Clinics run out of life-saving ARV drugs

2013-07-07 14:01

Report claims thousands are affected

Tens of thousands of HIV- positive South Africans are being forced to skip doses of their antiretrovirals (ARVs) as clinics – particularly in Gauteng, KwaZulu-Natal and the Eastern Cape – run out of the life-saving drugs.

Clinicians have warned that it not only puts people at risk of dying of Aids-related illnesses, but could increase the number of those infected with drug-resistant HIV. This week, the Gauteng health department confirmed that some of its clinics had run out of the drug lamivudine.

Elsewhere, tenofovir and the newly introduced one-in-three ARV drug have run out – despite Health Minister Aaron Motsoaledi’s assurances that the fixed combination dose, launched in April, would actually prevent clinics from running out.

A coalition of organisations – the Treatment Action Campaign, Doctors Without Borders, the Rural Health Advocacy Project and Section27 – has been investigating the problem. Its members have been collecting information about what’s known as “stock outs” at clinics across the country.

They know at least 6 000 people who use clinics around Mthatha who are being given too few ARVs and, as a result, are skipping doses. But they think the problem is far larger.

Marije Versteeg, project director for the Rural Health Advocacy Project, said: “Based on anecdotal reports, I have no doubt the number of people affected are tens of thousands.”

In a report released two weeks ago, the coalition said an “active investigation” would “uncover a nationwide problem of considerably greater magnitude than merely the individual reports of stock outs”.

Shortages of the three-in-one drug – a combination of emtricitabine, efavirenz and tenofovir – are concentrated in the Eastern Cape and KwaZulu-Natal.

A report just released by the coalition reveals that clinics around East London and in Eshowe, KwaZulu-Natal, were already complaining of shortages at the end of May, just over a month after the launch of the three-in-one dose.

Dr Lindiwe Sithole, a GP specialising in HIV, said on Friday that health authorities were playing with fire.

“You don’t give a person HIV treatment and suppress the viral load, and then take it away from them. That would be like killing them.”

She said the current shortages “will have long-term implications for all of us”.

“If the people who have interrupted their treatment develop drug resistance, they could infect others with a drug-resistant strain of HIV and we will find ourselves with people who are difficult to treat.”

Andy Gray, a senior lecturer in pharmacology at the University of KwaZulu-Natal, said treatment interruptions made patients more vulnerable to “virologic failure”, making HIV-positive people more vulnerable to opportunistic infections that could kill them.

Motsoaledi said he was surprised that clinics had run out of the three-in-one dose.

“As far as I know, manufacturers have supplied enough stock of the fixed-dose combination to all provinces and there is no reason clinics should be experiencing stock outs,” he said.

The Eastern Cape health department denied on Friday that it had run out of ARVs.

Spokesperson Sizwe Kupelo said: “ARV drug supplies in the province were at 92% and we are not aware of any clinic experiencing a shortage of the fixed-dose combination.”

In Gauteng, health department spokesperson Simon Zwane said they had received 30 000 batches of ARVs last Friday, which “brought some relief to some clinics”.

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