ARV/CART shortage for HIV+ patients concern

What appeared to be some issues regarding HIV positive patients accessing antiretroviral drugs via the regional health authorities’ network linked to the Ministry of Health and type five health centres is real as drug shortages become more pronounced. For the past three months or so several emails to GLBTQ Jamaica alongside Facebook comments and face to face discussions etc. have revealed a trend from persons being told to buy their medications at selected pharmacies with their National Health Fund, NHF cards to trying Drugserv; although the meds costs anywhere from $300 to $500+ per bottle with the card they also are short on stock, owing to the fact that persons were used to gaining said meds by the aforementioned clinic systems and via social worker departments and dispensaries located there instead of pharmacies so the pharmacies do not replenish stocks as fast I was made to understand.

Then there is the question of the over burdened Drugserv publicly aided pharmacies that are already pressured by crowds sometimes as early as 5 or 6am at their branches; one has to join a long line and or effectively bribe a security or others to hold a space in extreme cases (apart from knowing someone inside). They also have drug shortage challenges as the Cross Roads and Portmore branches according to checks are out on Truvada and or EFV and Atripla, the main drugs. Combivir AZT which is still prescribed for some patients is also low but seemingly not as the other items. The other rarer types and brands appear to be not as impacted as the main treatments. While the drugs are cheap it can be frustrating the wait but the technocrats who oversee these things live in unimpeded comfort as they can afford better treatment experiences in the health systems or fly to overseas centres, so who cares really?

The issue also came up for mention on radio on August 4 during the check mail section of the daily show “At Your Service” hosted by the popular Mr Darby, the persons who texted in did not want to be identified by were clear as to their frustrations. Some are stuck with repeat prescriptions unfilled or the available drugs that may also be on the slip are supplied and a reissued prescription is handed to the persons involved to go elsewhere. Also of concern are the other items some clients normally would get such as iron tablets in the form of ILV or Feso4, B-complex capsules, staggered dosages of Bactrim and certain creams such as Clotrimazole, Betnovate cream and Fluconozole for persons with skin issues as the immune systems are compromised and or may have other running conditions such as diabetes.

Strangely the HIV AIDS conference just ended and with all the powerhouses and bureaucrats who attended seemed more interested in preserving their heads in the soon to be ended Global Fund support in 2017/8 while the agitation for better drug stocks for present populations seems missing. While Africa featured in that department Jamaica did not; since the World Bank’s reclassification of Jamaica as a middle income country automatic qualifications for certain types of support come into effect. The main drugs such as Atripla (with tenofovir dixoproxil fumarate, TDF) Efivarenz and Truvada should never be short seeing they are available. The agitation that is to come on behalf of HIV patients is missing on many fronts, that it should get to the stage where patients are crying out is disturbing, when persons were assured that the drugs will be available consistently. Sometimes we have to wonder if there is any real concern about HIV positive patients given the feeling of complacency that has come to define the work.

Why aren’t said powerful HIV/LGBT outfits that control the cogs of prevention are silent on certain things? Items such as the expected switch over from tenofovir dixoproxil fumarate, TDF to tenofovir alfadamide where studies have shown better absorption of the latter in far less dosages (300mg versus 10mg) hence better CD4 and viral load results but the old generation ARVs or CART are still being dispensed. All of a sudden treatment naive patients are now the ones who can use the latter, despite the studies showing very little deleterious effects from the migration. TDF bleeds into the bloodstream so from a typical 300mg tablet maybe just over50% of that gets where it needs to go inside the cell cytoplasm. Then there is already ticklish question of adherence which can be frustrating in a sense for social and outreach workers, if not doctors and adherence staff. Persons do not take their meds on the basis of judging that they have no underline visible issues so they take chances or as a friend of mine hinted recently he is tired of swallowing pills, in other words treatment fatigue.

While the drugs maybe ‘free’ is not every impacted person can literally find the money to travel to the suggested pharmacies as they tend to be located far from the clinics the patients attend. For example in St Catherine persons from as far as Old Harbour or further are being told to go to a pharmacy in Kingston off Washington Boulevard. Again while the charge of $300 per bottle of one month’s supply the transportation cost to get there for some is debilitating as many persons are unemployed. The grants that would flow to assist persons in some sort of training or stipends for some are also all but dried up. Some persons would also be able to request basic food assistance such as rice, peas such items are becoming rare according to reports.

Why is it that the inventory systems have slipped that stocks have been allowed to go to such low levels is strange to me, persons have also been staggering their dosages to one tablet in the case of Atripla every other day so as to stretch the stock which is not recommended as yet despite a recent study citing the same drug suggesting three days dosages can provide the same results. One doctor who was contacted on the matter strongly cautioned that persons who are practicing such staggering should stop.

See a previous entries:

News From the 2016 International AIDS Conference

New single-tablet HIV treatment Genvoya wins FDA approval

Tenofovir Vaginal Ring Provides Protection Against HIV in Women

First Generic Atripla Approved for Developing Nations 2009

Taking Atripla Three Days a Week Maintains Undetectable HIV Viral Load, Pilot Study Finds

I hope that the powers that be can act quickly especially owing to the present ZIK-V infections and related possibly debilitating challenges such as GBS, HIV positive patients cannot afford that kind of exposure due to staggered treatment by shortages only to lead to CD4 counts falling. Some concerns were raised recently in a space of falling CD4 counts in MSM as well prior to the shortage coming into effect. I hope some change can come soon to alleviate the problems and concerns.

here are some figures from 2014:

HIV prevalence - 1.6% Males: 2%

Females: 1.3%

Estimated number of people living with HIV

Total: 29,000

Women: 11,000

Number of number of

people living with HIV under antiretroviral (ARV) drugs treatment

Total: 9,141 in 2014 (5,826 in 2010)

Adults: 8553 (5390 in 2010)

Children: 588 (436 in 2010)

ARV coverage (%): 31%

Estimated number of new infections and trend: 1,500

Overall: New HIV infections declined from 3,000 in 2000 to 1,500 in 2014, a 50% decline

Mode of transmission (2012)

- Heterosexual sex within partnership: 32%

- Casual heterosexual sex: 22%

- Sex workers, clients and partners of clients: 10%,

- MSM: 32%

- Female partners to MSM: 7%

Prevention of mother-to-child transmission coverage (number and %): 93% (74% in 2010)

Estimated number of HIV-related deaths: 1,300 people (2,400 in 2005; 46% decline)

Peace & tolerance

H