At least nine Free State clinics have run out of antiretroviral medication in the past three months, and an increasing number of patients are bearing the brunt, with the consequences, for many of them, being life-threatening, writes Makhosazana Mkhatshwa for Daily Maverick.
One patient from the Pilomoni Clinic in Mangaung district in the Free State said: “I haven’t had my ARVs in four months. When I go to the clinic they tell me they are out of stock. I’m afraid that my condition will deteriorate, and I will get very ill.”
The consequences are long-term too: “I’m also afraid that when I present at the clinic with those infections, I will be labelled a defaulter when in fact it’s not my fault, I’m just not accessing my ARVs,” said the patient, who asked not be identified.
Local clinics’ medication is provided by the Department of Health. The failure to provide adequate access to medicines, particularly ARVs, is not only deeply disturbing, it is life-threatening. To be effective, the HIV response requires consistent adequate access to the medication.
The crisis is not only in Mangaung but widespread throughout the province. Ritshidze data revealed that from July to August, about 40 patients reported stockouts of HIV medicine. Nine clinics reported sending patients home without the medication they needed because of stockouts.
Those 40 patients are 40 too many if it means unnecessary deaths for people whose access to healthcare is promised and guaranteed constitutionally.
It is not surprising that the province is behind with the 95-95-95 testing and treatment targets, particularly the last target of having 95% of individuals on ART virally suppressed.
The Tembisa model estimates that the Free State Province has only 67% of people on ART who are suppressed. A key reason for low numbers of people not being suppressed is poor management of HIV, which could also be attributed to the inconsistent supply of ARVs, among other barriers.
For some people, stockouts mean out-of-pocket expenditure because they have to procure their supply from private pharmacies, but for other public healthcare users without money, the stockouts mean they cannot access any medication.
Many people SA, unfortunately, face the reality of staying home with their condition as they rely solely on the public healthcare system for medicine. Stockouts sometimes last short periods, but occasionally, they take months, leading to complete discontinuation of treatment.
When it comes to HIV treatment, stockouts don’t only lead to deterioration of the person’s health, but essentially cause resistance to the medicine and when the patient restarts, their body no longer responds.
Once you are resistant to one regimen of HIV drugs you have to be initiated on secondary regiments, treating you becomes more complex and the drugs get more toxic – all of which can be avoided.
For the HIV response to be effective and lead to the achievement of the 95-95-95 global goals, patients need consistent adequate access to HIV treatment, among other things. Stockouts are a major setback as they contribute to treatment interruption, causing regression in the progress of having 95% of HIV-positive people on treatment.
The Department of Health boasts about high levels of stock availability. Our experience tells another story. And, while the number of clinics without medication might be a small percentage of the national tally, that is cold comfort for the patients struggling to access essential medication.
The Department of Health must take urgent actions to address the stockouts, and to monitor the situation to ensure all healthcare facilities have adequate stock of HIV medicines and other essential drugs.
It is critical that it takes all necessary steps to ensure communities have access to their treatment and to implement a communication strategy alerting communities if there are challenges and advising on alternative routes to access their medication in the interim.
The government’s inaction continues to cause pain and suffering among poor communities, particularly People Living with HIV (PLHIV). If this continues, the Free State will see more people disengaging from care, more Aids deaths and an increase in new HIV infections due to high viral loads among PLHIV.
Stockouts should be eliminated. We have and continue to call for six-month refills of ARVs for those who are stable on ART, as this will reduce the need to go to the facility and enhance adherence to treatment.
* Makhosazana Mkhatshwa is the Treatment Action Campaign’s Research Officer.
See more from MedicalBrief archives:
Stocks of ARVs running low countrywide, says Stop Stockouts Project
DoH confirms global ingredient shortage behind ARV stockouts
High prevalence of ARV and TB stockouts — SA survey
Report shows deteriorating conditions at Free State clinics