clinical Research Centre.

Prof Mugyenyi said there was a real danger of the programme collapsing completely because people are treated in family units, and denying a family member access to drugs would lead to sharing of what is available and therefore to under-dosage.