Tested but untreated: How Uganda's new AIDS efforts are leading to a drug shortage

Public Radio International

 

In many parts of the world, HIV/AIDS is no longer a death sentence.

Thanks to lifesaving drugs — and foreign financing to buy them — countries that were once the epicenters of Africa’s AIDS epidemic in the early 1990s have slashed infection rates in two and reduced deaths by nearly half.

With new efforts to eradicate the virus worldwide, and millions in US and foreign funding every year, some say the end of HIV/AIDS is near. But those same efforts are having the opposite effect in Uganda, where poor planning, lack of donor accountability and chronic budget gaps are leaving thousands of patients without treatment and US and Ugandan policymakers washing their hands of responsibility.

With the country’s HIV/AIDS rate expected to rise and clinics struggling to supply medication to a growing pool of patients, some say Uganda is jeopardizing the gains made in the last two decades and leaving the country vulnerable for a renewed epidemic in the coming years.

Read the full article at Public Radio International.

DSC_4816-Edit.jpg

Dozens of patients wait to collect their HIV/AIDS medication at Mayuge Health Centre III in Uganda.

The clinic is one of several in southern Uganda facing chronic shortages of both antiretroviral medications and Septrin, a complimentary drug that prevents infections in patients with weak immune systems.

About a third of the patients left empty-handed after clinic officials admitted they were out of both preventative medication and second line antiretroviral drugs

registration-patients-hiv-aids-uganda

An officer with the Ministry of Health registers new patients for HIV treatment at Mayuge Health Centre III in Uganda.

patients-waiting-hiv-aids-drugs-uganda.jpg

Women wait for their monthly prescription of HIV/AIDS medication at Mayuge Health Centre III in Uganda.

medication-distribution-uganda-hiv-aids.jpg

Clinic staff distribute their remaining HIV/AIDS medication to patients at Mayuge Health Centre III in Uganda. Other types of antiretroviral and antibiotic medication remain out of stock.

This clinic, along with others across Uganda, has experienced ongoing stockouts of HIV/AIDS drugs for more than a year. The Ugandan government insists the drug supply issues are limited and temporary.

registration-clinic-uganda

Community health worker Ignutious Lusalalira pages through a patient registration log at Mayuge Health Centre III in Uganda. Files containing new patient information, HIV testing outcomes and patients who have been lost to follow up are stacked behind him.

 
In January, there were one or two weeks when there were no drugs at all. If [the government] doesn’t fix this, people’s immunity will get worse.
Our patients will die.
— Ignutious Lusalalira & Sarah Bwenene, community health workers, Mayuge Health Clinic III
 

Shelves designated for ART storage remain empty despite multiple requests for emergency orders of Septrin and second line drugs.

There were “less than two months of stock” for most HIV/AIDS drugs according to a June 2017 Ministry of Health stock status document. Still, reports of ART shortages continued across western, northern and southern Uganda through May 2018.

empty-hiv-aids-clinic
hospice-hiv-uganda-patient-nurse.jpg

Rukia Webombesa waits for a hospice nurse to distribute a dose of liquid morphine in their home in south central Uganda. She is dying of AIDS.

Rural areas of Uganda have faced chronic stock outs of HIV/AIDS drugs for more than a year. Many blame the country’s new “test and treat” program, which aims to treat all HIV positive Ugandans regardless of the severity of their disease, for the shortfalls. They claim too much demand and not enough supply, coupled with poor donor management and chronic underfunding has left thousands of patients without their lifesaving drugs since June 2017. 

hiv-aids-hospice-singing.jpg
child-hiv-aids-hospice.jpg
mental-health-aids-uganda.jpg
We just have too many [patients]. The drugs are consumed, and by the time [the next supply arrives], the old stock is finished. So we always experience stock-outs.
— Paddy Babolana, HIV coordinator, Mayuge Health Centre III
hospice-patients-hiv-aids-uganda

Beatrice Namnganza, 50, is examined by a hospice nurse in southern Uganda. Namnganza tried to pick up her monthly prescription of antiretroviral but the clinic was out of stock. That was 13 days ago. She is dying of AIDS.

Maureen, 28, was diagnosed with HIV/AIDS during a routine medical appointment in 2013.

Forced into a polygamous marriage with a man who never disclosed his status, both Maureen and her two co-wives discovered they were HIV positive.

Maureen asked to sing a song about HIV/AIDS during our interview in October 2017. She said she learned the song when she was in primary school, long before she contracted the HIV/AIDS virus.

Maureen now lives alone in a small concrete room on the outskirts of Jinja, Uganda. She is receiving pain and end-of-life care from a local nonprofit. 

community-health-hiv-aids-uganda.jpg

Community health worker Annette Babinye Ayazika speaks with patients at Wabulungu Health Clinic in southern Uganda.

“At times, they have (the drugs) but they also run out of stock,” said Ayazika. And even when the drugs are available “the patients are too many,” she said. 

mother-hiv-aids-clinic-uganda.jpg

A woman waits to be seen by a doctor at Wabulungu Health Clinic III in Uganda.

clinic-uganda.jpg

Patients wait for a doctor at Wabulungu Health Clinic in southern Uganda. For the last five months, this clinic, along with a others in the area, have experienced shortages or complete stock-outs of HIV medication; some lasting as long as one or two months.

In April, the US government announced that it would increase its budget for HIV prevention and treatment in Uganda from $402 million per year to $408 million, in order to cover programs from October 2018 to September 2019. USAID also provided $18.7 million worth of ART to Uganda to “fill gaps in the public sector” late last year. Domestic funding for ART has remained the same said Kiragu.

Still, reports of ART stock-outs continued through May 2018 and “are still ongoing as we speak,” said Henry Zakumumpa, a health systems researcher at Makerere University.