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More than half of Ugandan AIDS patients don’t get the drugs they need

BMJ 2008; 336 doi: http://dx.doi.org/10.1136/bmj.39486.598044.DB (Published 14 February 2008) Cite this as: BMJ 2008;336:348
  1. Henry Wasswa
  1. 1Kampala

    The number of Ugandans with AIDS who are being treated with antiretroviral drugs is now 110 000, but health authorities say that more than twice that number should be receiving them.

    “We have about one million people with AIDS in the country,” said Emmanuel Otala, Uganda’s minister for primary health care, last week. “A total of 250 000 deserve to be put on the ARVs [antiretrovirals] because their CD4 count has reduced to below 200. Of these, so far there are only 110 000 on the drugs, and we have a deficit of 140 000 who would otherwise be on the ARVs. The resources are limited, because we depend on donors.”

    Dr Otala said that about 94 000 patients with AIDS were taking antiretrovirals at the beginning of 2007, with slightly more than 1000 new patients being put on the drugs every month.

    The country was the second in Africa after Botswana to begin distributing free generic antiretrovirals in June 2004 in a five year pilot programme that began with 2700 patients. The $70m (£36m; €48m) project, which targeted more than 100 000 people with AIDS, was funded by the United Nations Global Fund to Fight AIDS, Tuberculosis, and Malaria and by the US government, which pledged $15bn to fight HIV and AIDS in 14 African and Caribbean states over five years (BMJ 2003;326:1233 doi: 10.1136/bmj.326.7401.1233-b).

    “Given the present state of the epidemic, we should be able to reach the sick with the drugs, but it’s not so,” said James Kigozi, a spokesman for the state controlled Uganda Aids Commission. “It is a fact that we do not have the money to procure the drugs for everyone in need of them.”

    Uganda is to launch an ambitious multimillion dollar national strategic plan, which will run to 2012, to increase the number of patients taking antiretrovirals and to reduce the number of new HIV infections.

    The final draft of the plan says that for the plan’s goals to be met and to reverse the growth of the epidemic funding will have to increase from the $263m that was available in 2007 to $361m in 2012.

    “The number of people in need of ARTs will increase to 263 000 in 2012 and 342 200 in 2020,” the document says.

    It says that the strategic plan will focus not only on scaling up access to antiretrovirals but also on reducing the number of new AIDS infections from 135 000 a year in 2006 to about 100 000 a year by 2012.