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New HIV treatment guidelines yet to be implemented for Zimbabwe
PlusNews
July 19, 2010
http://www.plusnews.org/report.aspx?ReportID=89889
Zimbabwe's government
has adopted new guidelines set by the World Health Organization
(WHO) for treating people living with HIV, but there may not be
enough money to implement them.
The new WHO guidelines
recommend that countries start giving antiretroviral (ARV) treatment
to HIV-positive people with a CD4 count (which measures immune system
strength) of 350 or less, rather than at the previously recommended
count of 200.
Around 226,000 people
are obtaining ARVs from Zimbabwe's public health system, leaving
a treatment gap of about 340,000, but the new guidelines mean that
at least half a million people will now qualify for treatment, at
a cost of US$7 per person per month.
"We don't have enough
drugs to go full scale and provide treatment for all the 500,000
plus in need," admitted Dr Owen Mugurungi, the National Tuberculosis
and HIV/AIDS Coordinator. "But our long-term goal is to ensure
everyone in need of treatment has access to it."
Mugurungi said phasing
in of the new guidelines would not start until January 2011, but
government had begun training additional health workers, and in
the meantime pregnant women and infants would be given priority
in starting treatment earlier.
"Adopting and implementing
these guidelines isn't just about increasing numbers of people on
treatment," he told IRIN/PlusNews. "It's also about increasing
the quality of care of those on treatment - that's why it was important
for us to direct resources towards training of health practitioners
[and] increasing the capacity of our laboratories."
In line with the WHO
recommendations, Zimbabwe's new guidelines call for greater use
of laboratory monitoring, including CD4 count and viral load testing
(to determine the amount of HIV in the blood) in managing treatment,
and urge replacement of the widely used first-line ARV, staduvine,
which is associated with serious side effects, with the less toxic
but more expensive tenofovir.
Mugurungi said the health
department was banking on receiving increased funds from the treasury,
international donors and the national AIDS Levy (a 3 percent income
tax) to finance the scale-up of treatment and monitoring.
National HIV/AIDS programmes
have largely been funded by the Global Fund to Fight AIDS, Tuberculosis
and Malaria, and the Expanded Support Programme, a basket fund supported
by contributions from Canada, Britain, Ireland, Norway and Sweden.
So far, money has been
trickling in. About US$3 million was collected from the AIDS Levy
in the first quarter of 2010, of which about 50 percent was allocated
for treatment, and the Global Fund disbursed US$41 million from
two different funding rounds, but the combined figure falls short
of what is needed for ARV drugs alone.
HIV/AIDS activist Stanley
Takaona applauded the adoption of the new guidelines, but urged
government to mobilise resources to scale up treatment as a matter
of urgency.
"By announcing the
adoption of these new guidelines there are now high expectations,
so they must deliver and keep their promises - come January next
year, we don't want disappointments."
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