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Lives Of 2,500 Ugandans Living With HIV At Stake Over Persistent Stock-Outs Of Life-Saving HIV Medicines

Officials from  Civil Society Organisations (CSOs) led by Uganda Network on Law Ethics and HIV/AIDS (UGANET) addressing the press

By AbduKhalim Nsanja

Uganda has about 1.5 million People Living with HIV/AIDS (PLHIV), most of whom are on life-saving HIV medicines.

These medicines help PLHIV to restore or preserve immunologic function, improve quality of life and reduce HIV-related morbidity and mortality but also minimise infection.

Uninterrupted and adequate supplies of life-saving antiretroviral treatment are essential to achieving Uganda’s goal of defeating HIV and achieving the 95-95.95 targets of 95% of people with HIV knowing their HIV status, 95% of those being on treatment, and 95% of those having durably suppressed viral load.

However, the lives of about 2500 PLHIV who are on 3rd line treatment seem to be in danger following the persistent stock-outs of life-saving HIV medicines in the country.

The Government has committed through the National Strategic Plan of the Uganda AIDS Commission to improving access to second and third-line treatment regimens as a fundamental strategy to achieving reduction in new HIV infections and AIDS-related deaths by 2025.

On Wednesday, Civil Society Organisations (CSOs) led by Uganda Network on Law Ethics and HIV/AIDS (UGANET) told the press that over the last 6-9 months, monitoring of the quality and accessibility of the HIV response carried out by people living with HIV and other directly impacted communities has exposed chronic shortages of HIV treatment at facilities across the country, particularly third-line medicines such as raltegravir and darunavir for people who are “treatment-experienced,” meaning first- and second-line treatments are not effective for them.

They say that treatment-experienced HIV-positive people are more likely to be immunocompromised and are at great risk of HIV progression.

“Unfortunately, the government of Uganda, PEPFAR and the Global Fund have not resolved this stock out crisis: These findings were confirmed by the Ministry of Health’s most recent quarterly stock status report, which states Low stock levels of Raltegravir 400mg (0.3 MoS) and Raltegravir 100mg (2.0 MoS) and Darunavir 75mg (0.0 MoS) Pipeline of Darunavir 75mg (11.6 MoS) is expected in June 2002. Available stock of Ritonavir 100mg and Darunavir 600mg is short-dated”

The CSOs sought immediate resolution to the life-threatening crisis of HIV antiretroviral treatment stock-outs in the country.

Accordingly, the treatment shortages of third-line medicines are deadly especially when it is known that beyond this there are no options available for the affected clients. To live long, healthy lives and halt onward transmission of HIV, all babies, children and adults living with HIV need access to antiretroviral treatment that suppresses their viral load and keeps them healthy.

The CSOs revealed that the persistence in the problem with no solution a few weeks ending June and beginning July was so appalling that affected PLHIV revealed that they were at a phase where Clients were being given ART refills for as little as one week.

Civil society organizations speaking to clients and health facility managers around Kampala and Wakiso note that there is fear, panic and worry is out there over potential risks of having disease progression and drug resistance that the current HIV response at the moment may not handle because there are no options beyond 3rd Line placing the lives of close to 2500 clients served by the National response in jeopardy.

They say that while some medicines were recently delivered to Joint Medical Stores – JMS, “this has not resolved the grids rather as communities we anticipate further persistence of the stockouts because the supplies made a week ago are inadequate and incomplete-sub-optimal regimen is offered (only ritonavir), clients who have spent over a period of 5 months are reinitiated to care without any viral load testing done in response attempt to seek answers and redress mechanism.”

CSO Coalition are seeking the AIDS Control Program for answers as to why there were stockouts in the first place, dialogue on the potential strategies or solutions for ensuring that the affected clients get the needed support.

People living with HIV called for urgent responses to these reported cases of persistent stock outs of Raltegravit, Darunavir, and Ritonavir from the Government of Uganda, PEPEAR, and the Global Fund to Fight AIDS, Tuberculosis and Malaria (Global Fund).

However, the ministry of health says, there is adequate ARV medicine in various government medical facilities

Emmanuel Ainebyoona, ministry of health spokesperson says he consulted National Medical Stores – NMS and they have been working with partners distributing these drugs.

“Maybe there is a period when NMS was undertaking stock-taking, maybe it should have been that period where some of the arrangements were not available.”

Third-line treatment stock outs and the devastating impact on people living with HIV on 3 Line and CSOs Call to Action.

Stock-outs and shortages of HIV commodities at the health facilities increase the risk of treatment interruption, antiretroviral resistance, treatment failure, sickness and death Unsuppressed viral load can also result in onward transmission of HIV through sex or during pregnancy. Many people on third-line treatment are young people who already face extraordinary challenges living with HIV stigma and discrimination

Call and recommendations from CSOs:

a) Government of Uganda. Implement the 15% Abuja declaration as a signatory and ensure that each health sector including HIV has clear-cut expenses for all areas of intervention including commodities Government of Uganda in situations of such crisis speak out and inform the affected population with clear guidance on how the clients will be managed by service providers over the period of such crisis.

b) NMS: Deliver medicines with longer shelf life which will reduce on volume of expiries. Strengthening inventory management practices and Optimizing supply chain management of medical and pharmaceutical products for commodity security with minimal stockouts of essential products Timely delivery of supplies by NMS to mitigate the risk of drug stockouts.

c) Global Fund: The Global Fund must step up with an emergency procurement of medicines for third-line treatment, doubling current investments in order to ensure all people with HIV on the third line of continuous access to highly active therapy.

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