Covid-19 pandemic disrupts the provision of ARVs to people living with HIV in Kenya and globally

Covid-19 pandemic disrupts the provision of ARVs to people living with HIV in Kenya and globally

Jun 29, 2020 COLUMNS by admin

By The WoN Team

At 19-years, Rose is among the 1.5 million people living with HIV in Kenya and who are finding it increasingly difficult to access antiretroviral therapy treatment as the Covid-19 pandemic continues to wreak havoc on lives globally.

Due to the restrictions imposed on movement of people in some counties by the government since March, Rose is stranded in her rural home in Nyeri and is unable to access her supply of ARVs which she had left behind in Nairobi. She is also weary of stigma against people living with HIV/AIDs that still persists in this part of the country. That fear too drives her against seeking services at any other medical facility in the area.

“I had travelled on what was meant to be a short visit to my ailing mother when the government abruptly imposed the restrictions and I am therefore unable to access my ARVs which I left behind in Nairobi,’’ Rose says.

“I have not disclosed my HIV status to anyone and I cannot access the medicines in our rural health facility since it’s not youth-friendly. I am, therefore, waiting for the restrictions to be lifted so that I can access my ARVs in Nairobi,” she adds.

The teenager was infected with HIV when she was 15 years old.

Rose is not alone.  Naomi and her 10-year-old son are also living with HIV/AIDs and they collect their ARVs from a hospital in Nairobi, where they also attend their monthly clinic and associated services. They too are unable to travel from their Nyahururu home, in Laikipia County, to Nairobi, for their antiretroviral therapy treatment because of the lockdown. The 32-year old mother of one is worried that should the restriction measures meant to curb spread of the deadly Covid-19 not be lifted-at least the cessation of movement-their health would degenerate.

Now, the World Health Organisation and UNAIDS warn that disruptions to the regular taking of HIV medicines—due to the Covid-19 pandemic disruptions, places millions of lives at risk, with a new surge in HIV infections and deaths, a likely consequence.

A modeling group convened by the organisations estimates that if efforts are not made to mitigate and overcome interruptions in health services and supplies during the Covid-19, a six-month disruption of ARVs could lead to more than 500,000 additional AIDS-related deaths, including Tuberculosis in sub-Saharan Africa in 2020-2021.

“Lockdowns have impacted both the transport of goods across the value chain of production and the distribution of HIV medicines,’’ says the report titled, “The impact of the COVID-19 response on the supply chain, availability and cost of generic antiretroviral medicines for HIV in low- and middle-income countries”

It adds: “Barriers to the supply chain and a forecasted economic shock indicate a possible fluctuation in the availability of antiretroviral medicines and an increase in cost.”

The report indicates that the deadly pandemic is spreading across countries and regions at a rapid pace with lockdowns, border closures and restrictions on the movement of people and goods causing a huge impact on the value chain of production and consumption across different economic sectors.

Experts identify Kenya as one of the countries with the highest number of people living with HIV who are on antiretroviral therapy treatment in the world.

Out of the 1.5 million people living with HIV, 1.2 million have been enrolled on the life-prolonging medicines.

This translates to Kenya’s HIV treatment to represent coverage of 75 per cent compared to the global average of 53 per cent.

Globally, by the end of 2018, 24.5 million people were on antiretroviral treatment, according to the WHO and UNAID’s report.

The assessment of the situational landscape was based on intelligence collected from eight generic manufacturers of antiretroviral medicines in India that together account for more than 80 per cent of generic medicine production worldwide, the report says. It also was based on a survey sent by UNAIDS to government departments in seven additional countries —Kenya, Brazil, Indonesia, South Africa and Thailand—while responses are awaited from Egypt and Uganda, it adds.

Other barriers linked to the coronavirus disease identified include logistical issues faced by manufacturers that may indicate a potential disruption in the next few months.

Consequently, countries are advised to identify the risk level for the stock of all antiretroviral medicines, while coordinated action by governments is necessary to ease the supply chain and the distribution of medicines to facilities.

“Buyers (both donors and domestic governments) should enhance transparent and timely communication between countries and suppliers,’’ adds the report.

It indicates that the assessment of the situational landscape was based on intelligence collected from eight generic manufacturers of antiretroviral medicines in India that together account for more than 80 per cent of generic medicine production worldwide.

The onset of the Covid-19 pandemic, sea shipments have slowed down in many countries due to slow movement of goods in ports due to the lack of customs personnel as well as shortage of workers for loading/unloading ships.

“Other factors include lack of road transport, which makes getting goods to the port a challenge while Air freight processes have also become more complex,” the report says, adding that in three out of five countries, air freight is undergoing lengthy bureaucratic customs certification processes and delays.

In Kenya, the National AIDS and STIs Control Programme Head, Dr Catherine Ngugi has identified several challenges facing the provision of ARVs to people living with HIV amid the Covid-19 pandemic crisis in the country.

They include access to services in the face of restriction of movements, diversion of health care workers towards the Covid-19 response; impact of coronavirus on health care workers responsible for offering HIV services, decongestion of clinics; HIV commodity security and effects on vulnerable populations care and treatment services.

Others cited are, spaced out daily appointment, giving exact times of appointment while clustering patients per hour to avoid crowding in customer care centres.

 Most clients, Dr Ngugi says, had been re-called and given three months of ART while viral load monitoring is ongoing as all regional laboratories are operational.

“The Health Ministry plans to use Viral Load and GeneXpert platforms for mass testing in case of reduced operations while prioritisation will be given to those who are more vulnerable,’’ she says.

“We plan to adopt a two-pronged approach—providing three-month ART refill for all PMTCT mothers, and giving monthly clinic schedules. However, the ongoing challenge is low stocks of Nevirapine suspension (NVP) and Zidovudine (AZT) prophylaxis syrups for the 139,000 children living with HIV.’’

 Dr Ngugi also identifies key populations—who experience a disproportionate burden of poverty, marginalisation, high mobility and close physical contact with others through social and sexual practices —and are not on ART and not virally suppressed, at a higher risk of acquiring coronavirus.

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