Urgent need to address ARV stock-outs

Itai Rusike Correspondent
THE current shortage of life-saving anti-retroviral (ARV) drugs in Zimbabwe’s public health institutions is extremely worrying as this has serious health ramifications for people living with HIV and aids. It is disheartening that Zimbabwe — which has made tremendous gains in reducing HIV and aids-related deaths over the years through multi-sectoral efforts — is now experiencing a serious shortage of Abacavir — a second line ARV drug to the extent that people taking that drug are only being given a week’s supply instead of the usual three months’ provision.

The shortages will definitely compromise the health of those on second line treatment as they will default on taking their medication. Thirty five percent of an estimated one million people on ARVs are on second line treatment

Limited availability of ARVs impedes patient initiation, adherence and poses a major barrier to win against the HIV response as a country.

It should be emphasised that optimal adherence is essential to ensure individual treatment access and limit viral resistance.

Treatment for HIV and aids is threatened when ARV drugs are not available, undermining treatment compliance.

The weekly supply of the drugs will force people to commute regularly to their usual collection points, thereby incurring heavy out-of-pocket costs, a situation most people will not afford under the current harsh economic situation.

Some will fail to collect their drugs, leading to defaulting due to prohibitive costs. Even once drugs reach facilities, there are many other barriers to access.

Communities face charges for transport and fees to use facilities, face the costs of lost work time.

When drugs are not available in facilities, community members may be forced to buy them from private suppliers.

The cost of medications has increased significantly and medical care costs have been the highest rising element of the Consumer Price Index for some time.

If the current situation is not addressed urgently, Zimbabwe will end up losing some of the gains recorded over the past years.

It is important that the Government secures access to ARVs for the realisation of the 90-90-90 objectives; that is to initiate 90 percent of diagnosed patients and obtain viral suppressing in 90 percent of those on ART.

What is most disturbing is that the shortages of ARVs comes at a time the World Health Organisation (WHO) has warned of drug-resistant HIV as an emerging threat in developing countries.

It must be noted that drug interruption has been cited for increased cases of this new strain.

According to the WHO, rational drug use implies that “patients receive medications appropriate to their clinical needs, in doses that meet their own requirements, for an adequate period of time and at the lowest cost to them and their community”.

It is professionally unacceptable that the situation was allowed to deteriorate to these levels when the country has the Ministry of Health and Child Care (MoHCC) and the National aids Council (NAC), institutions that jointly superintend over the procurement and distribution of the life-saving drugs.

Both institutions must have raised the red flag well before the situation reached this crisis point if proper monitoring procedures were in place.

The major constraint to procurement in 2017 has also been the availability of foreign currency to procure ARVs.

Foreign currency supplies from the Reserve Bank of Zimbabwe can lag behind for as much as 4-5 months. There is need to advocate more immediate policy attention to be given to significant obstacles in drug access, including foreign currency supplies to Natpharm, timely payment to Natpharm of debts, adequacy of trained pharmacists in Government service, improved management of drugs with an information system that provides timely information on drug availability, improved equity in the distribution of available drugs with greater support of drug supplies to primary care level.

There are a number of factors affecting drug availability. It appears that at primary care level, the level and quality of staffing, expertise and resources is currently too low to provide for the basic requirements of a drug procurement and management system.

Higher levels of the health system are also not adequately supporting quality and supply in this level of care.

Resource constraints and foreign currency shortages have also limited supplies at higher levels. There are also shortages due to losses from supplies that have been obtained. This occurs when drugs expire or are stolen.

Government spending on health had declined in real terms and is currently concentrated in hospitals, particularly at central level.

There is disproportionately high expenditure on staff and health infrastructure as compared to other recurrent inputs such as pharmaceuticals and maintenance, resulting in the general shortage of medical consumables.

The shortage of foreign currency has undermined efforts to maintain a supply of affordable ARVs.

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