Free State ARV shortages: R9.5 million provided by CDC and National Treasury not enough to avert treatment delays, interruptions

Last week, TAC learnt that the Free State was experiencing critical, life-threatening shortages of ARVs and had therefore called for a stop to the provincial ART roll-out. The Manager of the province’s ART programme, Dr. Mvula Tshabalala, instructed provincial healthcare workers to stop initiating new patients on ART with the exception of pregnant women.

• To read TAC’s original statement on the issue from 10 November please click here.
• To read TAC’s update on the Free State ART shortages from 13 November please click here.

The alleged reasons for the shortages are a lack of funds to support the ART roll-out. The money allocated for the Free State’s ART roll-out was not sufficient to support the range of ARV regimens that healthcare clinics needed to make available to patients. Furthermore, not enough funds were allocated to support the roll-out of dual therapy for the prevention-of-mother-to-child-transmission (PMTCT). The result is that the money was quickly exhausted.

TAC and the AIDS Law Project quickly responded to these shortages, contacting the Treasury and the Department of Health to ensure that the shortages were immediately stopped and that further funds were dedicated to support the continued roll-out of ART in the Free State. Due to the delayed start of public ART programmes, many HIV-positive patients are presenting at clinics across South Africa in desperate need of immediate ART if their lives are to be saved. The shortages of ART in the Free State prevent these new patients from accessing antiretroviral therapy, and threaten patients who are already on treatment by interrupting their regimens. Treatment interruptions can foster drug-resistant strains of HIV to the detriment of the patient’s health and to the general health of the population.

On Friday 14 November, TAC learned that the United States Centers for Disease Control (CDC), which actively supports a number of HIV/AIDS projects in South Africa in conjunction with the Medical Research Council (MRC), had made R10 million available aimed at alleviating the ART shortages in the Free State. Of the money put forward by the CDC, National Treasury has advanced R9.5 million to the Free State Department of Health in the form of a conditional grant.

However, TAC has received calls from anxious doctors in the Free State who claim that the R9.5 million will not be dedicated to the stopping the ART shortages, but that it will rather be spent on comprehensive care for HIV in the province. These doctors claim that:

• R9.5 million is not nearly sufficient to address the ART shortages.
• This will result in the shortages simply being shifted forward to future months, meaning that healthcare workers are now facing critical shortages on an indefinite basis.

One doctor, working in the northern Free State, explained that his clinic is set to run out of the critical first line antiretroviral drug 3TC (lamivudine) by 15 December despite the advancement of the R9.5 million grant. He stated: ‘This will fracture the whole ART component for patients whose regimen includes this drug’. The doctor, who wishes to remain anonymous due to fear of victimisation by the provincial Department of Health, had turned away 30 patients in desperate need of therapy on a single morning (Monday 17). The doctor explained that the patients already on ART were extremely worried that their regimens would be interrupted, and that both he and his patients were ready pursue direct action against the local Department of Health to protest the dire impacts of the shortages.

The communications officer for the Free State Department of Health, Elke de Witt, could not be reached for comment.

TAC demands the following:

• An immediate end to the shortages which threaten HIV-positive patients and which prevent others in a critical state of health from initiating ART.
• The specific dedication of further funds to ART programmes in the Free State to ensure that the roll-out proceeds.
• An investigation into and full audit of the financial shortages stopping the roll-out to ensure that these are not repeated.
• That staff responsible for the lack of communication regarding the shortages to the appropriate state institutions and to the public be held accountable for failing in their duties to support the ART roll-out and to address related problems which have developed