Integrated Regional Information Networks - January 23, 2012
MBABANE, 23 January 2012 (PlusNews) - Swaziland is still short of
lab reagents needed for CD4 count testing, which is used to
initiate and monitor patients on antiretroviral treatment, and
HIV-positive people are growing increasingly frustrated as the
country enters its fourth month without a way to establish the
strength of their immune system.
"This is setting us back years in the way we treat people living
with HIV and AIDS. Government says it has no money to buy the
chemicals needed to determine CD4 counts," Thembi Nkambule,
director of the Swaziland Network of People Living with HIV and
AIDS (SWANEPHA), an umbrella organization for the country's HIV
and AIDS support groups, told IRIN/Plus News.
Deciding on when to start a patient on ARV drugs is usually based
on a combination of CD4 cell count test results and HIV disease
progression, which the World Health Organization (WHO) has
defined according to four clinical stages, with stage four being
AIDS. In addition, guidelines for managing patients on ARV
therapy also use CD4 count testing to measure the impact of the
medication on the patient's health.
The government's ongoing financial crisis again hit the health
sector in October 2011 when supplies of lab reagents - the
chemicals needed to operate the CD4 count apparatus - began
drying up. Since December, CD4 count testing has virtually ground
to a halt in Swaziland, which has the world's highest HIV
Shortages of HIV programme supplies in Swaziland were first
reported in mid-2011. Although the stock-outs have been largely
blamed on reduced revenues from the Southern African Customs
Union (SACU), the country also opted not to apply for funding in
Round 10 from the Global Fund to Fight AIDS, TB and Malaria.
Instead, it chose to assume financial responsibility for HIV
treatment itself, at a time when SACU revenues were already
expected to decline.
Health Minister Themba Xaba said in a statement, "We need R7
million [US$875,000] to purchase the CD4 machine reagents, which
is a lot of money. This, however, does not mean that patients are
not getting any treatment. There are clinical stages and
guidelines that are used."
In the absence of a CD4 count test, guidelines suggest that
patients at stage three or four, determined by observable
symptoms defined by the WHO, should be started on ARVs.
"Doctors can only go by how a patient tells them he or she is
feeling, or if there are symptoms. The problem is that many
people with HIV do not get sick or have physical symptoms while
their CD4 counts are dropping to the level where they must take
ARVs," said Nkambule.
"Not having accurate information on CD4 counts puts the doctor in
the same position as performing surgery blindfolded."
According to Nkambule, equipment for monitoring liver and kidney
function is also out of order. "When government ran out of money
we were promised by government that the health sector would not
be compromised," he added.
The health ministry is looking to the Ministry of Finance to come
up with the necessary funding. Xaba has advised HIV-positive
people to have their CD4 tests conducted at private labs.
However, the test costs R150 ($19), which is unaffordable in a
country where 70 percent of the population live below the poverty
"For many of us coming up with bus fare to the clinic is a big
challenge. Taking CD4 tests is not a one-off thing. Many tests
are required. I would say few people are going to private doctors
for these tests," said Mandla Tsela, an AIDS testing and
counselling officer in Manzini.
AIDS groups have criticized the constant uncertainty: in 2011,
the country also experienced ARV stock-outs and had to be bailed
out by the US President's Emergency Plan for AIDS Relief
(PEPFAR), which gave the country $7 million in emergency funding
in August. Swaziland now has a buffer stock of first-line ARVs
that should last until April 2012.
"Why does there have to be a crisis or something has to break
down before any action is taken? First the people living with HIV
and AIDS were put at risk because of the supply of ARVs, and now
we don't know really who should be on treatment because they
don't have their CD4 counts," Nkambule said.