Disruptions in HIV Drug Supplies and Funding Endangering Patients' Lives

Valérie Batselaere/MSF
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Cape Town, July 17, 2009 - Recent disruptions in the supply of anti-retroviral (ARV) drugs and other essential medical items in at least six African countries are putting HIV patients’ lives at risk, said the international medical humanitarian organization Doctors Without Borders/Médecins Sans Frontières (MSF) today, in advance of the International AIDS Society Conference in Cape Town, South Africa.

Funding gaps and supply management problems have led to the delay, suspension—or risk of suspension—of the supply of life-saving HIV drugs in recent months. The inaction of national governments, donors, and their partners must end and they must take urgent and concrete measures, said MSF.

The consequences of disruptions in funding and supplies are potentially catastrophic: if the start of new patients on treatment has to be suspended or delayed, then the lives of many in urgent need of drugs are at risk. For people already on treatment, the interruptions or lowering of dosages will lead to treatment failure and a higher risk of developing drug-resistance. Disruptions are having a direct impact on MSF’s HIV programs.

In South Africa, the government budget for health was cut due to the global financial crisis; finding alternative funding seems difficult in the short term.

“All around us, clinics stop enrolling patients because there are just not enough ARV supplies,” said Eric Goemaere, MSF head of mission in South Africa. “The waiting lists are growing by the day, risking that patients die before they start ARVs. It’s unbelievable that a relatively well-functioning ARV program has been allowed to be crippled in the space of just a few weeks. MSF will not be able to fill the gaps, and we seriously question why we should have to do so, in view of declared international commitments.”

In Malawi, delays in funding disbursements from the Global Fund for AIDS, Tuberculosis and Malaria have already caused worrying shortages in ARV supplies. As a result, ARV stocks are running dangerously low in several health facilities. In order to avoid further ruptures, the Ministry of Health, with the help of MSF and other NGOs, is currently re-distributing ARV supplies to different districts. MSF has also had to buy additional backup stocks, to ensure a steady supply for patients in its projects. For now, MSF is able to start new patients on treatment, but there is a real risk that this will have to slow down.

MSF teams in Uganda, the Democratic Republic of Congo, Zimbabwe, and Guinea are also seeing stock-outs and disruptions.

Disruptions are a result of a shortage of in-country funding and delays by donor governments in fulfilling their commitments. Major international funding institutions such as the Global Fund for AIDS, tuberculosis and malaria and PEPFAR face budget caps or uncertainty in the replenishment of funding. Country level supply management and procurement issues compound the problem, as any delays in funding place the supply chain in danger.

“MSF is extremely concerned about the lack of effective action from governments, their partners, and international donors in assuring the continued funding and supply of ARVs and other medical items for treatment,” said Meinie Nicolai, MSF director of operations. “They are playing with fire: no ARVs means no HIV/AIDS treatment. Governments and donors must respond to funding and supply problems urgently and effectively.”