Third-line ARVs available soon

After months of lobbying and campaigning by Zambian activists, the government has announced that it will provide free third-line antiretroviral (ARV) drugs to people living with HIV.



This week the government invited bids for supplying the drugs, which they at first had said were too expensive, and the number of people needing them still too small.



It is expected that the drugs will be available by mid-2011. More than 300,000 people receive ARV treatment at over 1,400 counselling and testing sites across Zambia.



Treatment advocacy and literacy campaign (TALC) coordinator Felix Mwanza said "many people" needed to switch to a third-line drug regimen. TALC’s records showed that at present over 200 people needed the drugs, but there could be many more.



TALC and other HIV/AIDS organizations launched an aggressive campaign to have a portion of the US$5 million set aside for the procurement of

AIDS drugs in this year's national budget allocated to third-line drugs.



As ARV access improves in Zambia, an increasing number of patients will eventually need third-line medicines, which are used when patients develop resistance and stop responding to first- and second-line regimens. Third-line drugs are either unaffordable or unavailable in many developing countries.



Research by PharmAccess, a Dutch foundation providing HIV treatment services to the private sector in sub-Saharan Africa, has shown that transmitted drug resistance in eleven countries increased by 38 percent for each year that a country had been scaling up ARV treatment.



Reports from the Eighteenth Conference on Retroviruses and Opportunistic Infections (CROI), held in Boston in the US last week, said a World Health Organization (WHO) survey of “early warning indicators” had shown that nine African countries had experienced substantial problems with drug stock-outs, loss to follow-up, and patients picking up drugs on time.



Zambia is no stranger to stock-outs. Earlier this year, clinics in the towns of Kitwe and Lusaka, both in Copperbelt Province, ran out of Nevirapine, Lavudine and Abacavir - three key ARV medicines used in the national treatment programme. In the private sector these drugs cost $70 for a month's supply, a sum far beyond the reach of many people.



Poor access to treatment also made it difficult for many HIV-positive Zambians to maintain their regimens. Mwanza warned that if people with drug resistance were not properly medicated, it could lead to the development of strains of HIV that were resistant to multiple classes of ARVs.

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Dr Peter Mwaba, Permanent Secretary in the Ministry of Health, said government had acknowledged the potential danger of having drug-resistant strains of the virus in the population, and that was why it was procuring the drugs even though they were expensive.



Analysts have attributed the stock-outs to a controversial halt to funding by the Global Fund to Fight AIDS, Tuberculosis and Malaria. In

June 2020, the Fund confirmed that it had not disbursed any money to Zambia's Ministry of Health since August 2009, after it found evidence of expenditures that could not be accounted for.



Disbursements were frozen after the Zambian authorities uncovered fraud in the Ministry of Health, and further investigations by the Fund showed that the ministry could not safely manage grants. The Fund demanded that the ministry return $8 million of unspent money, and that action be taken against the individuals involved in the unexplained expenditures.



Although funding has now resumed, organizations like TALC have called on civil society to closely monitor government spending to ensure that the supply of these vital medicines was not interrupted.



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