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

Cambodiaby Mony PenOnly pharmacists or pharmaceutical companiesregistered with the Ministry of Commerce andauthorized by the Ministries of Health and Agriculture,Forestry and Fisheries are eligible for license applicationand importation of pharmaceuticals and agricultural inputs. An import license fromthe MoH is required for the importation of pharmaceuticals and medical materialincluding raw ingredients and finished products.The drug registration process currently seems to work better in Cambodia incomparison with recent years because the MoH has announced that the drugs tobe distributed officially in the country must be registered with WHO for prequalifiedassurance.A local company, Cambodian Pharmaceutical Enterprise (CPE), produced cheapARVs to meet the needs of local patients. However, its drugs did not meet WHOprequalification standards and thus were barred from the market. Access totenofovir was limited in the wake of fall-out from a highly publicized and criticizedclinical trial; however, that controversy has died down and the medicine is nowmore easily available. Recently, some key second-line therapies have been madenewly available, including the heat-stabilized version of lopinavir/ritonavir (Aluvia)and a coated formulation of didanosine (ddI). New pediatric formulations are alsoexpected to be available soon. However, very few Cambodian HIV patients havebeen tested for drug resistance or even tested for viral load due to high costs andno subsidies from the national program; therefore, only about 10 percent of ARTtreatment patients are on second-line therapies.Drug stock-outsOne of the hardest tasks for health experts is to predict and plan for the quantitiesof drugs needed. For economic reasons, excessively high stocks should be avoided.On the other hand, a shortage of necessary drugs is even worse because of thehealth consequences.At present, it is difficult to assess how often stock-outs occur in Cambodia becauseof different reports from donors, the government, and health care providers. Forinstance, many donor and government staff report never experiencing stock-outsresulting from the structure of the drug delivery system. In contrast, some healthcare providers, especially at provincial levels, have complained about a shortageof necessary drugs and a poor system of drug transferring. They say they have had67