The continued supply of Antiretroviral drugs

By Dr Ian Clarke

Since the dismantling of USAID by DOGE there has been uncertainty regarding the continuing supply of antiretroviral drugs (ARVs) for the treatment of HIV. 

It is estimated that there are 1.5 million Ugandans on treatment and the longer there is uncertainty, the more rumours and misinformation will circulate. 

Treatment with ARVs works by suppressing the multiplication of the HIV virus, so a person taking their drugs regularly will have an undetectable viral load and will be able to lead a normal life. 

However, if they are irregular in taking their drugs the virus will become resistant and the viral load will rise, destroying their immune system. The person will not only get sick but will transmit the virus to his or her sexual partner. 

Therefore, for those who are on treatment, it is critically important that they take their treatment regularly and that the hospitals which supply the treatment also measure the compliance of their patients. 

If the word goes around that the clinics themselves have run out of drugs, patients will give up on their treatment, without even going to check on availability. 

This is a message that the drugs are still available – at least for the next six months. There are two ways in which ARVS are supplied - through government health facilities and through nonprofit or registered private facilities. 

The government health facilities should not be affected by the USAID shutdown because their supply is purchased by the Government of Uganda from Cipla and supplied through the National Medical Stores to government hospitals and health centres. 

The second way ARVs are supplied is through Joint Medical Stores (JMS) to non-government facilities such as faith-based hospitals. 

It is these drugs which will no longer be supplied by USAID. JMS had two contracts from USAID, one for procurement, and the other for storage and distribution. 

Dr Ian Clarke

In January, they received a STOP notice from USAID, instructing them to stop all programme activity. 

This was followed by a limited lifting of the stop order to allow them to receive any drugs which were in transit and to continue to distribute to hospitals and health centres for the current cycle, which was for the following two months. 

This means that most facilities will run out of those drugs by the end of April. 

However, JMS had already received a six-month supply of drugs from USAID, but could not distribute them because USAID terminated their contract for warehousing and distribution. 

Since these drugs cannot be sent back to America and USAID is not paying JMS to store or distribute them, the most likely scenario is that the health ministry will find an emergency budget to pay JMS and instruct them to continue to distribute them.
 
Alternatively, those hospitals and clinics which were receiving supplies could go and pick them up themselves.

Because the supply in stock will last for another six months, this will give the health ministry time to requisition an additional budget for the purchase of ARVs to fill the USAID gap indefinitely. 

I only hope that during this changeover period, people will not be put off from seeking treatment. The drugs are still there, and one hopes that the health ministry will take decisive action in ensuring that these drugs are made available to the clinics and hospitals which need them. 

The clinics themselves should also be proactive and go and pick up the drugs from Joint Medical Stores if their stocks are low. 

People should not give up and do nothing and both the patients and clinics should ensure that they are continuing to take their treatment on a regular basis; otherwise, we will lose years of progress that has been made in the fight against HIV because, not only will patients die, but more people will be infected. 

The actions of Elon Musk and Donald Trump are deplorable, but the various actors involved in Uganda, including the clinics and hospitals, the health ministry, JMS, Parliament and patients themselves, must take the responsibility into their own hands to ensure this situation does not deteriorate further.