Uganda has run out of most antiretroviral drugs (ARVs), HIV testing kits, drugs to treat opportunistic infections and several crucial diagnostic tools for HIV care, according to a recent Ministry of Health stock status report.
The report, posted by the ministry on 27 May, listed the status of medical supplies as of 1 May. It reported that central stocks of a number of first- and second-line ARVs, paediatric ARV formulations and HIV test kits were either out or below the minimum stock levels in country's three government warehouses - National Medical Stores (NMS), Joint Medical Stores (JMS) and Medical Access Uganda Limited (MAUL).
The report noted that the antifungal drug Fluconazole, used to fight opportunistic infections in people living with HIV, was out of stock at all three warehouses, while laboratory commodities for haematology, clinical chemistry and assessing CD4 counts - a measure of immune strength - were also running dangerously low. In addition, stocks of "nearly all first-line TB [tuberculosis] drugs" were low.
The ministry noted that a number for of requests had been sent to partners - including the US President's Emergency Plan for AIDS Relief (PEPFAR), the Global Fund to fight AIDS, Tuberculosis and Malaria, and pharmaceutical giant Pfizer - to boost stocks.
Ruth Aceng, the director general of health services at the Ministry of Health, told IRIN the countrywide ARV shortage was result of government's move to increase the number of ARV-accredited sites, on national, district and county level, to improve access to HIV treatment. The government has recently expanded its prevention of mother-to-child HIV transmission programme, and it is also running a voluntary medical male circumcision programme and a provider-initiated HIV testing programme, all of which have contributed to increases in the demand for tests and treatment.
Demand outpacing supply
As of 2012, some 62 percent of those needing HIV treatment in Uganda were on ARVs, up from 50 percent in 2010; that figure is expected to rise again in 2013.
"It's true we have an ARV shortage in the country. We made a deliberate effort to get everybody who was eligible for ARVs to be enrolled. The deliberate, ambitious expansion and the scale-up has brought the current stock-outs we are experiencing," Aceng, told IRIN. "Instead of enrolling 100,000 people annually, we decided to put all 190,000 who were eligible for treatment this year. This was a little ambitious plan for us."
"We are working around the clock with our partners to normalize the situation. We expect the drugs to arrive in the country in the next two weeks or so," she added.
Civil Society Organizations (CSOs) working to increase access to ARVs, TB drugs and other essential medicines said in an 11 June statement that 24 districts had reported stock-outs of HIV test kits. Health officials now fear the stock-outs will lead to drug resistance, illness and death.
"We call upon the members of the country coordinating mechanism to help expedite the process of procurement of the testing kits and other essential commodities through the Global Fund HIV Grant," the CSOs said. "We also urgently call upon the Ministry of Health, NMS, relevant offices in the local governments and [officials] in charge of the affected health facilities to ensure that clients obtain drugs and testing services."
"A big number of patients in the district have been affected [by] the current ARVs stock-outs. The patients can't refill their monthly stock because the drugs are not there. This is going to cause adherence issue[s] and create drug resistance, which is very dangerous," Janet Oola, health officer for northern Uganda's Nwoya District, told IRIN.
Persistent supply-chain issues
John Anguzu, health officer for the northeastern district of Nakapiripirit, said he had been forced to borrow drugs from neighbouring Moroto District to fill his patients' ARV prescriptions.
"This crisis is particularly concerning given Uganda's rising rates of HIV incidence, unique among East and Southern African countries," said the CSOs’ statement.
Uganda's HIV prevalence rose from 6.4 percent in 2005 to 7.3 percent in 2012, a sign that the country's once-successful HIV prevention programme is faltering.
The current shortage is only the latest in a list of supply-chain problems that have caused similar stock-outs of drugs and condoms in the past. Activists say continued mismanagement of the distribution chain is harming the country's HIV response.
"The Ministry of Health exactly knows the number of people on ARVs. I wonder what is difficult with them to focus and make the right quantifications of the drugs," Oola said. "The ministry should also have buffer stock for emergencies.”
"We are tired of this preventable crisis. It's time for [the] government to guarantee that stock-outs will be a thing of the past," said Margaret Happy, the advocacy manager for the National Forum of People Living with HIV/AIDS Networks in Uganda (NAFOPHANU).