HIV drug shortage sparks panic as refills drop

Seven weeks into US President Donald Trump’s suspension of foreign aid, including funds for HIV/ AIDS treatment, panic has gripped persons living with the virus as they cannot access the required drugs.

Some of these people have since been switched to other drugs that they had earlier abandoned because of their side effects, which is a recipe for a healthcare crisis.

The suspension of the United States Agency for International Development (USAID) and freezing of funding to the President’s Emergency Plan for AIDS Relief (PEPFAR) led to the closure of HIV clinics and programmes rendered by non-governmental organisations (NGOs). It also resulted in the loss of jobs for thousands of workers.

Although the health ministry assured Ugandans that everything is under control, the situation has already affected many persons living with HIV, as they cannot adequately access HIV drugs.

Some of the persons living with HIV told New Vision that they are now being given antiretroviral drugs (ARVs) for one month as opposed to six months.

Steven Bweyale, 73, a resident of Nyakabirizi in Bushenyi district, has been living with HIV for 24 years.

“Before, I used to receive a six months’ supply of ARVs during each clinic visit. But when I went to the clinic last month, I was given drugs for only one month,” he says.

Bweyale said some of his friends have received even shorter refills, lasting merely two weeks.

“I cannot keep going to the hospital because there are many people. You have to spend a whole day at the hospital in order to pick drugs due to long queues. Yet, I stay far from Bushenyi Health Centre IV,” he noted.

This is the same situation in Jinja where Huzairu Nyanzi, the team leader of young people living with HIV, revealed that facilities like Njeru Health Centre III has for the last two weeks been giving drug refills for only two weeks.

“All hospitals switched to one month, because of the closure of many HIV clinics, which were under USAID like Family Hope, which would handle more than 1,000 persons living with HIV. All these have been switched to Jinja Health Centre IV. So, you can go to the health centre and leave unattended due to the big number of people. Some of our colleagues fear to be stigmatised,” Nyanzi noted.

He said safe spaces have been closed and there is no private counselling like it used to be before.

This reduction in the drug refills not only increases the frequency of clinic visits, but also heightens anxiety among infected people about the stability of their treatment regimens.

Nobert Guminkiriza, the programme co-ordinator Bushenyi district HIV Network Forum, reported a significant shortage of post-exposure prophylaxis (PEP) and pre-exposure prophylaxis (PrEP) drugs across numerous health centres.

In response, some health centres like Rumuhumura Health Centre III and Bushenyi Medical Centre, a private facility which was accredited by the health ministry to offer free HIV services, had resorted to selling ARVs at sh10,000 per tin. However, the district health officer, Eliab Tayebwa, has since intervened and stopped this practice.

Guminkiriza warned that the scarcity of, especially PEP and PrEP drugs, could lead to a rise in HIV infections, particularly among young people and sex workers, who have increasingly relied on such preventive measures over condom use.

According to Guminkiriza, much as the number of patients is overwhelming at the HIV care centres, there was a general decline in the number of people seeking HIV services.

One-month refill explained

According to Tayebwa, the quantity of drug refills has been taken from six months to one month to avoid uncertainty.

“We can no longer give out six-month refills anymore because we are uncertain about its future availability.

You cannot give out what you do not have. Even some of these drugs are expiring in July, so, if we give them six months, it makes no sense” Tayebwa observed.

He attributed the decline in the number of HIV patients seeking drugs to the widespread misconception that services have been entirely discontinued.

“This belief is being perpetuated by lack of public sensitisation” Tayebwa noted.

ARVs stockout concerns

Flavia Kyomukama, the executive director of the National Forum of People Living with HIV, expressed concern regarding the sustainability of ARV supplies.

With the current national stockout of some ARV drugs like Abacavir/ lamivudine, Kyomukama said some mothers are forced to buy Nevirapine (ARVs for babies).

“Some of our members on the second line of ARVs have bought drugs at sh200,000 for just one month. Many of us have been switched to different types of drugs, which doctors had advised us to switch from for certain reasons,” Kyomukama, who has lived with HIV since 1994, said.

She added: “The biggest worry is sustainability because the procurement company, which used to buy these ARVs was closed. Joint Medical Store is also closed because it was under USAID. We know procurement in this country takes four or more months, we need an urgent plan.”

Kyomukama said people living with HIV are worried that due to the long queues at the general outpatient wards, many will stop going for drugs.

She called for a detailed emergency plan from the Ministry of Health, arguing that much as the ministry says all is well, things are not well on the ground.

Impact on healthcare workers

Peter Otim, a person living with HIV and counsellor at The AIDS Support Organisation (TASO) in Soroti district, highlights the challenges faced by healthcare workers following the funding freeze.

“We were all asked to continue working, but on a voluntary basis; we do not get salaries and we are not yet sure when they will come,” Otim said.

The lack of resources has also hindered the ability to conduct follow-ups on patients, potentially compromising drug adherence and overall health outcomes.

The closure of specialised HIV clinics has led to a surge in patients at general outpatient departments.

For instance, Muvubuka Agunjuse, a local NGO in Kampala providing youth-friendly sexual and reproductive health services, has seen daily attendance rise from 80 to over 150 individuals.

Their HIV clinics held every Tuesday now attract more than 250 young people, resulting in extended waiting times and strained resources.

When New Vision visited government-run health centres in Kampala, such as Kisenyi and Kiswa health centres IV, there were significant delays, with patients waiting up to five hours for care.

This situation is worsened by Uganda’s low doctor-to-patient ratio, with only one doctor available for every 25,000 people.

Health ministry comments

The health ministry has embarked on a major shift in the delivery of public healthcare services, sparking concerns among patients regarding drug refills.

Dr Daniel Kyabayinze, the director of public health at the ministry, clarified that the changes in drug refills are part of a broader strategy to integrate healthcare services and optimise resources.

“We have now shared our integration guidelines, which emphasise a patient-centred approach rather than a disease-centred one. This means that care is being streamlined so that patients with chronic illnesses receive comprehensive treatment at once rather than having to visit multiple clinics for different conditions,” Kyabayinze explained.

He added: “All organisational changes come with hiccups, but this transition is aimed at making healthcare delivery more efficient and equitable.”

He noted that while some patients may experience a temporary reduction in their drug refills, it is a necessary adjustment as the ministry works to optimise supply chain management.

“It depends on stock levels, region, patient stability and the need to ensure that medication reaches all those in need,” he added.

Currently, out of 1.5 million people, 1.3 million are believed to be on ARVs with 90% suppressing their viral load.