In mid-April this year, Stanley Takaona, 56, who is on antiretroviral treatment (ART) went to Harare Hospital Opportunistic Infections clinic to collect his three-month supply of antiretroviral medicines. According to a Daily Maverick report, it was when he was about to take the medicines at home that he realised they had expired and no explanation had been given by either the nurse or pharmacist at the hospital. The drugs had expired in June 2018. “I took photos and send them to the sister in charge only to be told that the authorities have extended the drugs for one year, that is until June 2019 even though my supply was going beyond June,” says Takaona.
The report says Takaona, now based in Murewa (less than 150km from Harare), was started on ART in 2002 and has been on HIV treatment since then. “One of the conditions we are told when being initiated on treatment is to check the expiry date and to maintain 100% adherence. Being given drugs that have expired is equal to defaulting,” Takaona added.
Reverend Maxwell Kapachawo, based in Harare, is quoted in the report as saying that information is not cascading down to the consumer. “The person dispensing the medication doesn’t inform the consumer, thereby raising fear and alarm,” Kapachawo said. “We lose trust in these health institutions when we are supposed to trust them particularly when we discover at home that the medication has expired.”
Currently, around 1.1m people are on ART of the 1.3m living with HIV in the country. According to Dr Evans Masitara from the Zimbabwe Association of Doctors for Human Rights, the date that you see printed on the pill bottle is the date until which the medicine’s manufacturer will guarantee the drug’s safety and potency. How long a drug actually remains safe and effective is often a matter of debate.
“In Zimbabwe, Health Professions Authority (HPA) and Medicines Control Authority of Zimbabwe (MCAZ) guidelines say expired drugs should be removed from the shelf and destroyed. But if they are the ones remaining the benefit of giving ART which is deemed expired outweigh the dangers of not giving ART at all,” Masitara said.
The report quotes Dr Owen Mugurungi, the director of HIV/Aids in the Ministry of Health and Child Care in Zimbabwe, as saying that people should not be worried because this has gone through MCAZ. “As MCAZ has tested and finds the medicines still safe for consumption, health workers should communicate and inform the patients,” Mugurungi said.
Takaona, who is also the president of the Zimbabwe HIV/Aids Activist Union Community Trust, believes there is a need for them to do their own investigation on the effectiveness and safety of the extension. “This is not fair because no proof was given. We were just told they were safe and had a shelf life of another year,” Takaona said. He added that as the leadership of people living with HIV they should have been engaged when the tests for extensions were done because “this involves human lives”.
Sabastian Chinhaire, former board chair of the Zimbabwe National Network of People Living with HIV (ZNNP+) regards the situation as unacceptable and a sign that something is amiss. “This is not only unacceptable but unusual for people to be given drugs that expired last year. Someone has neglected his/her duties in the chain supply line. Why we have to wait for drugs to expire is simply inefficiency,” Chinhaire is quoted in the report as saying.
He added that most (80%) of the country’s ARVs are from donors and that can lead to a case of either overstocking or shortages and this boils down to poor service delivery. “There is no way this can be verified by us consumers of the drugs, it’s a catch-22 situation whereby we end up taking up these drugs since they are life-saving. We have always advocated for domestic funding for these essential medicines and donor dependency is risky. What will happen if our major donors, such as the Global Fund, withdraw their support? It will certainly be the end of life for 1.3m people living with the virus in the country,” added Chinhaire.
MCAZ spokesperson Richard Rukwata was quoted as saying it was allowed by law to extend the shelf-life of expired drugs. “Shelf-life and expiry dates are determined scientifically and MCAZ has the authority to extend expiry dates after doing some test to see if the drugs in question can continue to be used or not,” said Rukwata.
“We just have to believe them and respect their position as we don’t have a choice or any substitute,” said Kapachawo.
Takaona said in the report that though Zimbabwe might not afford to be self-sufficient as a country, it must be seen to be doing something, particularly ensuring the Abuja Declaration target of allocating 15 % of the country’s budget towards health is met.Daily Maverick report