HIV activist groups in South Africa
are calling on the Minister of Health to address drug supply chain problems
which are causing HIV and tuberculosis (TB) drug stock-outs in the country’s Eastern Cape
According to a report launched at the
6th South African AIDS Conference by a coalition consisting of the
Rural Health Advocacy Project (RHAP), Doctors Without Borders (MSF), the
Treatment Action Campaign (TAC) and SECTION 27, 40% of the 70 facilities
surveyed by MSF and TAC during May 2013 in the Mthatha catchment area in the
Eastern Cape province had experienced HIV and/or TB drug stock-outs. More than
100,000 people, on antiretrovirals (ARVs) or TB treatment, depend on 300 facilities served by the
Medical staff at 24% of the affected
facilities were forced to send patients home without treatment because they
experienced stock-outs of essential HIV and TB drugs. These stock-outs were
reported to last, on average, 45 days at a time and have been ongoing since
October 2012. The organisations estimated that at least 5494 adults were not
able to take some of their ARVs and 561 children were sent home without
treatment since September 2012 when the drug supply issues began.
Lamivudine (3TC), tenofovir,
nevirapine, efavirenz, paediatric ARV formulations and Rifafour (a fixed-dose combination of four TB drugs) are the main
“This situation is catastrophic. It
means many thousands of people living with HIV have risked treatment
interruption for months now. The stock-outs consequently undermine clinical
benefits of life-saving ARV treatment. Over time, more deaths will occur as a
result and the likelihood of increased drug resistance is significant,” says Dr
Amir Shroufi, Deputy Medical Co-ordinator for MSF in South Africa. There have
been a number of reports of patients receiving dual or even monotherapy in the
Eastern Cape and Gauteng.
“I have been taking ARVs since 2008.
Each year this [a stock-out] happens at least six times. I go to the clinic and
they tell me there is no medication for me,” said a 36 year-old unemployed man
who lives in a rural village in the Eastern Cape.
“It is very difficult for patients.
We are telling them to adhere, but when they arrive at the clinic, which can take
up to two hours to access by car in the rural Eastern Cape areas, they are told
there is nothing for them and that they must come back another time,” said Vuyokazi Gonyela,
the TAC Eastern Cape District Organiser.
On 10 October 2012, staff at Mthatha
depot in the Eastern Cape staged a strike, following which 29 individuals were
suspended, leaving the depot with only 10 working employees. Coupled with
chronic supply chain issues, this precipitated widespread drug stock-outs in
The survey followed an intervention
by MSF and TAC volunteers during December 2012, which continued for three
months, to respond to the burgeoning Mthatha depot crisis by supporting
staffing, managing and ensuring drug delivery at the depot. This intervention
helped to clear the backlog of drug orders and to bring the depot closer to
normal levels of functioning.
“The MSF/TAC emergency intervention
in the Mthatha depot from December 2012 to March 2013 has shown that it is
possible to correct a disastrous situation with limited resources, even if the
impact remains short-lived without large systemic changes and action from the
provincial Department of Health”, said Gonyela, who led the intervention.
The main causes for the drug supply
problems are the lack of an early warning system for facilities to be able to
report potential shortages, drug suppliers failing to meet tender quotas,
government failing to pay suppliers, and poor ordering practices at health
facilities and medicine depots.
South Africa has one of the largest
ARV programmes in the world with over 2 million people initiated on ARVs in the
public sector. However, drug stock-outs are occurring across the country and
are not limited to HIV and TB medication, but extend to other basic chronic
medication such as hypertension (blood pressure) and diabetes medication, according to Dr
Francois Venter, Deputy Director of the Wits Reproductive Health and HIV Institute (WHRI). This was
reiterated by a number of healthcare workers attending the conference.
“The national Department of Health
should create an emergency team to respond to stock-outs – given the extent,
importance, and frequency of essential drugs stock-outs nationwide”, said John Stephens of SECTION27
organisations are recommending that when stock-outs are identified, the
underlying reasons must be established for each and appropriate action undertaken. The individuals responsible for the
stock-outs must be clearly
response to the drug supply problems, the organisations have set up a civil
society monitoring group which will focus on solving the drug supply problems and
continue monitoring drug supply across the country.
are aware of the drug stock-outs across the country and share your concerns,”
said Helecine Snyman, Head of Affordable Medicines at the South African
Department of Health.