HIV drugs shortage - Medication being rationed

BY INGRID BROWN Senior staff reporter

Tuesday, January 25, 2011    

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A shortage of two antiretrovirals (ARVs) to treat persons infected with HIV has resulted in rationing of the medication with persons only being able to receive a week's supply of the life-saving drug instead of the monthly dosage or none at all.

The drugs which are said to be in short supply are Lopinavir/Reponivir, the generic forms of Alluvia, and Entracitabine/Tenofovir, the generic forms of Truvada.

Tony Hron, programme development manager at Jamaica AIDS Support for Life, told the Observer that the organisation's clients have been complaining since last November that they have not been able to get the drugs at some public pharmacies.

"These drugs are central because persons who have been prescribed those ARVs have a strict regime and you may only miss one dose for the month," he said. According to Hron, failure to comply with this regiment will result in a rebound of the virus.

"These drugs require 90 to 95 per cent adherence," he told the Observer.

Head of the National HIV/STI programme, Dr Kevin Harvey admitted that there has been a rationing of the drug Lopinavir but said persons should begin receiving full supplies by next month.

"The stock is still not up to where it should be but we are hoping another supply will come in February, and so by the end of February everyone would be able to get their full supply," Harvey explained.

He told the Observer that the inclement weather in the United States and Europe, which saw the grounding of a number of flights, caused a marked delay in the arrival of the drugs from India last November and December.

"In December, the airline refused to take the large cargo so we had a shortage of lopinavir," Harvey said.

He said in order to prevent persons from running out of the drug totally, a decision was taken to ration the supplies to weekly instead of monthly dosages.

But according to Harvey, a shipment has since come in and that will soon be distributed, even as efforts are being made to fully replenish the stock in short order.

He said the treatment sites which were most affected by the shortage are the Kingston Public Hospital, the University Hospital of the West Indies and the Comprehensive Health Centre.

Cabinet, he said, has recently approved two contracts amounting to approximately $215 million for the continued purchase of ARVs.

But Hron said if it is a case that the inclement weather delayed the arrival of the drugs into the island, then there is cause for great concern. This, he said, has raised the issue of what would happen if Jamaica should experience some natural disaster which would disrupt the local distribution of the life-saving drugs.

As such, he said, persons living with the disease have been advocating that they be given two months' supply of the drugs instead of the 30 days supply they are currently given. This, he insisted, would save persons having to take an entire day out of the month just to have their prescriptions filled, a task which can take up to two days because of the strain on the public health sector.

"Why not give two or three months' supply of the drugs to those persons who have been on the drug for some time and are known to be adhering," he said. He explained that those persons just coming on the drugs would need monthly monitoring and would be required to receive their supply monthly.

Hron said he was not sure if there was a shortage of the drugs at private pharmacies but maintained that most persons now on ARV would not be able to afford the private cost which could run into thousands of dollars.

The Jamaica Network of Seropositives, an association for HIV-infected persons, admitted that some of its members are having difficulty accessing the drug, with many pharmacies only issuing a week's supply.

A member of the executive, who chose to remain anonymous, said the shortage has been on and off but has been more severe since earlier this month. Persons, he claimed, are becoming ill for not being able to adhere 100 per cent to the life-saving drug.

"An individual is not supposed to run the risk of not taking the drug for even one or two nights," he said.

Some of its members, he said further, are also unable to afford the bus fare to make the weekly trek to the pharmacy to collect the drug.

"Many persons are complaining that they don't have fare to be going every week to collect it, yet if they don't adhere (they) will find (themselves) getting sick," he told the Observer.

He said it is not easy for persons to have their prescriptions filled in other parishes which are not as badly affected.

"If I have a prescription from a Kingston hospital it is not easy to go to [a] hospital in St Thomas to fill that prescription because they are not going to fill it," he said.

He argued that many of its members only discover that there has been a shortage of the drug when they show up to fill their prescriptions at the treatment sites.





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