Togo: ARVs free, and in stock, at last

LOME, 21 January 2009 (IRIN) - After two years of unreliable - or no - access to antiretroviral (ARV) drugs in Togo, HIV-positive patients are resuming or starting treatment after new donor funding has re-stocked supplies and ARVs became free as of 14 November.

Simba Abalo, 47, told IRIN he was diagnosed with HIV in 2007 but was turned away from the state medical purchasing agency, CAMEG. One year later, after hearing radio announcements that ARVs were being offered for free, he went to the non-profit HIV services association Espoir Vie Togo [life, hope Togo] on 13 December in the capital Lomé.

"I hope they really are free. Otherwise, I cannot afford to pay both for myself and my wife," the retired soldier told IRIN. "It is OK if I die, but she needs to stay alive for the children. We are prepared that if there is still a shortage, she should start treatment before me," the unemployed Abalo told IRIN.

Both have since started antiretroviral treatment (ART).

Dwindling, then gone

ARV stock had been dwindling since The Global Fund to Fight AIDS, Tuberculosis and Malaria suspended part of its multimillion-dollar grant to Togo in 2006 and turned down a grant request in 2007 because of "irregularities" in oversight.

New patients were turned away for ARVs from June to November 2007, according to CAMEG. Patients already on antiretroviral treatment during that period could not get ARVs for about three months.

Medical studies have linked interruptions with increased drug resistance, in which ARVs, when resumed, cannot fight mutated HIV strains.

Measures taken to limit interruptions included an emergency government purchase of a US$365,000 three-month supply, two months' support from the French-led Network for Therapeutic Solidarity in Hospitals (GIP-Esther), and ARV loans from Burkina Faso and Benin.

Hundreds of people protested the ARV shortage in a November 2007 demonstration in Lomé, carrying signs that read: "Without generic drugs, death" and "Held hostage [to ARV shortage]." 

Thousands of new or unsubsidised patients unable to start or continue ART used antibiotics, instead, or no treatment at all. For the more than 3,000 unsubsidised patients, monthly costs were either $9 or $47, depending on the medicines.

In 2007 the average monthly income for those employed in Togo was $30, according to the World Bank.

Stopgap solution

"CAMEG was not accepting any new patients," said Abalo. "Even if they had the drugs, I could not have paid more than $4 a month since I had just lost my job as a security guard earning $70 a month. A nurse advised me to take the antibiotic Cotrimoxazole."

He said he did not always have the 68 US cents for each packet of the antibiotic. Abalo showed IRINhis CD4 test result from October 2007 -- 80.

A person's CD4 count is a measure of white blood cells able to fight against HIV. According to the World Health Organization, any patient whose CD4 count is at or below 350 should be on ARVs.

"When I didn't take my antibiotic pills because I had no money, I would vomit after eating. But if I could take it, I could keep food down," Abalo said.

Is free enough?

Togo's National AIDS Control Programme has estimated that an additional 4,000 patients will resume or start antiretroviral treatment as a result of the free ARVs. With current funding levels for ARVs, CAMEG's deputy director Takouda Pelei told IRIN his agency has enough stock to cover current patients on ARVs and up to 4,000 new patients until August 2009.

Togo has been approved for $94 million of additional Global Fund support for the next five years, of which $25 million is budgeted for ARVs and medication to fight opportunistic infections. Disbursement is expected in the coming months.

HIV services groups and the government estimate that at least another 18,000 people need treatment, in addition to current ARV users. As of 21 January, CAMEG is in the process of updating its nationwide count of ARV users, which was 11,490 at the end of 2007.

Pelei told IRIN it is critical to avoid another shortage. "Antiretroviral treatment does not work like a spigot. You cannot turn it on and off without risking the patient's life."

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