US helps bridge gap in ARV supply

The US government has boosted its assistance to Uganda's AIDS programme with an emergency supply of antiretroviral (ARV) drugs worth more than US$5.5 million to begin to put an estimated 72,000 HIV-infected people on the treatment over the next two years.

But it has also served notice that Uganda must find new sources of funding if its HIV programmes are to be sustainable.

"This donation by the American people will help bridge the gap in the availability of ARV drugs in Uganda and prevent stock-outs of the life-saving HIV/AIDS medications," said the US ambassador to Uganda, Jerry Lanier.

The donation is part of an increase in funding recently announced by the US President's Emergency Plan for AIDS Relief (PEPFAR) following appeals from Ugandan AIDS activists and health providers struggling to put patients on ARVs.

"I am glad that the donation was done in kind because the procurement cycle is too long," said Zainabu Akol, director of HIV programmes in the Ministry of Health.

Uganda receives more than $280 million a year from PEPFAR. An estimated 220,000 Ugandans - 53 percent of those in need - are on ARV treatment.

US warning

"The US Government cannot - and should not - be the only source of funding for Uganda's HIV and AIDS prevention, care, and treatment efforts," said Lanier.

He noted that the role of US aid programmes was not to lead another nation's response, but rather to work with it to identify opportunities where US technical and financial support could make a useful contribution.

"After 2013, the Global Fund and other donors will be contributing more. PEPFAR shall not increase funding after that because it is dangerous to be reliant on one country," Michael Strong, PEPFAR Uganda coordinator, told PlusNews. "We shall continue treating the people on treatment for life but we shall keep it at that."

"You can't have somebody from outside own 90 percent of your house - that mathematics does not tally. If for any reason that support is cut off, what happens?" asked Musa Bungundu, UNAIDS country coordinator for Uganda. "African countries are not poor, they just have other priorities; I would highly advocate for more resources from inside."

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The Ugandan government has made efforts to increase internal funding for HIV - Akol noted that the budgetary allocation for the purchase of anti-malarial drugs and ARVs had increased from $30 million to $75 million from 2009/2010 to the current financial year.

Efficiency

Akol also noted that under a new PEPFAR strategy - announced in December 2009 - more efficient systems would be put in place. For instance, there is a new supply management system with a centralized procurement system that will cut ARV costs. Uganda has experienced regular ARV stock-outs, partly because of poor supply chain management.

"We have realized that this system will cut costs by half," she said. "We have learnt many lessons over time; we have a lot of money but not many people are being treated."

A more country-driven response is at the centre of the new five-year PEPFAR strategy. US Global AIDS Coordinator Eric Goosby recently told IRIN/PlusNews that in the future, it would be important to "get smarter" at delivering services and reduce costs while still expanding treatment programmes.

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