Coalition faults Nigerian government on HIV treatment

Coalition petitions government on treatment of PLWHA.

In the past few months, it has been a trail of tears and fears amongst people living with Human Immunodeficiency Virus, HIV, as an increasing number were committed to mother earth due to complications of the disease. Though medically unconfirmed, health and treatment enthusiasts say the death toll rose when patients switched to the ‘dubious’ anti-retroviral drug, Tyonex, which was released into the market for the treatment of HIV positive persons.

Tyonex is produced by a local pharmaceutical company, Tyonex Nigeria Limited, in Ikotun Egbe, Lagos; and it is bugged by an integrity deficit in basic physical requirement and shoddy packaging.

The editor in chief of NigeriaHIVinfo.com, Steve Aborishade, on Monday told PREMIUM TIMES, “The Ministry of Health secured funding to procure and supply this drugs, but to cut cost, they opted for a local pharmaceutical company of whom little is known, but whose owners are obviously connected.”

He added that it is most unlikely that this company met the standard practice of obtaining a WHO prequalification to supply the drug, as no Nigerian company was yet to be certified.

Although, Tyonex was withdrawn just last week after much ado, this incidence birthed the voicing of the many concerns hitherto nursed by members of the civil society, treatment activists, as well as people living with the virus.

Nigeria currently has the second largest burden of HIV/AIDS in the world. Since the U.S. President’s Emergency Plan for AIDS Relief, PEPFAR, signed a MoU with Nigerian government to enable it increase its commitment to tackling the disease, treatment access has been nothing short of a nightmare to HIV positive persons in Nigeria.

In an observation made by a coalition of activists, Treatment Action Movement, TAM – made up of right activists, media practitioners, HIV positive persons, and global organisations – there is a continual stock out of paediatric ARVs. Thus, adult ARV tablets are broken into pieces and given to children, in the absence of specific children sensitive formulations. The implication of this stares us in the face. Only recently, the United Nations in a report titled, 2013 Progress Report on the Global Plan, showed that there were 60,000 Nigerian children infected with the virus in 2012, a figure higher than that of any country in the world. This also contributes to infant and child mortality, which the country is working hard to reduce.

The coalition, which met in December at an AIDS conference in South Africa, also noted that the laboratory monitoring, which is done for people on ARV to detect viral load – an indication of how they are responding to treatment – has dropped to only once a year in many centres as against the previous practice of every six months. As a result, it is usually late before it is known that someone is failing therapy.

It also observed that liver function test, LFT, is no more being done for patient monitoring but is being done as part of baseline tests. There are no new patients being put on third line drugs while there is zero salvage therapy for those failing third line. It said women living with HIV do not have access to pap smear tests in most Antiretroviral Therapy, ART, sites in Nigeria as part of the treatment package while the provision of family planning services targeting women living with HIV as a vital component of PMTCT interventions are virtually non-existent, save for provision of condoms.

The coalition captured all these in a letter written to the Minister of Health, Onyebuchi Chukwu, in October 2013 and added that the ART and the Prevention of Mother to Child Transmission, PMTCT, sites being run by state governments and mission hospitals have no provision for drugs for treatment of opportunity infections such as tuberculosis; while some still charge patients for services that are provided free in other ART sites.

Other conclusions listed in the letter are the inadequate funding for service delivery and increase in patient-provider ratio thereby compounding stress and burnout incidences among healthcare workers in ART sites. Alongside this, it was reported that there was a consistent reduction in training and updating of officials involved in ART management by Implementing Partners, IPs, responsible for provision of ART services in the country.

Not everyone living with HIV requires an ARV, but there are some who need it. Usually there is a follow-up system that tracks HIV persons on ARVs, but as it is now, many treatment sites do not follow up patients anymore due to lack of funding. As a result, there are lots of people who cannot be followed up and counseled to keep the positive attitude about life.

In light of these challenges, they requested for engagement of civil society organisations, treatment advocates and patients’ organisations in the procurement processes with regards to ARVs in the country and specifically the involvement of representatives of TAM and other partners as observers on issues of HIV/AIDS commodities procurement. They also request that the Federal Ministry of Health verifies whether Tyonex Nig Ltd has the World Health Organisation, WHO, pre-qualification which is a global precondition for pharmaceutical companies to trade inessential drugs.

“We humbly request that you use your good offices to ensure that Tyonex brands of ARVs are no more dispensed to our people in the ART sites even though it has been recalled. We request that a Committee representing the various relevant interests be setup, with active consultation and participation of TAM, to investigate our observations about the Tyonex brand of ARVs. We strongly request the cancellation of the contract awarded to Tyonex if a committee set up to probe our observations finds the company liable in any way,” they said.

Their letter and others led to the suspension of usage and distribution of the drug with the National Agency for Food and Drug Administration and Control, NAFDAC, saying it is investigating the drug and its manufacturers.

The coalition also called for a National Treatment Summit to be convened towards addressing the myriad of challenges plaguing the provision of ART in Nigeria. The summit, they propose, should bring various stakeholders including representatives of Government, TAM, Network of People Living With HIV/AIDS in Nigeria (NEPWHAN), Implementing Partners, civil society organisations, healthcare workers as well as drug manufacturers.