Botswana faces mass ARV resistance crisis following drug shortages
by Sunday Standard Reporter
Thousands of HIV\AIDS patients who are on government sponsored ARV therapy face drug resistance following recent questionable stop gap prescriptions in the wake of drug shortages.
Government dispensaries have for the past three weeks been rationing double doses of children’s ARV drugs to infected adults because public clinics and hospitals had run out of ARV drugs for adults. This has sparked fears among medical practitioners of a possible ARV therapy mass resistance crisis in the country.
Cases of ARV treatment adherence problems are also anticipated after public health facilities decided to ration drug supply to three days, down from the usual one month supply, adding to the fears of drug resistance.
Drug resistance refers to the ability of some microorganisms, including viruses such as HIV, to adapt so they can survive and multiply in the presence of drugs that would normally kill or weaken them. For HIV, drug resistance exists when the virus can multiply in the presence of one or more antiretroviral (ARV) drugs.
The standard treatment for people with HIV infection is called antiretroviral therapy (ART), which consists of at least three ARV drugs from at least two different classes of drugs. For the most part, ART is safe and effective in suppressing the ability of HIV to multiply and in preventing AIDS or death from HIV infection. Under some circumstances, ART fails to suppress HIV replication.
This could be due to suboptimal combinations of drugs, abnormal metabolism of the drug, or the person on ART not taking all the ARV drugs as directed. When HIV is not adequately suppressed, virus resistant to particular drug can emerge and keep multiplying to outnumber virus that is not resistant.
There are also concerns that double dosing of ARV treatment will result in the doubling of preservatives which may be above safe levels.
The Botswana Network on Ethics, Law and HIV/Aids (BONELA) reacted angrily this week saying it has learnt with shock that life-saving antiretroviral drugs (ARVs) are not available to those who need them most in health facilities countrywide. While by Friday evening senior government officials had started to hint that ARVs had arrived, there have been stock shortages for the last three weeks
in a number of Government hospitals.
BONELA Director, Uyapo Ndadi, said not only does the situation of drug unavailability show inefficiency on the part of Ministry of Health, but it indicates how little Minister John Seakgosing cares about his constituency. Ndadi said a lack of antiretroviral drugs in health facilities will result in non-adherence, drug resistance and death. "Minister Seakgosing and his technocrats have proved over and over again that they can misuse tax payers’ money in running the Ministry of Health." In a hard-hitting statement, the BONELA Director says "we are shocked that there is a short supply of antiretroviral drugs. Clearly this is a crisis of unprecedented proportions. Does it make sense to burn P21 million worth of drugs and a month later there is crisis of short supply. Someone must take responsibility and that should be the minister. He must go NOW. Our health care is our treasure and we should jealously guard against throwing it out of the window. Many people's lives hang on the antiretroviral drugs," said Ndadi.
Ndadi is of the view that the short supply is not a result of money but of bad management in procurement.
"I dread the day the central government took health care from local government without capacity and adequate preparation. Our clinics were doing just fine. Are they anymore? No," asserted Ndadi.
A senior medical practitioner, Dr Joe Makhema, on the other hand called for sensitivity in how the situation is addressed going forward. In an interview with the Sunday Standard, Dr Makhema said all parties, including the media, should have an appreciation of what is at stake.
"From a clinical perspective we all know the importance of adherence. Patients cannot spend a day without drugs. I am very much aware that officials at the Ministry of Health are doing their best. We need to source whatever drugs are available in the private sector for those patients who need them immediately. The fact of the matter is that we can't beat a dead horse about it; stock-outs are incidents we all fear. We hope it doesn't happen again," said Dr Makhema.
He said what was happening was unfortunate but stressed the importance of dealing with the situation in a more sensitive and mature way.
"We have to prevent this from happening again. I trust it will be the last. The media too should be sensitive," said Makhema.
Another medical practitioner who spoke to Sunday Standard on condition of anonymity said what was unfolding was a "disaster" that could take long and prove very expensive to correct.
When contacted about the situation the Director of HIV/AIDS Prevention & Care in the Ministry of Health, Refeletswe Lobelonyane, said drug supplies had arrived and that facilities had been instructed to go back to issuing a full month's worth of supply to patients.
Government health facilities throughout the country which are already understaffed were this week overwhelmed by the work load which increased many fold and queues at ARV dispensing work stations were at an all time long, following the decision to ration treatment to three days from the usual one months supply.