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

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Most people living with advanced HIV are in poor health, are economicallyimpoverished, and cannot afford proper nutrition. Nutritional access concerns wereexpressed by PLWHA we encountered in the field. When asked to be interviewed, atreatment adherent living with HIV/AIDS told us:“I am not interested in what you may want to ask me for now since I have not eaten.I need to cook, eat, and take my drugs.”A member of a support group had this to say:“I cannot attend support group meetings any more because I have to toil all daylong just to have food on my table. I will attend support group meetings only if I amassured that meals will be provided in meetings.”National AIDS Control CommitteeBased on the National Health Strategic Plan, the MoH determines the NationalAIDS Control Committee’s polices. In addition to providing direct support throughthe public sector, the committee through its provincial technical groups also fundslocal NGOs involved in HIV prevention and care.The MoH coordinates HIV/AIDS program activities, including drug procurement andtreatment. The government receives significant external support for these activities,including from the Global Fund and the Clinton Foundation.Incompetence and corruption have plagued the program at times. Data collectionhas been poor at the provincial technical group level. A recent external evaluationby donors revealed gross mismanagement, a finding that led to the temporarysuspension of funding for local HIV prevention, sensitization, and support/careactivities. Also, some members of provincial technical groups formed their own localNGOs and funded them; they have yet to provide evidence of any meaningful HIVrelatedactivity. Reports have also surfaced of provincial technical group membersrequesting kick-backs from NGOs before funding their activities. The overall resultof these problems has been poorly executed projects in the field.Limited civil society capacityCAMEROONThere is a great need to build the capacities of civil society advocates to assessand monitor government policies, financial management, and HIV/AIDS andhealth service delivery. A case in point: Civil society and PLWHA have only limitedinvolvement in the Global Fund process in Cameroon. The MoH, which serves asthe Principal Recipient, dominates the Global Fund CCM by controlling membership,setting agendas, and deciding meeting times and venues without consultation.There is no effective control regarding the PR’s use of Global Fund assistanceintended to improve the country’s HIV/AIDS response.39
CAMEROONLack of health care personnelOn average, there is only one doctor available to serve every 5,000 PLWHA inCameroon. Physicians receive relatively low salaries and must deal with poorworking conditions. Most doctors are inadequately trained on HIV/AIDS, especiallywith respect to nutrition, counseling, and drug side effects. The doctors’ inefficiencyand lack of adequate incentives is further compounded by overwhelming workloads.Between May 2007 (when access to ART was declared free of charge) andSeptember 2007, treatment centers in Bamenda, Douala, and Yaoundé witnessedmore than double the number of PLWHA coming for services.Reports have surfaced about unscrupulous behavior on the part of some health carepersonnel in the public sector. For example, some patients have been told that theymust pay for ARVs, even though the medicines are supposed to be provided free ofcharge.The government plans to recruit over 30,000 health care workers over 15 yearsto address the personnel shortfall and to be able to fulfill WHO standards in thefuture. It is unclear how successful these efforts will be, given how slowly thegovernment has moved to initiate them. Currently the government is recruitingcommunity health workers through public and private health institutions as well aslocal NGOs.Treatment for OIsOIs are a particular problem in Cameroon because most people are reluctant tobe tested for HIV, due to stigma associated with HIV and AIDS. People often gettested only when suffering from at least one OI, which indicates significant HIVprogression. Also, patients are required to pay for all drugs to treat OIs, includingprophylactic medicines such as cotrimoxazole. This places a high financial burdenon many HIV-positive individuals, some of whom forego necessary treatmentbecause they cannot afford the medicines.Diagnostic testsPatients are required to pay for all HIV diagnostic tests. The cost for a standard HIVtest ranges from $1 in public facilities to $4 in most private health institutions. Onlypregnant women and children below the age of five can receive HIV tests free ofcharge through the public sector.Meanwhile, individual CD4 count and organ function tests cost about $42, with asingle viral load analysis priced at about $68. Unsurprisingly, such costs are beyondthe reach of most Cameroonians. Those that can afford them often find it difficultto access such tests anyway. Many of the more than 100 treatment centers do nothave the necessary equipment to offer CD4 count tests, and viral load analysis is40
Page 1 and 2: Missing the Target #5:Improving AID
Page 4 and 5: ArgentinaDr. María Lorena Di Giano
Page 8 and 9: Executive SummaryAt the G8 meeting
Page 12: • UN agencies should provide incr
Page 16 and 17: Price should not be a barrier when
Page 18 and 19: The Global Fund and UNITAID: The Fu
Page 20 and 21: The real cost of free treatmentBy a
Page 22 and 23: Remaining work for asuccessful prog
Page 24 and 25: DOMINICAN REPUBLICto access rapid t
Page 26 and 27: DOMINICAN REPUBLICIn Santo Domingo
Page 28 and 29: ZIMBABWEtreatment, representing 35
Page 30 and 31: ZIMBABWEAccording to the Medicines
Page 32 and 33: ZIMBABWEZimbabwe’s application fo
Page 34 and 35: ZIMBABWENational government• Addr
Page 36 and 37: RUSSIAMigrantsRussia, with the seco
Page 38 and 39: a person with HIV will die very qui
Page 40 and 41: FamiliesIn Kenya, families are the
Page 42 and 43: INDIA2. Provide pediatric formulati
Page 44 and 45: Linking nutrition and treatmentBy W
Page 48 and 49: only available in the capital, Yaou
Page 50 and 51: ZAMBIAFindings in particular provin
Page 52 and 53: The DACA for Chadiza District was a
Page 54 and 55: Many health care workers are inadeq
Page 56 and 57: DRUG REGISTRATION BARRIERS & LOGJAM
Page 58 and 59: Country ATV RLPV/rLPV/r(HS)TDFArgen
Page 60 and 61: development and registration. Likew
Page 62 and 63: Capacity issues and delays in the W
Page 64 and 65: Lack of post-approval quality assur
Page 66 and 67: ARV PROCUREMENT, REGISTRATION,AND S
Page 68 and 69: ARGENTINAParallel importingRelating
Page 70 and 71: ARGENTINAAccess to ARVsNo difficult
Page 72 and 73: Viral load tests are available, but
Page 74 and 75: Cambodiaby Mony PenOnly pharmacists
Page 76 and 77: ChinaBy anonymous Missing the Targe
Page 78 and 79: CHINAThe current process for regist
Page 80 and 81: Dominican RepublicBy Eugene Schiff
Page 82 and 83: IndiaBy Abraham KK, Celina D’Cost
Page 84 and 85: MalawiBy Lot Nyirenda and Grace Bon
Page 86 and 87: MALAWIStock-outsAccording to an ext
Page 88 and 89: MoroccoBy Othman MelloukMorocco has
Page 90 and 91: Determine the patent status of all
Page 92 and 93: MOROCCOThe shortage occurred becaus
Page 94 and 95: As of November 2007, the unit cost
Page 96 and 97:
NIGERIADiagnostic testsDiagnostic t
Page 98 and 99:
The government’s initial inabilit
Page 100 and 101:
Increase training and capacity buil
Page 102 and 103:
treatment practice. The Minster ann
Page 104 and 105:
Ugandaby Richard Hasunira, Prima Ka
Page 106 and 107:
UGANDAExtracts from the MoH’s rep
Page 108 and 109:
ZAMBIAIn gathering this information
Page 110 and 111:
However, since manufacturing prices
Page 112 and 113:
105SHORT SUMMARY
Page 114:
PAKISTANAccess for marginalized gro
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