ARV delays could derail national rollout plan

A year after the Malawian government launched its HIV/AIDS treatment programme, the numbers of people awaiting treatment are stretching hospitals to their limits. In May 2004 the government began providing free antiretroviral (ARV) medication at public health facilities, hoping to reach 44,000 people living with the virus by June 2005. But the country's rollout has been plagued by delays of "up to eight months" in supplying the drugs, which had led to people in urgent need of treatment being forced to wait before accessing the life-prolonging medication, said Victor Kamanga, programme manager of the Malawi Network of People living with HIV/AIDS. Kamanga became sick in November last year. With a CD4 count of 135, he was told he would need to start taking ARVs. "But when I went to the [state] clinic in December to try and get them, they said I must go on the waiting list, which was six months long," he told PlusNews. "A private doctor advised me to buy them because I was in quite a bad way. Now I'm back at work and can go on ... but those that cannot afford to buy them could be in deep trouble," he remarked. According to Dr Tiwonge Loga, executive director of the National Association of People with HIV/AIDS in Malawi, turning to private doctors to access ARVs was "not an option for 90 percent of Malawians", as it was "extremely expensive". ARV shortages in the public health system meant people who had reached the stage of AIDS were told to "go home and wait", she noted. Even hospitals that were ready to roll out the medication "were sitting and waiting for ARVs", Loga added. "We recently attended meetings in the Northern region and heard that St John's Mission hospital, which was supposed to be dispensing ARVs in June last year, has still not started doing so. They keep being told the drugs will come; the drugs will come," Kamanga commented. Loga cautioned that if the procurement system did not improve, the problem of drug shortages and delays in a country with an HIV prevalence rate of 14 percent and 150,000 people in need of treatment, would not be solved. Admitting that the government had "expected the drugs to come in earlier", the health ministry's HIV/AIDS coordinator, Dr Erik Schouten, noted that the supply of ARVs was "a complex issue". He pointed out that only a few sites had waiting lists, and these would be shortened as more areas began receiving their consignments of drugs by the end of May. Malawi is purchasing ARVs with a US $20 million grant from the Global Fund to fight TB, Malaria and HIV/AIDS, which stipulates that the United Nations Children's Fund (UNICEF) should be used to procure the medication. UNICEF'S procurement role was due to capacity constraints within Malawi, Schouten said. "These are large amounts of money, and it's a large volume of drugs." But it would be "completely unjustified" to point fingers and identify a single cause for the delays, as "many stakeholders were involved", he stressed. Nevertheless, "we are getting a large consignment of drugs this month [May]" and all 59 treatment sites should begin providing ARVs from June onwards, he told PlusNews. About 19,000 people are accessing the medication through the public sector as well as treatment initiatives run by aid agencies like Medecines Sans Frontieres. In terms of the World Health Organisation's 'three by five' plan to provide treatment to three million people in the developing world by the end of 2005, Malawi should have 80,000 people on ARV therapy by the end of 2005. Schouten acknowledged that this was "not going to happen", partly because the medication had arrived later than planned, but also as a result of crippling staff shortages in the health sector.