UGANDA: Optimism as PEPFAR lifts funding caps

KAMPALA, 25 August 2010 (PlusNews) – More Ugandan HIV patients are set to receive life-prolonging medication after the United States President’s Emergency Plan for AIDS Relief (PEPFAR) responded to appeals by healthcare providers overwhelmed by patients they could not afford to treat by lifting funding caps.

“We have about 1,000 patients on the waiting list and we shall give them first priority. As soon as [PEPFAR] sends us the guidelines, we shall start clearing patients,” said Emmanuel Luyirika, director of the Mildmay Centre, a large HIV care facility in the capital, Kampala.

Funding caps by PEPFAR – which supports an estimated 87 percent of the 200,000 Ugandans on antiretroviral treatment (ARVs) – meant many health centres countrywide stopped taking on new HIV patients in the past year. Centres still accepting new patients were only treating those with a CD4 count – a measure of immune strength – of less than 100, far below UN World Health Organization (WHO) recommendations that patients start treatment at 350.

As a result, new enrolments on treatment dropped drastically from the previous average of 3,000 per month nationally, despite the fact that the 200,000 people on treatment represent just over half of the number of HIV-positive Ugandans needing ARVs.

“We have seen many people in our networks progressing to stage three and four of HIV [the final stages],” said Stella Kentutsi, programme manager of the National Forum of People Living with HIV/AIDS Networks in Uganda (NAFOPHANU).

Expanding treatment

In a recent blog on the Ugandan situation, US Global AIDS Coordinator Eric Goosby wrote: “To address immediate needs, PEPFAR will provide an immediate infusion of anti-retroviral drugs to allow partners to refill buffer stocks, avoid stock-outs and continue expansion of treatment services,” he wrote. “PEPFAR will provide increased short- and medium-term financial assistance to bridge this challenging period.”

Goosby also noted that the imminent withdrawal of UNITAID – an international funding mechanism that contributes paediatric ARV formulations to Uganda – had been delayed to 2011. He said PEPFAR’s priority would be to “conduct a highly detailed analysis of treatment expenditures in order to develop a plan that results in more people accessing treatment”.

On a visit to Uganda in May, Goosby was presented with a petitioned signed by AIDS activists and health workers urging PEPFAR to urgently increase funding or risk the death of large numbers of people living with HIV.

Sandra Kiapi, an advocate and human rights specialist with the Action Group for Health, Human Rights and HIV/AIDS, explained that the Obama administration had agreed to return to previous rates of patient enrolment. The caps had meant “HIV treatment waiting lists [reached] crisis levels”.

Ugandan HIV service providers said they could now start encouraging people to test for HIV, confident they would have access to treatment. “Now Ugandans who were tested but could not receive treatment have some hope, but first the HIV patients who were on the service providers’ waiting lists take priority,” said Peter Mugyenyi, director and founder of the Joint Clinical Research Centre, Uganda’s oldest HIV treatment facility.

An increase in the national budgetary allocation for HIV and malaria medication – up from US$60 million to $90 million in the current financial year – is also expected to boost the numbers on ARVs.

However, Kentutsi noted that while the injection of cash would save many lives, it would not be enough to ensure all Ugandans with a CD4 count of 350 and less are treated.

“Many people will still be on the waiting list and will be taking Septrin [an antibiotic given as a prophylactic to prevent opportunistic infections],” she said.

Source – IRIN


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