Friday, 25 April 2003 03:00

ARV Prices

Written by By Arthur Okwemba


After spirited attempts to have the HIV antiretroviral drugs prices scaled down to enable many of the HIV/Aids patient access them, those infected with the virus may have started to reap the fruits of their struggle.



Our recent investigations indicate that prices have plummeted and a one-month triple therapy can now be bought at Shs 3,000 compared to about Shs 50,000 two years ago.

But this is price offered only by Mission for Essential Drugs (Meds) in all Mission Hospitals estimated to number 30.

Some of these mission hospitals are Mukumu, Kikuyu, Nazareth, Chogoria, Consolata and St. Mary’s in Nairobi. The triple therapy offered by Meds is a combination of various anti-drugs approved by the World Health Organisation.

However, these ARV’s are dispensed only in mission hospitals with doctors who have expertise on how the drugs are used and work.

Hence not all such hospitals will have the drugs. Also, since most of these hospitals are not found everywhere in the country, a huge number of Aids patients are not benefiting.

A source at the National Aids Control Programme, say the government is thinking of using similar combinations used by Meds to provide ARV’s to 200,000 Aids patient.

According to Nascop, the 200,000 people are part of the estimated 2 million infected by the virus, but whose status has developed into Aids.

Although the government has a tentative budget of 3,000 per person, information has it that discussions are advanced on how the prices can be made much cheaper.

If these is implemented, then it is hoped those not being reached under the Meds or other programmes will be catered for.

It is understood Medis is able to provide the drugs at such affordable prices because they managed to import generic antiretroviral drugs from Cipla, a pharmaceutical company based in India as well as being able to utilize a programme run by Philips pharmaceuticals.

The programme, Accelerated Initiative Programme, is brainchild of two pharmaceutical companies, Merck Sharp and Dohme and Bristol Myers Squipp. Its objective is to avail HIV-drugs at affordable prices to the people living with Aids.

A triple therapy of these drugs is going for between Shs 4,000 and Shs 12,000 a month than the previous prices of between Shs 50,000 and Shs 80,000. All these different ARV’s combinations are found only in major hospitals, and are distributed by Philip pharmaceuticals.

Niraj Doshi of Merck Sharp and Dohme say the drugs are only available in hospitals because they have to be dispensed by doctors who have expertise in their use. Also, such strategy helps doctors to monitor the patient’s condition and response to the drugs.

HIV experts say they prefer drugs dispensed in hospitals or by well-known doctors because they fear people may abuse them the way it is happening to antibiotics.

“ If you abuse or fail to comply, then resistance strains may develop. This are likely to be very difficult to manage with treatment regimen available in the market,” warns Dr Moses Otsyula, the Head Virology department, Institute of Primate Research.

Besides Philips pharmaceutical, GlaxoSmithKlime has also come up with an initiative that attempts to avail ARV’s to HIV/Aids patients at a cheaper price. They have what they call distributor and access prices.

Access prices are designed to make the anti-Drugs affordable to majority of HIV/Aids patients, and are dispensed only in hospitals where there is doctor trained on their use.

Take Combivir drug. The access price is Shs 4,688, when the same drug is Shs 8,027 when sold at distributor price. Another is Epivir, which goes for Shs 1,684 at access price, and Shs 4,600 at distributor price. More than four different types ARV’s are distributed by GlaxoSmithKlime.

With such reductions in prices, Dorothy Odhiambo of Women Fighting Aids in Kenya says the number of people accessing ARV’s has increased from 7,000 to between 15,000 and 20,000 people.

She says: “ The situations has improved a lot, but there is still so much to be done taking in account the number of those infected.”

Dr S.T Patel of MP Shah hospital says the access has increased by over 20 per cent. He is upbeat that the prices of triple therapy such as of three drugs: Vitex, Zerit and Viramune has come down from Shs 54,000 to Shs 6,000 a month.

At the moment, there are about 23 different anti-HIV drugs in Kenya, which can be combined for use by people living with Aids.

According to government estimates, to increase access, more than Ksh 5.7 billion will be needed every month to supply generic ARVs to 200,000 infected persons, or 18 billion if they are original drugs.

Yet, in the 2002/2003 financial budget, the government allocated only 100 million for financing the purchase of ARV’s.

But, even as the prices of ARVs fall, people living with Aids now say they are faced with another challenges: monitoring the HIV viral loads or the amount of the virus in the body as well as the CD4 counts (immune system cells).

The knowledge of the viral loads and CD4 counts is important to determine whether a person should be put on ARV’s or if one is already on them, how they can be sequenced.

If tests indicate that the persons CD4 counts are below the 200 mark, then ARV’s have to be introduced. The test results also helps the doctor to tell if the patient is responding to medication or if they are lapsing or taking the medication as recommended.

But with tests to determine viral loads costing between Shs 7, 000 and Shs 10,000 a month and those of CD4 counts ranging between Shs 1, 200 and Sh 2,000, many of the HIV/Aids patients are finding it difficult to do routine monitoring of their status.

When it is recommended such tests be carried out at an interval of two or three months.

What this means is that even if people access cheap antiretroviral drugs, knowing when to begin taking them or when to change to another combination for effective results might be a problem.

In fact, the issue of monitoring has generated debate among people living with Aids, with some privately questioning the mandate and effectiveness of the Voluntary Counselling and Testing (VCT) centres.

They argue that by only establishing the HIV status of person is not sufficient as these centres do not assist those found positive to monitor their viral loads or CD4 counts.

Questions now abound on whether, if the government is still unable to fulfil its promise of providing ARVs in the VCT’s, will be able to shoulder an added cost and do CD4 counts and viral load tests for HIV/Aids patients.

Financing such a programme remains a big issue, as Dr Otsyula says one type of machine that does viral loads costs about Ksh 120,000. And it can only do 18 tests, after which a new machine has to be bought.

Dr Chris Ouma of Action Aid wonders how the government can manage this when in a recent survey they did, they found out that no single public hospital was monitoring its HIV/Aids patients. He also claims that as yet, the government has no treatment plan for those infected with the virus.

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