Lisa Isaacs
ANTIRETROVIRAL drugs fail to consistently reach patients in countries most affected by HIV/Aids, while multiple instances of stock-outs have been reported in South Africa, Doctors Without Borders (MSF) said.
As the world marks World Aids Day today, a new MSF report based on surveys conducted in SA, Mozambique, Malawi and the Democratic Republic of the Congo has highlighted the inconsistency in access to ARV treatment.
The report shows most stock-outs are due to the inability of ARV supply chains to ensure delivery. And even though necessary medicines are available, they do not reach peripheral clinics because of cumbersome procedures, logistical challenges or lack of resources.
Surveys conducted over two years in SA show that between 20 and 25 percent of local health centres were unable to dispense the complete quantities of HIV or TB medications.
In 80 percent of cases, the drugs were available, but did not reach the clinic’s pharmacies.
MSF also says that stock-outs at facility level have been shown to be worse today than in 2013.
“The system needs to be improved because we cannot fight HIV without medicines. To efficiently protect individuals’ health and decrease HIV transmission in communities, ARV treatment needs to be taken for life, without interruption,” MSF SA medical co-ordinator Gilles van Cutsem said.
MSF SA cited an example in 2014 with national stock-outs of a syrup to prevent HIV in children born of HIV positive mothers. They received a less optimal ARV with a higher chance of side effects instead.
“Most stock-outs happen in silence and patients go home empty-handed or with sub-optimal treatments. The availability of medicine in local health centres is not routinely monitored and, therefore, not acted upon, even though it happens regularly,” MSF pharmacist Tinne Gils added.
Department of Health Deputy Director General of Health Regulation and Compliance Anban Pillay has, however, identified a number of issues with the report.
He said the survey was conducted with a phone call to a clinic where staff were asked which drugs were out of stock. He said interviewers relied on memory and the assumption the persons they spoke to provided accurate information.
He said the department had been given a limited list of facilities that reported out-of-stocks, and on investigation it was found that some facilities were repeated for the same items that were out of stock.
“In others, where it was claimed there is no stock, many of them reported that they did have stock and didn’t know where this information came from. Others did not have stock, but borrowed from another clinic and supplied this to the patient,” Pillay said.