20100401
ipsnews

NAIROBI, Apr 1 (IPS) - Pregnant mothers who are HIV-positive could soon find it challenging to access life-saving HIV drugs because Kenya was denied 270 million dollars in funding from the Global Fund to Fight AIDS, Tuberculosis and Malaria.

The Global Fund cited the existence of two ministries of health and the jostling between them over control of funds as a major source of concern.

According to James Kamau, coordinator of Kenya Treatment Access Movement, jostling between the ministry of medical services and that of public health over who should handle donor money is already affecting the smooth functioning of the health sector.

"Already, due to the confusion and competition between the two ministries on who should control the money, procurement of essential drugs for public hospitals has not been done leading to shortages," Kamau says.

Dr John Ong’ech, a HIV specialist at the University of Nairobi, states the funding shortfall will worsen access to lifesaving treatment following the move by the World Health Organisation (WHO) to introduce new treatment guidelines.

In 2009 the WHO recommended new guidelines on antiretroviral therapy (ART), calling for an earlier start to treatment and urging HIV-positive mothers and their infants to take ARVs while breastfeeding to prevent transmission.

"Under the new guidelines, WHO raised the CD4 count (measure of immunity to ascertain when HIV positive persons should begin treatment) from 200 to 350. What this means is that more people than was the case in the past will require to be put on treatment.

"This is obviously a challenge considering we were already facing drug shortages in trying to treat people with CD4 count below 200," Ong’ech says. Approximately 600,000 people will now require treatment.

The new guidelines called for HIV-positive mothers to begin treatment at 14 weeks - up from the previous recommendation of 28 weeks - to prevent mother-to-child transmission. They further urge seropositive mothers and their infants to continue taking ARVs up to 12 months after giving birth. Of the 1.5 million women in Kenya who fall pregnant each year, 100,000 test positive for HIV.

Ong’ech says the new line of treatment recommended by WHO will require more funds, a challenging scenario in light of the reduced funding.

In its report denying Kenya’s appeal for the cash, the Global Fund raised concern over duplication of roles between the two health ministries and the existence of a huge unjustified and unsustainable workforce. The government proposals were also said not to be clear on how they would implement the projects they were sourcing funds for.

The Global Fund has denied Kenya two consecutive rounds of funding (eight and nine) and Kamau says the issues that led to the funds being held back persist. He says the Global Fund has in the past raised queries over Kenya’s absorption capacity for the monies which they request.

"Civil society exhausted its part of the allocation but the cash with the government, which should have been used to buy drugs and other services has never been used," Kamau says.

Kamau raises concern whether a new application for round 10 monies will sail through unless things change drastically.

Kamau now warns that unless alternative funds are sourced for it remains unclear how the government will continue to provide free HIV drugs since money from the Global Fund constitute a huge component of the total expenditure of the HIV sector.

"Approximately 300,000 people (with low CD4 counts) in need of life-saving antiretroviral (ARVs) drugs are now not sure of continued access to medication. These 300,000 HIV-positive people also include pregnant mothers and HIV-positive children," Kamau says. There are currently 1.4 million HIV-positive people in Kenya.

He says the situation is further aggravated by the fact that the Clinton Foundation, which also funds HIV/AIDS projects is set to stop at the end of 2010.

"It means more HIV-positive people will join the list of those who cannot access treatment," he says.

Sarah Oluoch, an HIV-positive resident of Kibera slums, told IPS that public health facilities are already experiencing erratic supply of ARVs and other drugs.

"I am not sure what is going on, but lately we keep getting different brands of ARVs every time we go to the hospital and this is causing confusion. In fact one of my friends with a newborn recently confused her medication taking one of the drugs twice because she is not accustomed to the changing brands," Oluoch says.

Currently, the government allocates 6.6 million dollars for each financial year towards fighting HIV, a far cry from the estimated 133 million dollars spent annually in previous years.

According to Kamau, the government allocation has only been enough to provide for 25,000 people, with monies from U.S. President Emergency Plan for AIDS Relief (PEPFAR) catering for slightly over 100,000 people and the Global Fund paying for another over 100,000 people.

Kamau says after 2010, there will be no drugs as the stocks purchased in previous years will run out at the end of the year. He says the remaining nine months in the year is not adequate time to source funds because of the bureaucracy involved.