Intended for healthcare professionals


Ugandan hospitals ration AIDS treatment as antiretrovirals start to run out

BMJ 2010; 341 doi: (Published 20 July 2010) Cite this as: BMJ 2010;341:c3900
  1. Henry Wasswa
  1. 1Kampala

    Doctors in Uganda have warned that the country is facing an acute shortage of antiretroviral drugs. New patients with HIV or AIDS are being turned away from clinics, and those lucky enough to be getting treatment are being given just one month’s worth instead of the usual three months’ supply.

    Zainab Akol, manager of the health ministry’s AIDS control programme, said, “All the 228 000 patients currently on ARV [antiretroviral] treatment are receiving the drugs. But because we do not have adequate quantities of ARVs, we have first to maintain those already on treatment. We do not recruit new patients at the cost of those we already have.”

    Uganda has about a million people with HIV. Of the total 2.5 million people estimated to have been infected by the virus since the early 1980s, about half have died, the health ministry says.

    Although Uganda has one of the world’s most aggressive HIV and AIDS control programmes, the rate of HIV infection has been rising in recent years. The health ministry estimates that there are now 130 000 new infections each year, including 20 000 among babies.

    In the mid-1990s the health ministry began antiretroviral treatment programmes for people with AIDS, but these have been hampered by the misuse of funds by government bureaucrats and the global financial crisis, which has resulted in massive reductions and delays in donations.

    Uganda’s HIV and AIDS control programme is mostly funded by the World Health Organization, UNAIDS (the joint United Nations programme on HIV and AIDS), the Global Fund to Fight AIDS, Tuberculosis and Malaria, and the US President’s Fund for Aids Relief (PEPFAR).

    Two weeks ago hundreds of women with AIDS staged peaceful street marches in the capital, Kampala, in protest at the scarcity of antiretrovirals.

    James Kigozi, a spokesman for the government run Uganda Aids Commission, told the BMJ, “The women were right to demonstrate, because there are no adequate drugs in hospitals. Hospitals are not registering new patients.”

    A doctor working for a Catholic mission hospital in central Uganda said that its AIDS clinic had began rationing drugs, stopped CD4 count tests, doubled outpatient fees, and reduced the amount of doses that patients can take away. The health centre has more than 5000 patients with AIDS.

    He said, “PEPFAR has stopped funding for AIDS programmes here, and we are feeling the pinch. We have introduced a system of rationing the drugs. The cost for the drugs for each patient per month is 35 000 shillings [£10; €12; $15], and a CD4 count costs 20 000 shillings. In the future the patients may have to pay for the drugs.”

    An estimated 500 000 Ugandans are eligible for antiretroviral treatment. The government planned that 350 000 would be given the drugs by June 2011. This number includes the 228 000 currently taking them.

    Dr Akol said, “Between now and June next year a total of 350 000 patients would be on ARV treatment, and this would need between $35m and $40m just to buy medicine. We have not procured enough ARVs, because there is inadequate funding.”


    Cite this as: BMJ 2010;341:c3900

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