Life-threatening antiretroviral treatment shortage in the Free State: DoH issues orders, "stop putting new clients on ARVs"

On Friday morning, TAC national offices began receiving phone calls from concerned healthcare workers and journalists requesting information about the antiretroviral (ARV) shortages at public sector health facilities in the Free State province. We have subsequently learned that healthcare workers have been instructed by senior government healthcare officials to stop initiating new patients on antiretroviral therapy (ART), and to halt baseline blood work and treatment literacy programmes in the province.

An anxious healthcare worker has since forwarded TAC a chain of emails sent by Palesa Santho, the pharmacist for the Free State's ART programme, and Dr. Mvula Tshabalala, the head of the province's Comprehensive HIV and AIDS Management Programme. These emails were sent to a list of government healthcare workers and focus on the province's shortages in ART treatments, instructing the workers to stop putting new patients on ART. The subject from one of the emails sent by Dr. Tshabalala is: ‘STOP PUTTING NEW CLIENTS ON ARVS'. (The emails in question can be accessed in PDF here.)

This is an extract from one of the emails sent by Dr. Tshabalala:

"The province (FS) is experiencing an acute shortage of antiretroviral drugs (ARVs). This will lead to clients on treatment defaulting not because of their own fault. The only way to avoid this is by keeping the remaining ARVs for the exclusive use of those on treatment already with the exception of clients on the PMTCT program (pregnant women)".

Dr. Tshabalala's email also explained that the ART waiting list would be ‘postponed':

"Those on waiting list will be postponed without changing their position on those lists".

His email went on to state that it was not known when new patients would begin to initiate ART:

"Presently it is not possible to speculate when the province will be able to start new clients on ARVs".

Dr. Tshabalala advised that ‘drug readiness training' should be suspended because it ‘ will raise false hopes... y the time we start them with ARS they may have forgotten everything they were told because they did not practice it'.

Dr. Tshabalala advised that baseline blood work for HIV-positive patients was no longer necessary because it would need repeating ‘when the drugs are here'. He advised that CD4 tests should continue so that people could be put onto the waiting list, acknowledging that most patients ‘come to our sites having done the CD4 counts alredy '. This advice, heralding from the head of the Comprehensive HIV and AIDS Management Programme, fails to consider possible fluctuations in CD4 counts which may have resulted between the time of the patient's last CD4 test and her/his presentation at a healthcare site.

Acute shortages in ART in the Free State threaten patients who are already accessing ART, and whose drug regimens may be interrupted as a result of the shortages, potentially resulting in drug resistance to the detriment of the patient's health. These drug shortages also prevent patients in urgent need of ART from accessing the life-saving medications. As is evident in Dr. Tshabalala's assurance that pregnant women will still be given access to ART, a system of triage is now in operation in the Free State with regard to these essential medicines.

These treatment shortages are a violation of the health rights of South Africans and the precepts of the National Strategic Plan on HIV/AIDS. TAC and the AIDS Law Project demand:

• An immediate end to the treatment shortages and stoppages which threaten the lives of HIV-positive citizens in the Free State;

• A detailed investigation into the source of these shortages and stoppages which allegedly stem from gross financial mismanagement within the Free State Health Department. This must include an audit of each ART site and of its suppliers;

• The establishment of an interim committee and process which will ensure that treatment is made available to patients while the investigation and audit is underway;

• That staff members responsible for the treatment shortages and lack of communication to the public be held accountable;

• That stronger systems are in place to deal with issues arising from the scale-up of the ART roll-out.

Halting the ART roll-out, treatment education programmes and diagnostics procedures should never be regarded as possibilities.

TAC spoke to Palesa Santho, the province's pharmacist for the ARV programme, and Dr. Mvula Tshabalala, the head of the Comprehensive HIV and AIDS Management Programme, both of whom declined to comment. TAC was referred to Elke de Witt, from the communications department, who failed to answer her telephone despite repeated attempts. Modoer Khokho, the Executive Manger, was also unavailable for comment.

Statement issued by the Treatment Action Campaign November 10 2008