Government takes first steps to roll out less toxic ARVs

HIV-positive people on treatment will be switched from regimens containing the antiretroviral Stavudine to less toxic combinations in line with UN World Health Organization (WHO) guidelines, according to a senior official.

"We want to start initiating patients to the safer drugs recommended by the WHO as soon as next month [August]," Ibrahim Mohamed, director of the National AIDS and Sexually transmitted infections Control Programme (NASCOP), told IRIN/PlusNews. "We will be communicating this to treatment facilities in the country; we are working [on] the guidelines which they will be given."

WHO has recommended that Stavudine be replaced with less toxic drugs such as Tenofovir (TDF) or Zidovudine, better known as AZT. Some of the side-effects of Stavudine include nerve damage and changes in body shape.

"We have sourced drugs and when they arrive, we will distribute them throughout the country once we issue guidelines to health professionals," Mohamed said.

Patients have greeted the news with cautious excitement. "People have been experiencing side-effects with Stavudine but you have to make a choice between living [with the side-effects] or refusing to take it and end your life," said Doreen Anjalo, who has been on ARVs for four-and-a-half years. "Our only worry is where the government will get the money."

Funding concerns

According to Mohamed, Anjalo is right to be concerned. Two consecutive rejections by the Global Fund to fight AIDS, Tuberculosis and Malaria mean the government may remain cash-strapped for a while and may be unable to roll out the new drugs quickly.

"Of course we are going to be gradual because we don't have much money to start implementing this at once - we expect to phase it [Stavudine] out completely by the end of four to five years."

People have been experiencing side-effects with Stavudine, but you have to make a choice between living [with the side-effects] or refusing to take it and end your life

At an estimated US$20 per person per year, Stavudine is significantly cheaper than Tenofovir, which costs $85, and Zidovudine, which costs $91 per person annually.

In addition to paying for more expensive drugs, the government has agreed to follow new WHO guidelines to treat people at a higher immunity level, or CD4 count, which will increase the numbers in treatment.

"You know we are expected to not only phase out the toxic drug but also to initiate patients [to] treatment earlier than before; the financial implications are there and we are grappling with that too," said Mohamed.

A budgetary allocation of $11.25 million for ARVs will only contribute a fraction of the cost of the additional treatment and new drugs. According to the Kenya National Strategic Plan for HIV/AIDS, the government faces a shortfall of nearly $1 billion to treat an estimated 500,000 people by the end of 2013; so far, some 300,000 Kenyans receive ARVs.

"We as the government must look for alternative sources of funding; there are various recommendations being pursued now, but we are also looking forward to getting money from the [next round of the] Global Fund," Mohamed said.

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