30 May 2012

South Africa: Tenofovir Shortages Continue

The continued stock out of the antiretroviral tenofovir and the failure to advise health workers on how to deal with it is a looming disaster, HIV Clinicians and activists are warning.

Reports of stock outs go as far back as October last year with the explanation given that the drug suppliers Aspen and Sonke were not able to meet the demand once they were awarded the tender.

Dr Francesca Conradie, President of the Southern African HIV Clinicians Society said they had submitted the clinical guidelines for health workers on how to swop out medications in February, but that it has not been ratified by the health department meaning it is not being used.

"You can safely swop antiretroviral therapy in some patients who've got an undetectable viral load and some you can't. There are some people who have to be on tenofovir because they have hepatitis B. That group of patients cannot be swopped out, but it's only between eight and 10 percent of the population. The rest of the population can be swopped," Conradie explained.

She said it was not ideal to swop patients using tenofovir to AZT or D4T, but that it was safe in the short term.

The fact that the document guiding clinicians on how to swop drugs has not been ratified by the health department, means doctors on the ground are not able to follow it.

"It's not good that we've run out of tenofovir, but that we don't have a plan to respond to it, is a disaster," she said.

Conradie confirmed that this meant patients were receiving sub-optimal treatment. "It is a disaster because the other two drugs, 3TC and D4T have a low barrier to resistance, and the treatment will fail."

SECTION27 Director Mark Heywood said they were receiving numerous reports of shortages, both in urban centres such as Johannesburg, but also in the outlying areas in the Eastern Cape, Mpumalanga and parts of Limpopo.

"Clearly there is a problem and it is a problem that needs to be addressed quickly," said Heywood.

He said the situation was placing doctors in a difficult situation as they were forced to either give patients smaller quantities of tenofovir or swop to drugs such as D4T with horrible side effects.

In Johannesburg, a patient who asked not be identified, confirmed that her clinic in Mofolo, Soweto had told patients it was out of tenofovir.

She was told earlier this week that there was no tenofovir in stock and that she had to return today (THURSDAY). She took her last tablet yesterday (WED).

The national health department's Dr Anban Pillay laid the blame for the stock out at the door of the drug suppliers Aspen and Sonke. He said that despite warnings that donation stock of tenofovir would no longer be available and the shortfall would have to be made up by the drug companies, they had failed to do so.

However the Treatment Action Campaign said the department had to shoulder the blame as it had failed to manage the supply of the drugs and should have intervened earlier.

Rural doctors have also pointed out that switching drugs meant patients had to undergo viral tests, to ensure their viral load is suppressed.

However, in rural areas the turnaround time for viral load test results is too long, which means D4T is substituted blindly for tenofovir.

This means that resistance is likely to develop in some patients and they will fail on their treatment.

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