Bitter-Sweet findings from the 6th annual national monitoring of ARVs, TB medicines and diagnostics survey by HEPS Uganda

The Coalition for Health Promotion and Social Development (HEPS Uganda) under the umbrella of the Uganda Coalition for Access to Essential Medicines (UCAEM) annually conducts national surveys on availability of ARVs, TB medicines and diagnostics surveys in accredited ART services providers in Uganda. The findings from the survey are used to inform access to treatment policies.

 Against this background HEPS conducted the 6^th in a series annual survey on availability of ARVs, TB medicines and diagnostics in Uganda, the survey was conducted in 118 public, private and private-not-for-profit (PNFP) health facilities accredited by Ministry of Health to provide ART in four regions of Uganda (Central, Eastern, Western, and Northern). A basket of 67 essential medicines for tuberculosis and ART was surveyed: 57 ARVs and 10 anti-tubercular’s.

 Results from the survey

Of the 57 medicine formulations assessed by the survey, a total of 14 medicines were not found in any of the facilities surveyed. Most of the medicines that were not found in the surveyed facilities were monotherapies. This suggests that patients are receiving combination therapies, which reduces the pill burden and hence increasing chances of adherence.

The triple combination therapy of Zidovudine+Lamivudine+Nevirapine was the most available medicine, found in 69% of public facilities, 70% of private facilities and 67% of mission facilities.

Availability of double combination Tenofovir+Lamivudine has grown from complete unavailability in 2011 to 62% of facilities in this survey. At the same, results show that the highly toxic combination of Lamivudine+ Nevarapine + Stavudine (commonly known as Triomune) has phased out completely as it was not found at any treatment site.

Availability of medicines for children remains was very poor. The only triple combination medicine available Lamivudine+Nevirapine+Stavudine was in less than 3% of public facilities; in none of the private facilities; and only 8% of mission facilities.

On eMTCT medicines, the preferred first line treatment for pregnant mothers,

Tenofovir+ Lamivudine+ Efavirenz 300mg+300mg+300mg, was available in only 26% of public facilities; 62 of private facilities and 50% of mission facilities.

Medicines for TB treatment initiation phase (Rifampicin/ Isoniazid/ Pyrazinamide/

Ethambutol tab/cap 150mg/75mg/400mg/275mg) were the most available TB medicine, found in 81% of facilities in the public sector, in 77% of facilities in the private sector, and in 60% of the facilities in the mission sector.

In summery

It was established that the toxic combination of Triomune have been totally phased out which is a positive development and means that clients are now receiving safer and more tolerable medications

However universal access to treatment is still a challenge, even the most available triple combination medicine was not available in all facilities

Continued use of non film coated tenofovir+lamivudine; a two drug combination used with a third medicine, typically efavirenz or nivirapine. This two-drug combination is notoriously bitter and was recalled by NDA in January 2014 following widespread complaints by people living with HIV and their providers when it was being used in 2013, this drug has continued to used.

The low availability of ARVs in rural private facilities is an indicator of skewed access to HIV treatment

Management of HIV in children remains a major gap in the national response

Poor availability of anti-TB medicines in rural private facilities poses equity challenges