The new international targets in the fight against HIV have moved towards a more qualitative approach to measuring the success of ART programs.
Whilst it used to aim at getting a set number of people initiated on treatment, UNAIDS strategy now aims at reaching 70% of people living with HIV virally suppressed by 2020 (it’s the “90-90-90” targets: 90% of people knowing their status; 90% of those started on treatment; 90% of those with an undetectable viral load).
In order to be virally suppressed people need to remain adherent to lifelong care, which is already a challenge.
ARVs routinely fail to reach patients where and when they need them, most often despite the fact that there are sufficient stocks of those drugs in countries.
Drug stock outs put individual’s health at risk and represent an immediate threat to the success of ART programs as it discourage people to remain adherent.
Nationwide surveys conducted two years in a row in South Africa show that between 20 and 25% of local health centers were unable to dispense the complete amount of one or more HIV or TB medication.
In 80% of the cases the drugs were available in the country but did not reach the clinic’s pharmacies.
In Kinshasa 77% of the city’s local health centers surveyed had experienced stock outs of at least one ARV over a period of three months, and 41% out of 17 surveyed Mozambican clinics in Maputo City and rural Tete province.
This report is a first of its kind, looking at the availability of ARVs at patient level. Whilst shortages due to international suppliers’ inability to meet demand are acknowledged, lack of drug availability in local clinics, stemming from failure to ensure “last mile” delivery is not monitored and therefore woefully ignored.