COVID-19 disrupted supply of ARVs ‘particularly troubling’ in SA

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Across South Africa and around the world, the pandemic has disrupted the supply of antiretroviral drugs, endangering the lives of many of the more than 24m people globally who take the medications that suppress the HIV virus.

In sub-Saharan Africa alone, a study by UNAIDS found that a six-month disruption of antiretroviral therapy could lead to 500,000 additional Aids-related deaths.

AP News reports that the disruptions are particularly troubling in South Africa, which has 7.7m HIV-positive people, the world’s largest number, with 62% of those depending on the government’s antiretroviral programme, also the world’s largest. Anti-coronavirus restrictions have hindered both imports of the drugs and the local production and distribution of the medications.

In addition, many HIV patients have stopped going to the often-crowded clinics for fear of being exposed to the coronavirus. And others cannot afford the transport fares to reach clinics.

In June, UNAIDS executive director Winnie Byanyima said countries should “urgently make plans now to mitigate the impacts of higher costs and reduced availability of antiretroviral medicines.”

“We’re worried that we’re going to be seeing an increase in deaths in co-infections such as TB and other opportunistic infections,” Dr Nomathemba Chandiwana, an HIV research clinician, is quoted by AP as saying.

Clinics in central Johannesburg have seen a 10% to 25% drop in people coming for HIV treatment, she said. On top of that, several clinics have had to close temporarily when nurses and doctors have become sick with COVID-19.

The report says COVID-19 is similarly disrupting vaccinations. The past few months have seen a 25% reduction in childhood immunisations, according to Shabir Madhi, a professor of vaccinology at the University of the Witwatersrand (Wits), who warned of possible outbreaks of measles. The diagnosis and treatment of tuberculosis also has also been hampered by the pandemic, risking the lives of many of South Africa’s neediest citizens, health experts say.

“Disruptions to these medications is a public health problem. It threatens the poor and most vulnerable,” said Vinyarak Bhardwaj, deputy director of Doctors Without Borders’ programme in South Africa, which has HIV programmes in the Western Cape and KwaZulu-Natal provinces.

Reliable supplies of antiretroviral drugs are so critically important in South Africa that a monitoring programme, Stop Stockouts Project (SSP), was created in 2013 and is closely tracking and responding to the disruptions amid the COVID-19 pandemic.

 

All over the country, the SSP received reports of ARVs stockouts and shortages. In Gauteng alone, Health-e News reports that the number of ARV stockouts has doubled, with and that both TEE and TLD treatment combinations showing similar number of stockouts.

“The project has received reports of both shortages and stockouts from Gauteng especially in the Ekurhuleni district where some patients were give 14-day treatment while others were referred to other facilities meaning they left their nearest clinic with no medication,” says Ruth Dube of SSP.

The SSP is working with the Treatment Action Campaign to advocate for chronic patients to receive four to six months’ supply to minimise their exposure to COVID-19 in public spaces such as clinics.

“There might be a little impact caused by lockdown but the problem of shortages started way before lockdown,” says Dube.

To decrease the shortages of medicines in facilities, SSP proposes better monitoring and advanced warning facilities, with stockpiling of essential medicines before stocks are depleted.

 

Full AP News report

 

UNAIDS material

 

UNAIDS study

 

Full Health-e News report

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