ARV rollout - quality not quantity?

As the Zambian government takes stock of its progress in providing treatment to its HIV-positive citizens during 2005, activists and health officials agree that more emphasis should have been placed on quality, and not quantity. Having failed to meet its target to treat 100,000 HIV-positive people by the end of 2005, the Zambian government is now providing antiretrovirals (ARVs) to about half that number. "The compiled data we have of people on ARV treatment as of November last year is 43,771, but once all the centres across the country send their reports by end of January we will reach 50,000," the national coordinator of antiretroviral treatment (ART) at the Central Board of Health (CBoH), Dr Albert Mwango, told PlusNews. Despite failing to meet the treatment goal, the country had done well. "Meeting half of the target is no mean achievement, given the many challenges the country is facing in the health systems," he pointed out. CBoH projections indicate that 85,000 people living with HIV will be eligible for treatment every year. However, a shortage of drugs has meant no new patients were currently being enrolled on the treatment programme, Mwango noted. "Procurement procedures are already in process and we might only get the drugs by mid this year, [but] we have enough for those who are already on treatment." Activists question whether the rush to meet quotas of people getting the drugs could be behind the shortages, as this has happened before. In 2004, Dr Brian Chituwo, then Zambia's health minister, announced in parliament that supplies of Triomune-30, a fixed-dose combination of Nevirapine, Lamivudine and Stavudine, had run out. The coordinator of the Network of Zambian People Living with HIV/AIDS (NZP+), Clement Mfuzi, stressed the need for government to pay closer attention to people currently on treatment instead of number-crunching. "As a country we did very well [in getting more people on treatment], but more effort is needed in providing [more effective] support systems to people on treatment," he warned. WHO HIV/AIDS Country Officer Sansan Myint admitted that the World Health Organisation's (WHO) campaign to put three million people in the developing world on anti-AIDS drugs by the end of 2005 had been an ambitious target, but noted that it had helped mobilise all stakeholders in HIV/AIDS to do something about the pandemic. However, there was still room for improvement, particularly in the patient monitoring and information systems, she added. According to Dr Mwango, "There are many challenges faced by the health systems in Zambia today and HIV/AIDS has added a massive strain on the already deteriorating systems that are in existence." For instance, it was very difficult to get information from the districts to the national office, as nothing had been done to improve the country's reporting system. He explained that a new Health Information System Management (HIMS), to be adopted by all partners, had since been put in place, allowing ARV record data from across the country to be updated on a daily basis. "Other constraints in the ART programme include the lack of human resources on the ground to implement the programme. It's a major problem that needs addressing, as the few people we have move on to other countries once we have trained them," he observed. An additional 20-30 health facilities will be in operation by 2007, expanding the rollout. "Antiretroviral treatment services will be extended to selected rural health centres in all the nine provinces soon," Mwango noted. Former health minister Dr Brian Chituwo announced a move by government to abolish the cost-sharing policy in the ART programme in July last year, but there have been delays in implementing the policy in centres located outside the capital, Lusaka.