Government says paediatric ARVs to continue

The South African health ministry on Tuesday retracted an earlier statement that it would instruct provincial health departments not to put any additional children on antiretroviral (ARV) treatment.

Instead of suspending the enrollment of children, the ministry would warn participating hospitals to make sure they had enough ARV supplies before treating new patients, spokesperson Sibani Mngadi said.

"The point is that there is a problem with government supplies of antiretrovirals for children," he said. "Provinces need to check whether they have secure and sustainable supplies when they enrol children onto the programme because it cannot be interrupted."

Dr Nono Simelela, head of the HIV unit in the ministry of health, originally said it was unclear whether the pharmaceutical industry could supply ARV drugs without interruption. The ingredients for the paediatric forumla (either crushed tablets or syrup) was currently being sourced from overseas and, according to Mngadi, this had created difficulties.

Dr Ashraf Coovadia of the University of Witswatersrand Pediatric HIV Working Group at Coronation Hospital in Johannesburg told PlusNews that he had not received a directive from the health ministry with regards to stopping placing children on paediatric formula.

"As far as we're concerned, we will continue to access children for treatment and continue to put children on treatment. We have sufficient supplies for our existing patients for the next month or two."

Coovadia said that he was sure that Simelela was concerned about the long term, "five to six months from now."

"The ability of the national department to supply us far into the future is of real concern ... we rely entirely on the national department and if they tell us we don't have sufficient supplies, we could not put aditional children on paediatric forumla nor could we continue treatment for the children we already have on formula. We simply cannot work independently from them," said Coovadia.

Peadiatric formulations, with all drugs, lag behind in terms of research and production, and they tend to be more expensive. In the western world, adult ARV treatment is more common, yet in the worst affected countries, paediatric AIDS and the drugs needed to treat the smallest patients is an increasing reality.

Linda Philip, chief operating officer of Aspen Pharmacare told PlusNews that they have the capacity to produce paediatric forumla, but cannot until they are registrated by the government's Medicines Control Council.

"As we wait for registration, we have not yet been approached about paedicatric formulations, but we have a facility waiting to produce these drugs. We were asked, upon the opening of our new, high-capacity manufacturing facility how many OSDs (oral solid dosage - tablets and capsules) we could produce. We plan to discuss suspension (syrup) in an upcoming presentation," Philip said.

Aspen is one of a handful of pharmaceutical companies involved in the tender for supplying the government's national ARV programme. The government reportedly secured limited stocks of ARV medication until suppliers are decided upon through the tendering process "in a few weeks."

According to Mngadi, only three of South Africa's nine provinces - the Western Cape, KwaZulu-Natal and Gauteng - are supplying paedicatric forumla.

According to the recently released findings of the first national study of HIV risk in South African children, the HIV prevalence rate among children aged between two and 18 is 5.4 percent.