Shortage of AIDS drugs hit Ghana’s Eastern Region
A major crisis is threatening the effective treatment of HIV and AIDS in the Eastern Region where hospitals that provide anti-retroviral therapy (ART) are experiencing shortage of some of the drugs.
During a visit to hospitals in the region, a reporter of the Daily Graphic learnt that all the hospitals seem not to have much problem with the supply of ARVs for the treatment of People Living with HIV/AIDS (PLHIV) on first line treatment.
However, they only had a limited stock of Efavirenz drugs which come in 50mg capsules which are meant for children instead of 600mg tablets for adults.
This situation has resulted in adult PLHIV taking 12 pills of the 50mg drugs daily instead of a single dose of 600mg of the ARV, which is described by a number of the health personnel and the National President of PLHIV as “cumbersome”.
From April to June 2012, all the 20 ART centres in the region are also facing a shortfall in CD4 reagents used to monitor the progress of persons living with HIV (PLHIV) on treatment, as well as reagents used for early infant diagnosis of babies exposed to HIV.
PLHIV seeking treatment at three referral hospitals at the Agormanya-based St Martin De Porres Hospital and the Atua Government Hospital both at Odumase-Krobo, as well as the Eastern Regional Hospital at Koforidua are always turned away due to shortage of the life-saving drugs.
These hospitals, together with other ART centres, have run out of stock of Alluvia drugs, which are essential for the second line treatment of HIV.
Currently, they have only a limited stock of antiretroviral drugs (ARVs) for first line treatment mainly 50mg pills of Efavirenz meant for infected children instead of 600mg for adults.
The alarming shortages are compelling the three referral facilities and others sites to ration first line drugs to PLHIV in a bid to prevent a complete shortage of the ARVs.
“We are only giving our clients drugs that will last for a week or two instead of the normal three months medications”, said a Medical Assistant at the St Martin De Porres Hospital, Mr Joe Tetteh.
“Such medication has necessitated the need for clients to make a frequent visit to the hospital almost every week and this is making the cost of HIV treatment extremely expensive for many PLHIV who travel several kilometres from all parts of the country to access treatment”, he stated.
The Eastern Region, which until 2011 consistently recorded the highest in HIV prevalence in the country from 7.6 in 2002 to 3.6 in 2011, experienced the shortage of ARVs at the latter part of March 2012 till date.
The magnitude of the problem is becoming so alarming in spite of the numerous assurances given by relevant authorities that the anomaly would be rectified.
HIV statistics obtained from the Eastern Regional Hospital at Koforidua showed that from 2009 to 2012, of the 8,000 PLHIVs in the region enrolled on ARVs, 60 persons have been put on second line medications.
However, the number of people on second line treatment is higher at the Agormanya Hospital where of the over 4,000 PLHIV enrolled on ARV treatment, 75 are said to be on second line treatment.
The story is not different from the Atua Government Hospital where an estimated 3000 patients are seeking treatment at the facility with a number on second line medications.
Pathetically, PLHIVs who have been enrolled on second line treatment and are in urgent need of “Alluvia” drugs are always told in the face by frustrated health personnel wherever they go that there are no drugs.
The drug interruption is reported to have caused a large number of PLHIVs to be on a “drug holiday”, a default which is beyond their control and spells a doom for their health.
“Our survival depends so much on these drugs and the persistent interruption is now our greatest nightmare”, said Mr Andrews Ofori, a 48-year-old PLHIV volunteer assisting health personnel at the ART centre of the Agormanya hospital.
“We are advised to take our drugs daily but now we are defaulting because the drugs are not available”, he said, narrating how he and another volunteer at the hospital are overwhelmed with endless phone calls from other PLHIV to find out whether drugs are available at the hospital.
These concerns were also shared by the National President of Network of Association of PLHIV (NAP+Ghana), Mr Clement Azagwe, who claims that PLHIVs on second line ARVs have not been able to access “Alluvia” drugs even at the country’s premier health facility, the Korle-Bu Teaching Hospital, where majority of PLHIV have been enrolled on treatment.
“For the past eight months, those on second line treatment have not taken drugs which they need to sustain their lives”, he stated.
“I have personally borrowed drugs from well-to-do colleagues on several occasions with a promise to return the drugs later”, he said, asking “what about those who are not privileged like me to have friends who can assist them with drugs?”.
“If we joke as a country, those of us living with the disease could develop drug resistance and this will potentially undermine our efforts to achieve universal access to treatment”, added Mr Azagwe.
Similar sentiments were shared by Mr Tetteh of the Agormanya Hospital.
He said that although majority of the PLHIVs enrolled on second line treatment at the facility presently look quite healthy, they face the long-term risk of developing resistance if the interruption continues.
“This challenge causes a huge risk to the health of majority of our clients who can’t take their drugs daily as required”, he stated.
At the Eastern Regional Hospital and the Atua Government hospitals, desperately-looking HIV counselors declined to express their frustration at the shortage of ARVs for fear of being victimised but I managed to persuade them to say a few words on condition of anonymity.
“So long as clients enrolled on ART continue to take their daily dosages, the viral load is reduced significantly but once they take a break, they face the risk of having viruses multiplying so rapidly”, said one of the health personnel.
“Besides, if an interruption occurs the viruses can also make new copies and become resistant which is extremely dangerous to PLHIV”, added the health staff.
“We should remember that a virus that is resistant will not be sensitive to drugs anymore and patients will become very sick.
“Again, patients who develop resistance may spread the resistant virus to other negative persons who will also develop resistance to ARVs and will not get a better treatment even if they have not been on ART before”, added the health personnel.
“It is therefore not the best practices for patients on treatment to take a break since the taking of the drugs is for life”, lamented the medical personnel.
“Our patients complain that taking 12 pills of 50mg ARVs at a go every evening instead of one normal 600mg is a big challenge they are encountering”, said Mr Tetteh, adding that “patients complain of side effects such as vomiting, nausea and diarrhoea”.
The shortage of Efavirenz is reported to have started when the National AIDS Control Programme (NACP) introduced new treatment guidelines for new drugs and phased out Nelfinavir drugs in early part of 2012, replacing it with the Alluvia drug.
With regard to CD4 reagents, all the health facilities in the region are facing acute shortage of this device, making it difficult to monitor the progress of PLHIV on treatment and to enrol new patients.
The situation is causing the health personnel to use their clinical judgement to determine clients who deserved to be enrolled on ARV in contrast to World Health Organization (WHO) guidelines which requires health personnel to obtain accurate and reliable measure of CD4+ cells which is essential to assess the immune system and manage the health care of persons infected with the virus.
“Since we can’t monitor the CD4 of our patients, we are not in a position to determine when to put a patient on treatment”, said a health staff at the Atua Government Hospital.
“Even when a clients tests positive, we have to take a sample of the blood to the Eastern Regional Hospital at Koforidua for confirmation or otherwise and this delay cripples our ability to perform efficiently”, added another HIV counselor.
Sharing similar concerns, the National President of PLHIV said “when a person tests positive at Korle-Bu Teaching Hospital, the client is asked to go a private hospital like the Medlab Clinic in Accra where he pays GH¢150 to have his or her CD4 taken before being put on ARV”, he said.
The shortfall of ARVs and CD4 reagents is posing a great threat to effective treatment of HIV and AIDS. The region has consistently seen a significant reduction of HIV prevalence from 7.9% in 2002 to 3.6% in 2011 as well as a marked reduction in stigma and discrimination.
“This mark achievement and any attempts to ensure universal access to ARVs are however under a serious threat if drug interruption is allowed to continue”, said some of the health staff, who therefore appealed to the government to give the issue the needed attention to address the challenge.
“Any failure on the part of the government and those in charge for the procurement of ARVs will mean a life sentence for the 8,000 who are on treatment at all the ART centres in the region,” they added.
Source: Daily Graphic