ARV Shortage

August 2013

 

At the moment there is a shortage of anti-retroviral drugs (ARVs) throughout Zambia.

Many health facilities, Mwandi Mission Hospital included, have very low levels of stock or have completely run out of Truvada and Abacavir. We were only given 21 bottles of Neviripine syrup for children in the last dispatch from Medical Stores and we have only a few tablets of the same drug left. We have tried to procure a consignment through CHAZ (Churches Health Association of Zambia) but they too have run out. There may still be some stocks available at Mongu, the Western capital, 400km away. Our vehicle is tanked up, waiting for the word to go.

 

A Ministry of Health spokesman reported in the ‘Times of Zambia’ on 27 July, that the country was expecting 91,500 bottles of Truvada in three weeks’ time (mid-August) and another 400,000 bottles in September this year, with the last consignment of 300,000 bottles of the same drug in October. The Ministry of Health says there is no cause for alarm as there is enough Truvada in-country to last until the next batch is received.  Other ARVs are reported available as well. In the meantime the Government had ordered another 600 000 bottles of Truvada which should arrive in September as well.

 

In typical “Govspeak” the reason for the shortage was put down to “some logistical challenges in the procurement process.” Another contributing factor was a world shortage of Tenofovir a vital ingredient in the manufacture of Truvada. In what is seen as a possible threat to increase resistance some patients on Truvada and Neviripine are being given Atripla instead. Neviripine is used as second-line treatment according to Zambian protocol. Depending on availability patients are being issued with 2 weeks supply at Mwandi instead of the usual 3 months’ supply.

 

Allafrica news recently reported that Zambia is now meeting its Abuja 2001 Declaration responsibility to spend at least 15% of the budget on healthcare, part of this to help meet the cost of keeping around 500 000 people on ARVs. This works out at almost 4% of the total population. Around $80 million of $120 million the ARV programme costs comes from donors. Last year the Government contributed $10 million and this is to be raised this year to $35 million, hoping to match a dollar for dollar contribution leading to greater Zambian ownership in footing the bills and implementation of programme. With so many calls on it and with limited resources it is not easy for the Government to achieve greater sustainability in the programme.

 

Meanwhile at Mwandi to serve 1800 people needing ARVs, a neighbouring mission over 4 hours away has some extra stock at the moment and has promised to share some with us. The Province as well may have some it can give us in the meantime. The AIDS Relief vehicle was sent yesterday to collect what was available. We await its return.

 

Sturm und Drang in Vienna: Our diary

Saturday 17 July: The Multi-Faith Pre-Conference of the International Aids Conference met at the Technical University. The opening religious ceremony was excellent, with all the various faiths found in Vienna taking part. It was also good to see that WHO are giving due recognition to the work of faith-based institutions on the ground but sad to hear that PEPFAR have 'straightlined' their funding. Ida found it a good forum to raise two major concerns she had on the unsuitability of some of the paediatric ARVs and the lack of variety in comparison with adults. The pharmaceutical companies need to be lobbied on this issue. Returning to PEPFAR, if budgets continue to be reduced, then universal access will fall by the wayside and faith-based institutions will end up having to play God which is not their role. Those two points were picked up and used during the conference by more authorative speakers.

Sunday 18 July: The Opening of the Conference with the 18th Life Ball which was being held out of doors at the Rathaus was washed out by a tropical thunderstorm called Petra just as Whoopi Goldberg dressed as Mother Earth started to sing. The great and the good including Bill Clinton, Mette-Marit, the Crown Princess of Norway and various other prominent German-speaking politicians and celebrities rushed for cover including 50 black Promenade Dancers dressed in white and 50 white dancers dressed in black, while those in fancy dress including avatars, fauns, elves and pixies plunged into the fountains. Other prominent personalities present were Boris Becker, Patti Labelle, Prussian and Austrian Princesses plus the Mayors of Berlin and Vienna. Unsurprisingly, there were no Scottish peasants invited.

Monday 19 July: The first Plenary Session of the Conference and Bill Clinton's keynote speech was a highlight. Regarding funding Faith-based Institutions should lobby Congress to make the right choice by supporting, continuing and increasing funds for care, treatment, infrastructure and systems. Greater care and stewardship was also a pre-requisite for a dollar wasted puts a life at risk. Jobs need to be done faster, better and cheaper, in other words doing more with less. African governments need to keep their part of the bargain and devote at least 15% of their national budgets to Health Care. As regards prevention, scaling up should be done with what works. Large sums of money of money can be raised through small amounts given by many people. Education and advocacy are priorities.

Ida presented her poster entitled The United Church of Zambia Mwandi Mission Hospital Voluntary Counselling and Testing Strategy for Hard-to-Reach Populations. This dealt with a mobile outreach program that visited social events and rural and fishing settlements to increase the number of people who know their HIVstatus, so that they can access the HIV Programme before they are ready to start anti-retroviral treatment and become sick.

Tuesday 20 July: The main event was a peaceful but noisy demonstration through the streets of Central Vienna by 15 000 people on Tuesday evening to show solidarity with the campaign for human rights throughout the world and especially for those living with HIV and Aids. It also called on Governments around the world to increase funding for fighting the disease. An interesting fact: the Church of Scotland has given much more money to the worldwide fight against HIV and Aids than the Austrian Government, who to its shame gave a paltry single contribution of E1m to the Global Fund away back in 2002 for condoms for Africa..It was pointed out that the city of Vienna would be benefiting to the tune of E45m going into the local economy from hosting this conference alone. The Demo closed with a live concert given by Annie Lennox, the former Eurythmics singer, who is now the United Nations AIDS Goodwill Ambassador.

Wednesday 21 July: Marjorie Clark's Presentation of the Church of Scotland's HIV/AIDS Project at the Global Village. This was also another good opportunity for networking. Marjorie explained that the Church of Scotland”s Programme started in 2002 and its position was reiterated in 2006. It is to bring life and hope by breaking the silence on HIV and Aids and standing with partner Churches to offer practical support and to speak up for the voiceless, involving all Church members. This year the project becomes an integrated programme of the World Mission Council.

One of the most successful fundraising ventures had been Souper Sunday. Congregations had a simple soup and bread lunch after a Sunday Service in January. Last year over GBP100 000 was raised in this way from over 300 individual Churches. These congregations' generosity was a good example of many smaller sums of money adding up and together making a considerable amount. Mony a mickle maks a muckle.

Thursday 22 July: A good day for hearing about the new WHO PMTCT (Prevention of Mother-toChild Transmission) and Feeding Guidelines. The mothers will in the future be covered by ARVs until they stop breastfeeding. This will mean that more babies should be able to be breast-fed. This is a step in the right direction but in an ideal world all pregnant HIV+ mothers would be able to access long-term triple therapy anti-retrovirals.

The integration of palliative and home-based care at a workshop was another useful meeting and contacts made for future-training. This is an area that is lacking at present in Mwandi but steps are afoot to work at this through the Woman's Christian Fellowship in our 13 out-of-station preaching points.

Another interesting talk was given by a Dutch doctor based in Mozambique who has formed his ARV patients that default into cell-groups that help support each other, provide a form of mutual accountability and pick up ARVs for each other. This is a simple and effective way of cutting down waiting time in queues and transport costs for these patients. This can only happen with stable patients but is another good idea that can be adapted for use by the Mwandi Programme.

Friday 23 July: The closing day. The Global Village is being packed up but nonetheless excellent presentations on the maltreatment of prisoners living with HIV and Aids in Eastern Europe. It has been good to see how HIV and Aids affects other areas of the world and not just Africa.

We have also managed to visit Schoenbrunn Palace and the Spanish Riding School. Keith Catriona and Mubita also toured the Zoo, went to a Gustav Klimt Exhibition and did a cycle-tour of the Wachau are where the imprisoned Richard the Lionheart was found by Blondel, the inconclusive Battle of Duerenstein between Napoleon and the Austro-Russian Coalition in 1809 and the Anti-Freeze in the White Wine Scandal of 80s.

On Saturday 24 July we set off by rail for Geneva via Zurich.