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

The government’s initial inability to procure sufficient ARVs was due to thefollowing:the essential ARVs were not registered with the Philippines National DrugFormulary;bulk procurement quantities could not be estimated because HIV clinicscould not produce data on the actual number of persons in need of ARVsor those currently receiving them;drug distribution mechanisms were not yet organized;diagnostic tests were unavailable, including those for CD4 counts, viralload, and liver function; andstandard treatment guidelines had not yet been established.The delay was so critical that WHO intervened in the third quarter of 2005 tofacilitate procurement of the needed ARVs. Even then, significant problems arose.Inaccurate estimates resulted in overstocks of Duovir (lamivudine/zidovudine) andnevirapine at the same time that a stock-out of efavirenz occurred.ART in the Philippines todayAs of October 2007, nearly all of the almost 500 people diagnosed with AIDS inthe Philippines are not receiving ART. Many have chosen not to begin treatmentbecause they fear potential side effects, a situation that indicates a lack ofappropriate treatment literacy and education among HIV-positive individuals.Although there are now 11 treatment centers distributed around the country, thenumber of adequately trained and competent health providers capable of providingHIV/AIDS management remains limited.Currently, all ART purchases are supported by the Global Fund, and drugs areavailable free of charge through the government treatment program. Of those onART, the majority are taking efavirenz, which is classified as a first-line medicineand an alternate to nevirapine if patients on the latter develop side effects. A feware taking a second-line drug, Kaletra (lopinavir/ritonavir).Ongoing challenges to effective HIV treatment deliveryHuman resourcesPHILIPPINESRapid turnover of trained health providers at treatment centers hasnegatively affected the quality of service delivery.Many providers at the treatment centers have insufficient knowledgeabout ART.91