Coalition decries "regular" shortage of HIV drugs

Although the cost of anti-retroviral drugs, which have proved to be an essential treatment for HIV/AIDS, has significantly reduced in recent months, frequent shortages on the local market is placing many patients at risk, according to a coalition of organisations fighting for access to essential medicines in Kenya.

Several pharmaceutical companies last year reduced the prices of their anti HIV/AIDS drugs for use in Africa by public institutions, international agencies and nongovernmental organisations (NGOs) by between 50 and 98 percent.

However, the Kenya Coalition for Access to Essential Medicines, which groups several NGOs, argues that the price reductions have not been matched with consistent drug supplies. This, in turn, has made more dangerous the use of the drugs, which have high levels of toxicity and are usually administered under strict therapy regimes.

"Our problem is being tied to monopolistic supply," Liza Kimbo, executive director of the Cry for the World Foundation, a member of the coalition, told a news conference in Nairobi, on Tuesday.

"The pharmaceutical companies accepted to reduce the prices of the drugs, but they are not willing to back it up with sufficient supply. It is a question of giving with one hand and taking with another," she added.

GlaxoSmithKline and Boehringer Ingelheim, two of the pharmaceutical companies with anti HIV/AIDS drugs on the Kenyan market, on Tuesday contested the Coalition's view and suggested it was overstating the problem of stock shortages.

The NGO coalition has urged the Kenyan government to allow more than one supplier of the same medicines on the Kenya market. It has also urged it to pressure pharmaceutical companies to extend credit to local distributors on all anti-retrovirals (ARVs) - regardless of their price - in order to "adequately buffer their stocks" and ensure that treatment regimes are not interrupted or upset by risky switches to substitutes.

According to official government figures, at least 700 people die from AIDS-related disease in Kenya every day - a health burden which has prompted the Kenyan government to declare HIV/AIDS a national disaster.

John Wasonga, a doctor with the HIV project at Mbagathi Hospital in Nairobi, told Tuesday's press conference that a majority of his 15 patients who can afford to buy ARVs were being forced to default on their treatment due to the shortage of the required drugs in the market. As a result, he said, some were suffering severe side effects from frequent changes in treatment regimes.

Wasonga cited "regular" shortages of reduced-price Videx (25 mg) and Zerit (30 mg) tablets, produced by pharmaceutical company Bristol-Myers Squibb (BMS), which, he said, had forced HIV/AIDS patients to switch to alternate medications or interrupt their treatment altogether.

"To get a patient to adhere to a strict therapy is a difficult job," he said. "To [have them] default for weeks because drugs are out of stock is making an already difficult job even more difficult."

The international health NGO Medecins Sans Frontieres (MSF), which is spearheading a global campaign for access to essential medicines, said the cause of the supply shortage was two-fold: manufacturers were not delivering their discounted medicines regularly; and, local distributors were unable to keep buffer stocks of discounted ARVs because credit facilities were typically offered on normally-priced ARVs only.

MSF also cited shortages of drugs, such as AZT pills, from GlaxoSmithKline. It said these were equally unavailable in Kenya for two weeks in March and April. Epivir, another GSK anti-retroviral, was also unavailable in August last year, the health NGO stated.

"A guaranteed drug supply is crucial in antiretroviral treatment, as correct dosage and rigorous adherence to scheduling are needed for the medicines to work successfully," the agency said. "Furthermore, patients who do not closely adhere to their treatment run a higher chance of developing drug-resistant strains of HIV," it added.

GlaxoSmithkline commercial director for East Africa, William Kiarie, told IRIN on Tuesday that his firm was caught off-guard by the surge in demand for ARVs which followed the reduction in prices, and was trying to correct the situation by increasing its buffer stocks.

"Obviously, with prices going down, the demand for these drugs multiplied. Nobody was prepared for this," Kiarie said.

"The impression being created by the Coalition is not true," he added. "Our biggest ARV product, Combivir, has never been out of stock. We have only been out of stock of two items, whose demand was much lower."

Kiarie said GlaxoSmithKline was committed to making its products available at discounted prices to the Kenyan market. "We feel we have worked hard for products we don't make any profit from. We have now increased our buffer stocks, and should not experience any shortages," he added.

Joseph Ng'ethe, local manager for Boehringer Ingelheim, told IRIN that his firm had not only reduced its prices for its main ARV product, Nevirapine, but had always maintained a constant supply of the drug, which is used in the treatment of acute AIDS infections and in an effort to prevent mother to child transmission of the disease.

"As far as we are concerned, our product has always been on the market," Ng'ethe said. "We can guarantee that. It has never been out of stock."