Cost of Anti-Retroviral Treatment On Developing Nations. 29/10/10

For every two people on ART, five more are in need.

AllAfrica

Harare — For every two people on ART, five more are in need.

Currently, there are 260 000 people on treatment nationwide and 593 000 are in need right now, according to Dr Tsitsi Mutasa the national ART co-ordinator.

This paints a grim picture for those testing HIV+.

It makes it even more difficult to persuade a friend or relative to take an HIV test if ART is not easily accessible.

One is bound to ask what would be the use if one does not afford the medication and expects to be registered on the Government ART programme?

I would still maintain that having your health monitored still makes sense.

This puts the figure at only 7 percent of those in need of ART being able to access it.

Only 20-30 percent of orphans and vulnerable children are receiving assistance.

The majority are not accessing it.

The figure is far off the expected region.

The principle of universal access tries to cover as many of the vulnerable groups to ensure equity.

It really sounds depressing, but should not dissuade one from knowing one's status.

Zimbabwe's population stands at 13 million and for this 1,1 million people today are living with the HIV virus.

The prevalence rate has gone down, possibly due to ART and behaviour change as presently 1:6 people are infected with the virus.

In the past, the prevalence rate was 1:3 and stood at a dangerous level.

The current figure is still unacceptably high but this move in the right direction should be applauded and more effort should be made to ensure the figure keeps going down.

Inspite of the gloomy picture painted above, one still needs to know one's status.

The advantages of knowing your status are many.

As scary as it could be, not knowing your status could be equal to a captain in a radarless ship with no compass taking into the stormy oceans.

In does not follow that everyone who tests HIV+ should take ART.

If one's CD4 count is still able to see the person lead a healthy life then that person has not yet got to a stage of needing ART.

A person testing HIV+ and has a CD4 count of 600 has no need to commence ART.

A CD4 count of 350 and below according to new WHO regulations is a requirement for one to commence ART.

Medical personnel assess any person who tests HIV+ and one can be recommended to start the prophylaxis regimen and not ART.

On this stage one is only on antibiotics and cotrimoxazole which is affordable and easily accessible is used.

The WHO recommendation to up the threshold is not sustainable in the case of Zimbabwe and other developing nations in my opinion.

My concern with these regulations are that Zimbabwe as a developing country has many challenges and the health sector also feels the pain of funding shortages.

Currently when it required one to have a CD4 count of a threshold of 200 and below to commence ART we had a waiting list on the national programme.

This figure of 593 000 in need of ART means the figure will double if the WHO recommendation is implemented.

The reasoning that putting a person early on ART has merits can not be argued, but my argument lies in the fact that as a country we cannot sustain that requirement.

We depend on the Global Fund and NAC, which are struggling with the swelling numbers on the waiting list already using the threshold of 200.

What is suitable for a first world country can not be suitable for a developing country.

I have no conflict of interest but what is suitable for Zimbabwe as a country cannot be suitable for say Italy.

WHO should not have a blanket dose for the whole world.

Assessment and suitability to contain situations should be used as a ranking and recommendations should be made regionally on suitability.

This implies that an additional burden of HIV+ infected people countrywide should now be considered eligible for ART.

For those who afford it on their own there is no problem, but for those who need to be put on the free Government programme, then there is a hiccup.

Scaling up access to antiretroviral drugs (ARVs) will soon become an impossible task under the new guidelines.

Ten years ago testing HIV+ was like a death sentence.

Medication was expensive in the region of 12 000 pounds to 15 000 pounds annual for a person. This prohibitive price meant poor countries could not even dream of supporting national programmes.

Then only brand names were in circulation and the introduction of generic medicines saw the prices plummet to affordable levels.

Today with generic medication the prices have even gone down to US$88 annually for a person.

There is debate currently taking place that use of generic brands should be stopped.

This could lead to massive deaths in Zimbabwe and countries in the same economic status. The country relies on the use of generic brands.

For the layman a generic medication works the same way as a brand medication.

A brand is patented and no other companies can make it for a duration of twenty years.

Were it to be equated to electrical gadgets it would be a brand name say in a television.

So under those conditions generic medicine which is mainly made by Indian companies and of late a local company Varichem has opened a plant to make generic ARVs could see their efforts being thwarted.

Since the full implementation of the Trade-Related Aspects of Intellectual Property Rights Agreement (TRIPS) by the World Trade Organisation in 2005, supply of generic drugs for new ARVs has no longer been possible, unless through the use of compulsory licensing systems.

However, the use of such systems in their present form remains not only complex but also unattractive to developing nations.

Can the developing nations remain silent when it is a matter of life and death for their populations when the new measures are implemented?

The WHO recommendation could be on the framework of what is good for the goose should be good for the gander. It is not necessarily so.

Those who afford to buy brand names for electrical gadgets can buy the brand names, but the poor should be allowed to buy any form of television, it still functions in the same manner they can watch the same programmes.

This could be the nearest explanation of brand and generic medicine.

A doctor who commented on condition of anonymity said that affordability of ART remains a challenge and for as long as we rely on donor funding we remain a dumping ground.

"Stavudine which is mainly used in the first line has long been discarded in the developed world for better replacements, but that is what we still have donated here, for me no medication is better than giving something that has been proved to have severe side effects," he said.

He pointed out that he stopped prescribing it to his patients three years ago.

He urged people on ART to call their health centres or doctors if they experienced any of the following allergic reactions: hives; difficulty breathing; swelling of your face, lips, tongue, or throat.

- liver damage leading to -- nausea, stomach pain, low fever, loss of appetite, dark urine, clay-coloured stools, jaundice (yellowing of the skin or eyes);

- lactic acidosis -- muscle pain or weakness, numb or cold feeling in your arms and legs.

- uneven fat deposition.

He recommended those who could afford to change from using Stavudine which is not user friendly.

This change can only be done by professional health personnel not by backyard friends and relatives in the Diaspora sending family and friends replacement ART.

Your health matters, only let the professionals handle that.

In all your gettings, get understanding.