ZIMBABWE: New treatment guidelines yet to be implemented

Harare, 19 July 2010 (PlusNews) - Zimbabwe's government has adopted new guidelines set by the World Health Organization (WHO) for treating people living with HIV, but there may not be enough money to implement them.

The new WHO guidelines recommend that countries start giving antiretroviral (ARV) treatment to HIV-positive people with a CD4 count (which measures immune system strength) of 350 or less, rather than at the previously recommended count of 200.

Around 226,000 people are obtaining ARVs from Zimbabwe's public health system, leaving a treatment gap of about 340,000, but the new guidelines mean that at least half a million people will now qualify for treatment, at a cost of US$7 per person per month.

"We don't have enough drugs to go full scale and provide treatment for all the 500,000 plus in need," admitted Dr Owen Mugurungi, the National Tuberculosis and HIV/AIDS Coordinator. "But our long-term goal is to ensure everyone in need of treatment has access to it."

Mugurungi said phasing in of the new guidelines would not start until January 2011, but government had begun training additional health workers, and in the meantime pregnant women and infants would be given priority in starting treatment earlier.

"Adopting and implementing these guidelines isn't just about increasing numbers of people on treatment," he told IRIN/PlusNews. "It's also about increasing the quality of care of those on treatment - that's why it was important for us to direct resources towards training of health practitioners [and] increasing the capacity of our laboratories."

In line with the WHO recommendations, Zimbabwe's new guidelines call for greater use of laboratory monitoring, including CD4 count and viral load testing (to determine the amount of HIV in the blood) in managing treatment, and urge replacement of the widely used first-line ARV, staduvine, which is associated with serious side effects, with the less toxic but more expensive tenofovir.

There are now high expectations so they must deliver and keep their promises

Mugurungi said the health department was banking on receiving increased funds from the treasury, international donors and the national AIDS Levy (a 3 percent income tax) to finance the scale-up of treatment and monitoring.

National HIV/AIDS programmes have largely been funded by the Global Fund to Fight AIDS, Tuberculosis and Malaria, and the Expanded Support Programme, a basket fund supported by contributions from Canada, Britain, Ireland, Norway and Sweden.

So far, money has been trickling in. About US$3 million was collected from the AIDS Levy in the first quarter of 2010, of which about 50 percent was allocated for treatment, and the Global Fund disbursed US$41 million from two different funding rounds, but the combined figure falls short of what is needed for ARV drugs alone.

HIV/AIDS activist Stanley Takaona applauded the adoption of the new guidelines, but urged government to mobilise resources to scale up treatment as a matter of urgency.

"By announcing the adoption of these new guidelines there are now high expectations, so they must deliver and keep their promises - come January next year, we don't want disappointments."

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Theme (s): Care/Treatment - PlusNews, HIV/AIDS (PlusNews),

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