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South African HIV and TB Patients Experience Interruptions of Life-Saving Drugs

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Kim Lewis
Thousands of HIV and TB infected people in South Africa’s Eastern Cape Province are at risk of death and other diseases due to ongoing interruptions of their life-saving drugs. That, according to a report by the international medical aid group, Doctors without Borders (or MSF.)      

The report was highlighted at the South Africa Aids Conference that opened June 19 in Durban. It was released five months after a coalition of advocacy groups raised an alarm about the crisis at the Mthatha Medical Depot, the main supplier of anti-retroviral and TB drugs for the province. The groups include Doctors without Borders, the Rural Health Advocacy Project, the Treatment Action Campaign, and SECTION27.

“We phoned one-hundred facilities in the eastern Cape and found that out of these, forty have had stock-outs of TB drugs and anti-retroviral or HIV drugs within the last three months,” said Gilles Van Cutsem, medical coordinator for Doctors Without Borders in South Africa.

Speaking from the conference site, Van Cutsem confirmed that stock-outs were lasting an average of 45 days, and that on the day they phoned the facilities, 25-percent still had stock-outs.

The MSF official explained that the stock-outs had tangible consequences.

“A large number of patients have had to interrupt their anti-retroviral, and or TB treatment -- which increases your chances to get resistance to treatment, and ultimately to failed treatment, and this would lead to increased excess deaths and illnesses,” he said.

Van Cutsem blamed the recurrence of stock-outs on, among other things, the failure of manufacturers to produce drugs as quickly as they promised. As a result, he lamented, Mthatha Medical Depot that services three-hundred clinics in the area is not adequately supplied.

Van Cutsem added staff shortage and the drug procurement process also contribute to the ongoing stock-outs at the Mthatha Depot.

“Because there has been this ongoing crisis in supply, the clinics have also developed erratic ordering behavior because they never receive the drugs they order. They start ordering more, so they can make up for lack of stock. So when that happens at a very large scale, then that whole supply chain is broken,” explained Van Cutsem.

The MSF official said at the start of the conference, the provincial manager of pharmaceutical services requested his group’s help in recruiting temporary staff for the Mthatha Depot. He said MSF is collaborating with provincial and national health authorities to address this and other issues related to the stock-outs.

Van Custem said the recurrent stock-outs will have long-term effects on those living with HIV and TB.

“Stopping anti-retroviral drugs doesn’t have an immediate effect. You’re not going to feel sick the same day, but it increases your chances of becoming resistant to the drugs. And so the real effect of these multiple interruptions are only going to be seen much later when patients start failing treatment they need,” he explained.  
       
According to Van Custem, that puts affected patients in a highly vulnerable position. He said those in need are left on their own to find drugs at another far away clinic, or be forced to stop treatment all together.

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