International medical humanitarian organisation, Médecins Sans Frontières (MSF), has urged the Global Fund to Fight AIDS, TB and Malaria to make urgent policy changes for countries which are gradually losing donor support.
Manoj Pardeshi, general secretary of the National Coalition of People living with HIV in India, told The Indian Express, “This will increase the risk of critical drug stock-outs and alarming drug quality issues in many countries, including India”.
The Global Drug Facility, which helps countries procure TB drugs, has documented a number of problems related to the Global Fund’s policies. In the past 18 months, 15 countries in Asia, Africa, Eastern Europe and Central Asia regions have experienced stock-outs of TB drugs. Additionally, 29 countries in these regions, along with Latin America, have purchased TB drugs of unknown quality, and 21 countries have purchased TB drugs and tests at prices that far exceed the lowest global prices they should be paying.
MSF has witnessed similar problems in countries where it works, including stock-outs of TB drugs in Armenia due to pharmaceutical corporations not registering their products in the country, stock-outs of paediatric HIV drugs in India due to a lack of quality-assured suppliers and an unstable supply of HIV drugs in Guinea due to Global Fund co-financing expectations that exceed the capacity of national systems, said Dr Greg Elder, medical coordinator of MSF’s Access Campaign.
People receiving treatment for tuberculosis and HIV in these countries have faced dangerous treatment interruptions and have been treated with drugs of unknown quality, and the countries are also faced with paying much higher prices for drugs, said Dr Els Torreele, executive director of MSF’s Access Campaign.
In a statement, Torreele said, “The current pace of Global Fund country transitions, hastened by underfunding from donors, is creating a ticking time bomb where people’s HIV and TB treatment is jeopardised by unknown drug quality and drugs simply not being there… Allowing countries to fall off a cliff without mitigating the risks for people who need treatment could reverse nearly two decades of progress against two of the world’s deadliest infectious diseases”.
Over the last 16 years, the Global Fund’s purchasing of HIV and TB treatment commodities has helped secure affordable prices through high-volume orders and attracting multiple competing suppliers.
In order to avoid drug stock-outs and quality issues, MSF called on the Global Fund Board and Secretariat to urgently carry out risk and readiness assessments for countries expected to increase their co-financing of medical commodities, as well as countries currently undergoing transition.
“In India, there is a frequent stockout of anti-retroviral drugs like Nevrapine Tab… the Global Fund cannot throw up its hands and now say it is the government’s responsibility,” said Pardeshi.
He said efforts were on to educate persons living with HIV to adhere to the treatment protocol, but there were consistent issues of drugs getting over. “We then lose patients who are on treatment and refuse to continue with the drug regimen,” Pardeshi said.
In India, approximately 2.3 million people live with HIV, of which 1.3 million are on treatment. “This issue needs to be urgently addressed due to frequent stock-outs,” he said.
“We are calling on the Global Fund to look before it leaps and find solutions by working with countries and other players, because people’s lives are on the line. The number of drug stock-outs is an alarming sign that countries’ transition from Global Fund support is being handled in a rushed manner,” he added.