Nairobi — The government achieved more than it bargained for when it urged people to get tested for HIV as part of its anti-Aids campaign. Many answered the call, and learnt that they were positive. But now they cannot get anti-retroviral drugs because they are not available.

The crisis stems from a government initiative six years ago to make anti-retroviral (ARVs) widely available to patients.

While the number of people in treatment has been increasing thanks to the rapid results initiative, there has been no money to buy the drugs or the amount to do so has not increased to keep up with the rising number of patients.

Government officials say they are unable to offer a regular supply of anti-retroviral drugs because too many people need them, and they do not have the funds to buy them.

A report produced by a team of technical experts from the ministries of Medical Services and Public Health and Sanitation, World Health Organisation, universities and other key stakeholders shows that for this year, the gap in funds needed to buy anti-retroviral drugs is Sh2.5 billion. By the end of 2013, this will have ballooned to Sh16 billion if there is no major intervention.

So serious is the situation that several weeks ago the government rushed to the US President's Emergency Plan for Aids Relief (Pepfar) for a bailout.

It is feared that current stocks will run out this week, and ministry of Health officials are crossing their fingers that the deal with Pepfar will go through. If it does, there will be sufficient drugs for the next six months as the ministry waits for more funds from the Global Fund to Fight Aids, Tuberculosis and Malaria.

The lack of drugs comes at time when there is an unprecedented number of people receiving treatment.

By end of December 2009, there were 360,000 people receiving ARVs from government hospitals and clinics. There are 7,000 new patients every month. The target for 2010/2011 is over 540,000 people on public treatment and about 770,000 by 2013.

"It is just too much for us. We might not be able to cope with the number of people on treatment if the government and donors continue to operate at the current funding level," said a senior Health ministry official, who sought anonymity because of the sensitivity of the matter.

The growing number of people in treatment has made it very difficult for the government to maintain a six-month stock.

In many cases, the Health ministry has transferred drugs from regions with spare stock to high-demand areas or has had to appeal to international organisations for bailouts.

This situation will get worse when the ministry starts implementing the new WHO guidelines that recommend use of less toxic but more expensive drugs and putting people whose CD4 count - the indicator of immune strength - is below 350 on ARV therapy regardless of their symptoms. The implementation of the new guidelines is expected to begin in July.

The 2005 government guidelines require a person to start ARV treatment if his or her CD4 count is below 200. This means that thousands of people whose count is between 200 and 350 are to begin the treatment. In view of these new changes, experts say the government needs Sh7.8 billion for ARV therapy for the year 2010/2011.

"The government is addressing the issue, and everything will be fine in the coming months," Dr Ibrahim Mohamed, the director of the National Aids and STDs Control Programme (Nascop), said.

Funds to buy ARVs come mainly from donors--the Global Fund, Pepfar and the Clinton Foundation. The government is yet to intervene in a significant way. In the 2008/2009 and 2009/2010 financial years, it allocated only Sh500 million to buy ARVs.

But Sh6 billion is required for the 2009/2010 period; in 2010/2011, Sh8 billion, 2012 Sh10 billion and in 2012/2013, Sh12 billion will be needed, according to a government report prepared by Nascop.

The minimal government funding of HIV/Aids programmes, medical experts argue, is unsustainable as the number of people needing treatment and care rises.

Nascop is now working on a proposal to increase the government's share of financing to Sh1 billion a year to meet the growing demand for treatment instead of leaving the bulk of funding to donors.

Future programmes

This is particularly urgent in view of the recent revelation that the Global Fund might not be able to support future programmes in many countries.

The other problem is that Pepfar - the leading provider of ARV treatment in Kenya - has capped the number of people it is going to support for the next five years at 190,000. At the moment, it supports around 130,000 of the 330,000 people being treated in government health centres. If the ceiling is reached by the end of the year, the agency will admit new patients after 2013.

A drug procurement case pending in court and the many issues the Global Fund has with its existing grants to Kenya pose other serious problems.

Recently the Fund rejected an appeal for a Sh5.5 billion proposal in Round Nine, citing poor coordination between the two ministries and a budget whose activities did not match with funds requested. HIV/Aids programmes have been split between the two ministries, leading to intense wars over control of money and programmes.