Rush to seek Aids drugs strains clinics

There is an unprecedented number of HIV positive people getting on to the HIV treatment at a rate that is raising concerns as to whether the government and NGOs will cope.

In less than a year, more than 70,000 people have joined the HIV treatment programme, exerting massive pressure on drugs, facilities and personnel.

By the end of November 2010, the number of people on the ARVs treatment programme was 440,117, excluding those getting drugs through the private sector.

Of these, 404,198 were adults and 35,919 were children. About 8,000 people are now being enrolled on the treatment every month, notes Nascop’s Kenya Anti-Retroviral Drugs Stock Situation - December 2010 report.

It is estimated that over 400,000 HIV/Aids patients in need of HIV treatment are yet to be reached.

Concerned with how these massive numbers of patients are going to be sustained on treatment in future, the National Aids Control Council (NACC) has set up a Technical Working Group chaired by Prof Richard Muga, to come up with concrete options on HIV/Aids treatment and care.

The team is expected to present it report and policy recommendations before the June Budget.

This move is coming at a time when estimates from the government and organisations working on HIV indicate that by June this year, over half a million people will be on treatment.

The massive increase is as a result of a combination of two factors: the rapid results initiative and the adoption by the government of the new WHO guidelines that require a person to start ARV treatment when the CD4 count is 350 and below instead of the 200 and below CD4 count being used by health facilities in line with 2005 government guidelines.

What this means is all persons who have between 200 and 350 CD4 counts are now eligible to enlist in the treatment programme.

The increased numbers are also escalating the cost of running CD4 count tests and putting more pressure on the few nurses and doctors who have to manage the now high number of HIV patients.

While these high numbers are receiving praise as the country moves towards universal coverage of HIV treatment, there is worry within the health sector that funding is not increasing in tandem with the volumes on treatment programmes. Likewise, there are no assurances on future external funding.

US President’s Emergency Plan for AIDS Relief (Pepfar), which supports half of the patients on treatment, for instance, has indicated that it is not going to increase the current HIV/Aids funding for the next four years.

There is concern that even if Pepfar agrees to continue funding HIV/Aids programmes after 2014, when the current funding comes to an end, the amount is likely to remain the same or be less.

By September, 2011, the Clinton Health Access Initiative, the main funder for HIV treatment programmes for children, will stop any further procurement of paediatric ARVs, according to Nascop’s Kenya Anti-Retroviral Drugs Stock Situation-December 2010.

The government is expected to provide budgetary allocation to take care of over 35,000 children currently receiving treatment and care services or scout for a donor partner to do that.

The Global Fund, on the other hand, has been unable to realise its desired funding which might have adverse future implications on the funding extended to Kenya.

In October 2010 at the Fund’s Third Voluntary Replenishment meeting in New York, donor governments pledged US$11.7 billion for the years 2011-2013, but this was less than the US$13 billion ‘lowest funding level’ identified by the Fund as necessary to continue to expand its work and far less than the ‘ideal’ US$20 billion objective.

“As a result, expanding access to prevention, care and treatment programmes will be more difficult, and efficiency savings (such as providing money only to those countries that are seen as ‘the worst affected’) may have to be considered,” says Avert, an HIV/Aids Charity Organisation based in the UK in its recent newsletter.

The Technical Working Group on Sustainability for HIV/Aids, Kenya, 2010 report warns that between 2010 and 2014, the ARV and Prevention of Mother To Child Transmission (PMTCT) programmes are going to experience a funding gap in excess of Sh15 billion.

With such trend, the country may not be able to sustain more people on treatment programme unless the current funding sources and levels are urgently addressed.

It may not also afford to shift HIV positive persons on treatment to tenofovir from the toxic stavudine drug, in line with the WHO recommendation.

While stavudine, one of the drugs in the first line treatment of HIV, costs about US$7 for a monthly dose, tenofovir costs US$15 or more for the same duration.

At the moment, over 80 per cent of the funding for HIV programmes in the country is externally sourced. Pepfar funds the treatment and care of half of the patients, with the other half on the treatment programme financed by the Global Fund and the government.

In the 2010/2011 national budget, Sh900 million was allocated for the HIV treatment and care programmes. People living with HIV/Aids have said such amount should be increased and confirmed as a budgetary support line given every year.

The problem with heavy reliance on external funding is that it is not assured. “Using external funding to run HIV/Aids programme may not be sustainable in the long-run.

“We need to start thinking more of how to use resources generated locally to finance these programmes,” says Dr Ibrahim Mohamed, the Head of National Aids and STD Control Programme (Nascop).

To wriggle itself from this uncertainty and avoid a major crisis in the treatment programme in future, health experts say the government needs to increase its budgetary allocation to HIV treatment, care, support, and prevention programmes to more than five billion.

In addition to this, innovative approaches need to be adopted to raise funds locally. One of the proposals by NACC’s Technical Working Group that seems to be gaining popularity in the HIV and Aids circles is the establishment of an HIV and Aids Trust Fund to which the government, donors, the private sector, and individuals will make contributions.