Demand for ARVs still outpaces supply,

The Observer Newspaper by Racheal Ninsiima Friday, 19 September 2014

Despite a remarkable increase in access to antiretroviral therapy (ART) between 2003 and 2009, the number of people in need of the drugs continues to outpace the response. Between 2011 and 2013, the number of ART recipients has risen by 75 per cent from 329,060 to 577,000. However, over the same period, the number of people with HIV/Aids also rose from 1.2 million to 1.6 million. 

The government adopted the 2013 World Health Organisation (WHO) ART guidelines, which expanded the threshold for eligibility for treatment from a CD4 count of 350 cells/mm³ to one under 500 cells/mm³. This also means more people need ARVs. According to the mid-term review report of the national HIV/Aids strategic plan 2011/12-2014/15, released at last week’s national joint annual Aids review, in Kampala, about 1.4 million people are eligible for treatment. Of these, about 193,500 are children below 15 years. 

“The new guidelines have brought the ART coverage figure down to 43. 6 per cent (2013 guidelines) from 70.2 per cent (2010 guidelines) among eligible children and adults with fewer adult males (174,582) enrolled on ART compared to females (349,068),” said Dr Andrew Balyeku, a treatment and care consultant with Uganda Aids Commission (UAC). The new recommendations also include providing ART to all infected children under five irrespective of their CD4 count. Within the report’s review period (2011-2013), Uganda has seen a decrease in new HIV infections from 162, 000 in 2011 to 137,000 in 2013.

Fewer infections

This is attributed to the expansion of Option B+, a programme aimed at having all HIV-positive pregnant mothers enrolled on lifelong treatment. It aims at elimination of mother-to-child transmission (EMTCT) of HIV by 2015. “By the end of 2013, EMTCT services had been rolled out in all government facilities up to health centre IIIs and the number of active EMTCT sites increased from 965 in March 2012 to 2,130 in September 2013,” the report says. Consequently, the number of paediatric new infections reduced from 28,000 in 2011 to 9,000 by the end of 2013. There was also a sustained increase in the coverage of paediatric ART between 2011 and 2013. The proportion of eligible HIV-positive children who were enrolled on ART increased from 25 per cent in 2011 to 41 per cent in 2013 (41,520 of the estimated 107,000). “The figure is predicted to [fall] to 8,000 by the end of this year and we now need to refocus our strategies on other sources of new infections such as the risk populations and youths,” said Dr Ruhakana Rugunda, the minister for Health.

Challenges.

According to the report, more than 1.4 million men have been circumcised, exceeding the mid-term target of 1.2 million men. In the early phase of the HIV pandemic, Uganda received global acclaim for successfully reducing the HIV prevalence from 18 per cent in the 1990s, down to five per cent in 2005. Subsequently, the annual rate of new HIV infections stabilized, leading to a stable adult HIV prevalence of between six and seven per cent for the past 10 years. However, these earlier gains were clawed back by many challenges that left HIV/Aids a major public health challenge.  “There is generally inadequate supply of HIV test kits, poor counselling services especially in private clinics and quality concerns about safe male circumcision and thus, some clients miss follow-up visits,” said Dr Joseph Matovu, a consultant with UAC.  http://www.observer.ug/index.php?option=com_content&task=view&id=33938&Itemid=114

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