KENYA: Poor ARV programme infrastructure hampers efforts

Disagreement on the infrastructure for Kenya's antiretroviral programme has made it difficult to have a coordinated approach to fight the HIV/AIDS pandemic, the director of the AIDS Control Programme told PlusNews on Tuesday.

Dr Kenneth Chebet said the launch last month of national antiretroviral (ARV) treatment guidelines was the first step in trying to create a "standardised" approach between the public and private sectors. The guidelines were released following a meeting held by various stakeholders to discuss the "realities" of administering ARV therapy in the country.

Only about 2,000 of 2.2 million HIV positive Kenyans receive ARVs, said Chebet. "Most of these people get them from private clinics and donors because the public health sector has no access to these drugs."

"Health workers in the public sector were initially scared to initiate ARV therapy because of inadequate monitoring," he said. Following the stipulated WHO guidelines on ARV monitoring was difficult because of limited resources in the country.

Effective monitoring requires proper equipment and trained staff, to among other things, accurately measure the viral loads of patients. Counselling is also required.

According to Chebet, developing countries need a simplified monitoring system. "What is applicable for the developed world may not apply to developing countries like ours because we need to look at poverty and other challenges".

Despite the government adopting drug patent legislation last year that allowed it to import generic drugs, the cost of ARVs also remains a major challenge. The wide-scale use of generic AIDS drugs has yet to take off in the public health sector.

In response to these problems, WHO recently created an interim working group and published a guide to ARV treatment in resource limited settings - See
www.who.int/HIV_AIDS/WHO_HSI_2000.04_1.04/003.htm#3.5

Among other issues, the working group outlined the importance of drug information and counselling for patients; the need for emotional support and confidentiality; adherence techniques to the regimens, and the need for further research.

"It is important to discuss how the drugs are going to be paid for before embarking on treatment since financial constraints are a common reason for default from treatment. The importance of adherence to therapy and the consequences of intermittent therapy, cessation of therapy or of taking sub-optimal doses to minimise drug costs, should be candidly discussed with all concerned," WHO noted.

"In resource limited settings, where the conditions necessary for the introduction of ART have been fulfilled, priority for treatment should be given to symptomatic patients with severe immune damage (i.e. CD 4 count below 200 cells/mm3), because these patients are at a high risk for disease progression," the working group said.

With a national treatment approach in place, Chebet expects "dramatic changes" in ARV treatment in the country. "We will be embarking on countrywide training for health workers, to educate them about administering ARVs successfully and then with the new law, drug prices are going to drop."

Chebet also expressed hope that UN Secretary-General Kofi Anan's Global AIDS Fund would distribute funds for AIDS drugs.

Theme (s): Care/Treatment - PlusNews,

[This report does not necessarily reflect the views of the United Nations]