Missing the Target #5: Improving AIDS Drug Access ... - CD8 T cells

ZIMBABWEtreatment, representing 35 percent of the 260,000 in need of ART and 75.1 percentof government’s target to treat 120,000 by year-end. Of these, 7,000 are children,representing 23 percent of the 30,000 children in need of ART. This is a slightimprovement from a total 82,000 people on treatment in July 2007 and 4,794children at end of March 2007. WHO estimates, however, place the number ofthose in need of treatment at 321,000. 3The total number of PLWHA in Zimbabwe is estimated at 1.3 million, of whom132,938 are children below the age of 14 and 651,402 are women. 4The treatment access data includes individuals served by government and churchrunmission hospitals and private sector programs. While the bulk of patients arecovered through 81 public and mission health facilities, it is estimated that thenumber of private patients has declined from 10,000 in July to 6,000 due to variousfactors such as the unavailability of drugs caused by government policies andinflation, which has escalated the cost of treatment.Between July and October 2007, significant changes aimed at improving ARVtreatment delivery took place in Zimbabwe. These included decisions by the Ministryof Health and Child Welfare (MoH&CW) to eliminate user fees for patients on thegovernment treatment program, and a shift from voluntary counseling and testing(VCT) to provider-initiated counseling and testing (PICT).However, although the elimination of user fees was a welcomed step, the movehad limited impact because it was done without addressing barriers such as thecost of diagnostic tests and transportation. Transport costs have continued to soarin the prevailing hyper-inflationary environment, making it difficult for patientsto visit health institutions to collect drugs and receive medical attention. In someareas, patients fail to visit for as many as three months in a row while trying to raisemoney for transport to the nearest health center. Such gaps in treatment availabilitymay result in patients developing resistance to some ARVs.Meanwhile, patients must also pay for diagnostic tests. On average, for example,one CD4 test costs Z$22 million while a liver function test costs Z$21 million, whichwas the average civil servant’s monthly salary in October. Attempts are being madeto reduce the cost of diagnostics. “We are working on modalities so that diagnosticsare rationalized to make them free,” Dr. Parirenyatwa said.3 WHO 20064 Ibid.21