Widespread stock outs of HIV, TB meds ‘a national crisis’

South Africa is experiencing yet another shortage of ARVs. (Photo: Jean-Marc Giboux)

The findings are part of a new report released 28 November by a civil society coalition comprised of organisations including the Treatment Action Campaign, Medicines Sans Frontières and the Southern African HIV Clinicians Society under the banner of The Stop Stockouts Campaign.

Between October and September 2013, the campaign interviewed about half of all health facilities in the country. One-in-five health centres surveyed reported shortages of HIV and TB medicines in the last three months.

The Free State was the worst affected province, with more than half of facilities surveyed reporting stock-outs.

Percentage of surveyed facilities reporting ARV and or TB stock outs
Percentage of surveyed facilities reporting ARV and or TB stock outs

In Gauteng, about 20 percent of all health centres went without the vital medications – putting the country’s richest province on par with the impoverished Eastern Cape. Ekurhuleni and Johannesburg were among the province’s worst offenders, with roughly a quarter of health facilities reporting shortages.

According to reports delivered in provincial legislature last week, the province will miss its annual HIV treatment initiation target by about 280,000 people.

In Tshwane, about 21 percent of health posts surveyed experienced stock outs.

Olga Monyane a patient from Winterveld outside Pretoria, said she had been turned away without ARVs so often she thought she was going to die.

At that time, sisters at nearby clinics confirmed both the ARV lamivudine as well as the new three-in-one, fixed-dose combination (FDC) ARV were out of stock.

“The minister, during the launch for the FDC, promised trucks full of stock,” said one nurse on condition of anonymity. “We are still waiting.”

About eight percent of all clinics surveyed nationally reported that the newly introduced FDC ARV was missing from their stock rooms. About 20 percent of health centres nationally reported sending patients like Monyane home empty-handed during stock outs that lasted about a month in some cases.

In the Western Cape, about nine percent of all City of Cape Town facilities surveyed reported running short of drugs. . National Health Insurance pilot district Eden was second worst affected district followed by the Central Karoo, which also made headlines earlier this year for having the country’s highest stillbirth rate, according to the District Health Barometer.

Health officials, including heads of departments as well as depot or facility-based pharmacists, can be sued in their official capacities for failing to ensure access to medicines, according to Section27 attorney Sasha Stevens.

The worst may be yet to come

More than two million South Africans are currently on HIV treatment and about 300,000 are treated annually for TB. Monitoring of HIV medicines is relatively stronger than that of other medicines, meaning the new report could just be the tip of the ice burg, according to Dr Indira Govender from the Rural Doctors Association of South Africa.

The campaign estimates that at least 90,000 HIV patients were directly affected by the shortages.

SSP survey found that 20 % of affected health centers sent patients away without treatment - shown here in red
SSP survey found that 20 % of affected health centers sent patients away without treatment – shown here in red

But Dr Francesca Conradie, president of the Southern African HIV Clinicians Society, cautions the worst may be yet to come, as the stockouts could lead to drug-resistance..

Drug resistance can develop when HIV and TB patients are unable to take their daily treatment. Developing drug resistance means patients must be switched to more expensive treatment regimens with more possible side effects. For TB patients, it can also mean running out of treatment options altogether.

Conradie says the campaign plans to continue monitoring stock outs to check whether shortages can be linked to rising resistance rates but in the meantime, it is clear stock outs are unravelling years of work devoted to HIV and TB treatment adherence.

“We’ve spent the last several years telling patients to take treatment religiously, to not miss a dose, to set special alarms to remind them,” Conradie told Health-e News. “Now that patient goes to collect their medicine and the person in authority says, ‘we don’t have them’.”

Worse yet, clinicians may be unwittingly putting patients at risk especially when it comes to the ARV efavirenz, which was lacking in about 18 percent of clinics.

“Stopping and starting efavirenz in use with most other medicines is dangerous for patients because of the side-effect profile and because resistance can develop very quickly,” she said. “In a case where a patient may be on a combination of efavirenz, lamivudine and tenofovir – if you don’t have one of these and are not able to give a reasonable alternative,  it is better to not give any ARV at all until you can restart a full regimen.”

“Some experts are warning that we could soon see a global shortage of efavirenz,” she added. “The degree to which that will affect us will depend on how fast we can roll out the FDC.

The Department of Health is taking the report seriously but says that the report may exaggerate the scope of stock outs in the country, according to Department of Health spokesperson Joe Maila.

“We don’t think that we are having that kind of crisis although we do take the issue of stock outs very seriously,” he said. “We are running one of the largest treatment programmes in the world with over 2.4 million people on treatment so we are going to have these kind of challenges but to suggest it’s a ‘national crisis’ is not correct.” – Health-e News Service.

OurHealth citizen journalist Mishack Mahlangu contributed to this report.

Read more: “Medicines go missing – and so do budgets”




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