Antiretroviral shortage, so patients receive rationed medicines
HIV Ethics & Policy
Antiretroviral shortage, so patients receive rationed medicines
“My son and I are taking antiretrovirals at the J Dumani clinic in Vosloorus. They have a rule that they don’t give out antiretrovirals for children unless they are there. So that means now I have to keep my son away from school twice in a week. We live far from the clinic and I can’t afford the taxi fare for us to get there anymore,” explained Buhle (name changed). “What’s worse is that the teachers will start asking questions as to why my child is continuously absent from school and I’ll be forced to disclose my child’s status at his school. I’m not ready to do that,” she explained.
A 41 year-old woman, who has been on antiretroviral treatment since 2008, explained that she has been turned away from Ebony Clinic on two occasions since she became a patient there in January this year. The reasons given to her by the clinic are that there was no nurse to attend to her and no medication available at the clinic. She was forced to get antiretrovirals from a friend and was off treatment for several days after her medication ran out. “I don’t know what to do now. My complexion is changing and I get dizzy spells and I’m becoming weaker by the day. The telephone numbers on the wall say we must call and report shortages but the response is always, 'Somebody from the head office is coming.' Nobody ever comes,” she says.
Nomsa Mmope, Chief Director of Strategic Health Programmes for the Gauteng provincial health department, gave two reasons for the TDF shortage. First, patients are now initiated on antiretrovirals at a CD4 count of 350. This change came into effect in August 2011. Before that, patients had to wait until their CD4 counts dropped to 200 before starting treatment. Second the increased number of people getting counselled and tested for HIV, as part of the national health department's scaled up testing campaign, has increased the demand for antiretrovirals. This, explains Mmope, has led to reduced stock, including donated antiretrovirals received from the national department.
To resolve the problem Mmope says that health care workers are ensuring that the available drugs are rationed among patients to reduce non-adherence and defaulting, "We're prioritizing those patients who experienced side effects from [possible replacement antiretrovirals] to receive the remaining TDF."
Tracey Sibeko is the manager of HIV/AIDS, STIs and TB (HAST), which is part of the Ekhurhuleni metro municipal government. HAST has to ensure services, including medicines and sufficient staff, are provided to 96 facilities. Sibeko explained that, “TDF and abacavir [also an antiretroviral] have not been available for over two months now and when we ask we are told that it is not Gauteng that is experiencing a shortage in medication, but that it is a national problem. Instead of answers we received a guidelines document for dealing with the TDF shortage from the department.”
Patients on treatment need to take three antiretroviral drugs daily. If they default on treatment, they risk developing resistance which means their treatment will become less effective or even stop working. Patients are unlikely to become sick immediately if they miss a few days of treatment, but if patients develop drug-resistance they have to change drug regimens and will have fewer treatment options in the future. The Southern African HIV Clinicians Society has released guidelines for dealing with the TDF shortage. It states:
Antiretroviral (ARV) treatment interruptions and suboptimal ARV therapy are associated with treatment failure and the development of viral resistance to available ARVs. Treatment interruptions are also associated with a number of health complications. Changing a patient back to stavudine (D4T), with its known side effects, could lead to increased rates of nonadherence and consequent treatment failure if not accompanied by careful counselling.
The society has also written a letter to Health Minister Aaron Motsoaledi requesting an urgent investigation into the reasons why there are critical drug shortages.
After numerous attempts over several days to get comment from Sizwe Hadebe, spokesperson for the national health department, Hadebe referred GroundUp to Shireen Bardesi this afternoon. She in turn referred us to Dr Yogan Pillay the Deputy Director-General whose phone went straight to voicemail.