Activists concerned over drug shortages in ARV roll-out

Shortages of a critical generic antiretroviral (ARV) drug used in Zambia's treatment programme have revealed a lack of adequate planning by the government that could derail the ARV rollout, activists told IRIN on Thursday. Zambian health minister Dr Brian Chituwo announced in parliament this week that supplies of Triomune-30, a fixed-dose combination of Nevirapine, Lamivudine and Stavudine, had run out. But there was "no reason to panic or get alarmed", department of health spokesman Dr Victor Mukonka told IRIN. "There will be no treatment interruptions - this is only one drug out of 16 formulations that are available in the country." This was not good enough for the country's AIDS activists. Winston Zulu, coordinator of the AIDS NGO Kara Trust said: "There has been this sudden rush to meet all these WHO quotas [WHO's '3 x 5' goal of providing treatment to 3 million people by 2005] without proper planning - that is why we are seeing problems like this." Eric Nachibanga, a member of the Network of Zambian People living with HIV/AIDS agreed. "The government rushed in before the community was prepared to handle it. They bought drugs in bulk without putting in place proper procurement procedures." Zulu warned that the national treatment programme could be in trouble. "I am very scared about the provision of ARVs in Zambia because it is not being done well. As someone who has been taking ARVs for years, I know that bad treatment is worse than no treatment." According to Mukonka, the government had already issued an emergency tender for Triamune-30 and a consignment was expected "very soon". HIV-positive Zambians who are currently taking Triamune-30 will be given separate tablets of the component drugs until new supplies arrive. Both Zulu and Nachibanga expressed concern about the nutrition of HIV-positive Zambians on treatment. "In Botswana, ARVs are being distributed with food packs, but this is not being done here - people are getting ARVs on empty stomachs," Zulu pointed out. The current cost-sharing scheme, where patients at public hospitals are required to pay Kwacha 40,000 (US $8) for ARVs, was another cause for concern. According to Nachibanga, this was not feasible for the majority of HIV-positive people. Zulu called on the government to "go back to the drawing board", and instead of expanding the treatment programme rapidly, should make sure patients currently on treatment were monitored and received adequate support. The health minister told parliament this week that the government had managed to exceed its target of 10,000 patients on treatment and 12,000 people were now receiving anti-AIDS drugs. "The government should be commended for taking such a bold step and activists should be supporting us, instead of getting people excited for nothing. People must understand that we have a plan and we are still on course for meeting our target of treating 100,000 people by 2005," said health department spokesman Mukonka.