ARVs: Hogan acts

BELINDA BERESFORD AND LINN DAVIS Nov 17 2008 06:00

The news that the Free State health department could run out of anti-retroviral drugs by January is significant, not for the apparent lack of management it reveals, but because of the response by the National Department of Health.

Insiders say that once informed that the HIV-positive patients in the Free State could be enduring a life-endangering halt to their treatment in a few weeks, Minister of Health Barbara Hogan immediately told her department to sort out the problem. The Free State had decided that no new patients would be put on the ARV programme.

In the context of the new ministerial regime this meant identifying the problem and solving it. Hogan ordered that a high-level department of health "fix-it" squad be dispatched to the Free State.

Meanwhile, insiders say that the antiretrovirals (ARVs) needed by Free State are likely to be supplied from a buffer stock kept by USAid to alleviate any shortages that might occur in programmes it funds. This could not be confirmed.

There are two particularly pressing questions. Why did the province run out of money despite apparently being under budget? And why did the health department decide on the extreme response of refusing to take on new patients?

At the beginning of this month the head of Free State's HIV programme, Dr Mvula Tshabalala, sent out an email saying the province had "an acute shortage of ARVs. This will lead to patients on treatment defaulting though no fault of their own. The only way to avoid this is by keeping the remaining ARVs for the exclusive use of those on treatment already." He said that pregnant women were excepted from the ban on new patients, as were children.

Following this announcement Palesa Santho, head of pharmacy for the Free State ARV programme, informed Free State health officials: "You are the sites faced with an even worse situation whereby you have to turn patients away because of the present circumstances. The same patients who look at you as their last hope of life."

National treasury spokesperson Thoraya Pandy says the Free State was allocated R189-million for its ARV programme. So far R94,6-million has been transferred to the province, of which R90,8-million has been spent.

Pandy said that the Free State ARV programme was slightly under budget at mid-year and no more than marginal overspend was expected. The money is a conditional grant, which means that it can be spent only on the ARV programme and may not be used elsewhere.

CONTINUES BELOW

Click here

Whatever the cause of the Free State's draconian behaviour, a problem across all the provinces seems to be lack of funding for the ARV treatment programmes. In part this may be due to the success of the programmes, many of which appear to be outstripping their targets. Above-expected demand for treatment could lead to a shortage in the amount of drugs either budgeted for or available.

Such a scenario, however, could be alleviated by responsive planning. Some of the problems appear to be the result of bad budgeting, management or the lack of monitoring and evaluation. Budget planning needs to accommodate not only the first-line treatment regimen used for adults, but also the more expensive costs of second-line and paediatric treatment.

Ian Sanne, professor of infectious diseases at the University of the Witwatersrand, said: "These situations happen all over Africa and this demonstrates a ramp-up of activity and the need for a buffer stock to be available to provinces."

An extra R300-million was allocated by treasury in October for antiretroviral treatment, including prevention of mother-to-child transmission of HIV during pregnancy. This money was allocated to the four provinces that appeared to have budget shortfalls for these areas -- and did not include Free State.

The Free State department of health has requested money from the United States President's Emergency Plan for Aids Relief (Pepfar). And the national department has allocated an extra R9,5-million to the Free State for the ARV programme.

Dr Francesca Conradie, deputy director of the clinical HIV research unit at the University of the Witwatersrand, described the move by Free State as "a travesty".

"By even considering a treatment interruption we run the risk of undoing much of the excellent gains that have been made in the ARV programme," she said. "Unlike most other medications, a missed dose or missed doses can render the treatment ineffective. This is caused by the development of resistance in the virus. Not only does this affect the individual concerned but it may allow a resistant virus to be spread."

Drug-resistant virus has serious implications for the individual -- who would have to change to a different cocktail of drugs, possibly with more side effects -- and the health system which would face higher medicine costs.

Around the country…

KwaZulu-Natal has about 191 000 patients on ARVs and has been allocated R700-million. This funding is insufficient and the province has applied for more.

More than 60 000 people are on ARVs in the Eastern Cape and the province aims to have 100 000 people on treatment by the end of next year. The province has been allocated R181-million, but says that it expects financial constraints in the future.

The Northern Cape has more than 11 000 patients on ARVs and expects to add about 4 000 people during the next year. It has received more than R50-million and does not expect to face financial constraints that would affect its provision of ARVs.

The North West province has about 54 000 patients on ARVs and expects to add another 10 000 in the next financial year. In a statement the province said it had "had some short falls in respect to providing medicines and conducting laboratory services", but had requested additional funding.

As of April this year 28 787 people in the Free State were receiving ARV treatment.

-- Linn Davis

TOPICS IN THIS ARTICLE

ARVs: Hogan acts

Tags

IN THIS WEEK'S PAPER

Advertisements

Sponsored links