Ambitious plans to roll out ARVs

Zimbabwe plans to roll out antiretroviral (ARV) treatment this month at five pilot centres across the country, and expects to have 260,000 of an estimated 520,000 HIV-positive people on the programme by the end of next year. Given the country's current health crisis the task appears formidable, but health officials are optimistic, despite overwhelming obstacles, particularly the acute shortage of foreign currency. The ministry of health said the government's rollout programme would benefit from the experience gained by local NGOs, faith-based organisations and the private sector, all of whom have already implemented drug distribution, albeit to a limited number of people. The World Health Organisation (WHO) is also providing technical support and has encouraged the development of tools for delivering the ARVs. The authorities point to existing laboratories at most hospitals, a strong medicines regulatory authority and the availability of cheaper generic drugs as positive signs for success ofthe programme. The triple generic drug treatment is expected to cost less than Zim $100,000 (US $25) per month thanks to partnerships with local manufacturers, such as Varichem. "Our major problem is to make sure that we have a reliable and adequate supply of drugs," the coordinator of AIDS and TB programmes in the ministry of health and child welfare, Dr Owen Mugurungu, told PlusNews. "Zim $2 billion [US $474,608] is coming from the AIDS levy and Zim $10 billion [US $2.4 million] from the Ministry of Finance, so we have Zim $12 billion [US $2.8 million] available to us," he explained. The five pilot sites for the programme have been chosen because of their location and existing infrastructure, and include the two largest referral hospitals in the country, Harare hospital in the capital, and Mpilo hospital in second city, Bulawayo. "Between the two of them, Harare and Mpilo will take about 1,000 patients each and the other three centres about 500 to 600 each. Of the 4,000 [initially] patients we aim to treat, at least 800 are children," Muruguni noted. The pilot hospitals all have Opportunistic Infections Clinics (OIs) and will also be able to carry out CD4 counts which measure the strength of the body's immune system. At present, CD4 testing facilities are only available at the Harare and Mpilo hospitals. Patients would qualify for treatment if the results of the CD4 count was below 200. The OI clinic at Harare Hospital currently has a modest staff complement of one medical officer and one physician, two nurse counsellors and two trainee nurses. It is housed in cramped quarters in the outpatient building, but plans are underway to move to bigger premises to cater for the anticipated increase in patient load. "The clinic has been running since October 2003 and we have been treating people with drugs, although not with the ARVs. We have people waiting already, although they are less than 100," the head of the clinic, Dr Paul Chimedza, told PlusNews. He added that the CD4 count would help to monitor the effectiveness and possible side-effects of the drugs. There were also moves to approach the Department of Social Welfare and the UN's World Food Programme to step up aid to food-insecure people identified for treatment. It is likely that around 7.5 million of the country's estimated 11.65 million population will require food aid through the next few months.