Kenya is reviewing its strategy against HIV/Aids to accommodate new guidelines on anti-retroviral therapy released by the World Health Organisation.
To implement the recommendations, the country needs to raise an additional $72.53 million over the next four years to boost its budget for anti-retroviral (ARV) drugs administered to Aids patients.
The WHO guidelines released in November last year, propose commencement of treatment at an earlier stage of infection than was previously the case, in addition to suggesting a change in first line treatment to less toxic but more expensive drugs.
It would see a larger number of patients, up to 20 per cent, being started on drugs than had been foreseen by the National Aids Control Council in the third Kenya National Aids Strategic Plan launched in January.
According to the National Aids and Sexually Transmitted Infection Control Programme (Nascop), 354,000 people living with HIV are on treatment, but still, a significant number of patients are yet to be reached considering that an estimated 600,000 HIV patients in the country need the drugs.
The new guidelines present a new challenge, making it even harder to reach additional Aids patients with ARVs. Under the third strategic plan prepared by NACC, a target had been set to reach at least 80 per cent of the eligible patients by 2013.
According to the WHO, the guidelines are not only meant to reduce risk of transmission of Hiv by decreasing the viral load earlier during infection; but also boost the immune system against opportunistic infections.
“The policies came out after we had prepared our strategic plan and we have had to go back and cost them,” said Regina Ombam, the head of strategy at NACC. Ms Ombam said that HIV/Aids treatment takes up the bulk of the budget, at about 58 per cent of the total cost of Hiv/Aids programmes.
In the guidelines, WHO argues: “ The incremental costs due to an additional one or two years on ART may be partly offset by decreased hospital and death costs, increased productivity due to fewer sick days, fewer children orphaned by AIDS and a drop in new Hiv infections.”
Phase out Stavudine
Besides initiating ARVs earlier, the WHO guidelines also suggest the phasing out of Stavudine, which is used as a first line drug but has been found to have long term adverse effects. It will be replaced by Tenofovir and Zidovudine. A new third line treatment, which is presently non-existent, will also be introduced in the country.
In implementing the guidelines, the WHO recommends a phased approach where the changes would be introduced in stages.
Kenya has developed a roadmap for phasing out Stavudine at a rate of 20 per cent annually beginning June this year. However, the ART programme officer at Nascop Dr Irene Mukui said that the initial focus would be on patients with adverse reactions.
It is projected that for the 2010/2011 financial year, an extra $9.57 million will be required, a figure that is forecasted to grow to $15.21 million, $21.94 million and $25.81 million in the three subsequent years.
Dr Mukui said that the additional costs would go towards training of health providers on new guidelines, printing and dissemination of new guidelines, human resource needs and infrastructure such as laboratory equipment and space.
The WHO also proposes increased use of viral load laboratories to monitor quality of treatment and care, as well as to diagnose failure of treatment. This will translate in the need for the establishment of more facilities.