By Michael Gwarisa
ZIMBABWE today (21/08/2017) woke up to devastating news that the country’s public health and pharmaceutical institutions have been hit by massive Anti Retro Viral (ARV) drug shortages.
According to an article in the Herald, HIV positive people on second line Abacavir ARV drugs are the most affected and they are being given a week’s supply of the drug instead of the traditional three moths supply due to stock outs. It is believed that the huge stock outs and shortages in drug supplies are being exacerbated by the prevailing cash crisis which has seen local health institutions and pharmacies failing to make orders with international suppliers.
The issue of drug shortages however could soon become the least of our worries as we might be faced with yet an even worse and life threatening situation whereby more cases of ARV drug resistance will be recorded. The shortage is affecting not less than one million people who are on second line ARV treatment.
Even though the National AIDS Council (NAC) had budgeted for $20 million for the procurement of the second line drugs since they are not catered for under any funding from the donor community and development partners, they are are yet to receive their allocation and they have not made any procurement since beginning of the year.
Funding for first line ART drugs has however been secured up to the year 2020, and procurement is done through NAC and NATPharm.
A ministry of health Pharmaceuticals official said, availability of first line treatment medicines for HIV is adequate to support targets up to 2019. However, there has been an increase in demand for second and third line ARV medicines due to increased Viral Load (VL) testing.
According to the World Health Organisation (WHO) recent report, Zimbabwe is amongst the six countries in Southern Africa that have registered vivid signs of HIV drug resistance. With the ARV stock outs in place, Zimbabwe stands at an even greater risk of battling the drug resistance issue.
WHO said Zimbabwe had exhibited huge signs of pre-treatment Drug Resistance which is above 10 percent, meaning already 10 percent of people who have not been initiated on ARVs in Zimbabwe have a drug resistant virus.
Health Care practitioner Dr Cleopas Chimbetete said that the biggest cause of HIV drug resistance is non adherence or defaulting in taking medicines according to the prescribed schedule and the issue of ARV stock-outs was a worrisome phenomenon and a threat to the fight against HIV.
Now, with HIV positive people going for weeks without the second line treatment drug, more individuals are at risk of falling victim to drug resistance and this might derail efforts and progress that has already been registered in terms of combating AIDS in the country.
HIV drug resistance is whereby the HIV Virus is able to make new copies of itself in the presence of ARVs. Meaning one may be on treatment, or taking ARVs but the ARVs will no longer be able to work against the virus hence the virus has developed resistance.
The kind of drug resistance that most people who are already on ART face is known as pre-treatment drug resistance, this means that when you are put on ARVs, you already have HIV drug resistant virus within you.
So whether you had taken ARVs before and you had not told us, or you were infected by a virus that is already drug resistant but what we know is at the time of starting ARVs, you already had a virus that was resistant to drugs.
Having said that, government has to up its efforts to ensure the country’s healthcare centers and pharmacies are well stocked with ARV medicines of all lines.
The $20 million that NAC asked for must be availed sooner than later if this catastrophe is to be averted. Surely if government can allocate millions of dollars towards some non critical gatherings and events, its also noble that it prioritises the health of its citizens.