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NAMIBIA: Strategies to keep patients on ARVs

16 Sep 2008 15:17:36 GMT
Source: IRIN

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JOHANNESBURG, 16 September 2008 (IRIN) - Just over 50 percent of HIV-positive Namibians thought to be in need of life-prolonging antiretroviral (ARV) treatment are accessing the drugs, but the country is struggling to keep track of patients.

Namibia is one of the least densely populated countries in the world. With a population of just two million scattered across an area more than four times the size of the United Kingdom, delivering life-long ARV treatment to some of its more far-flung corners is a major challenge.

Dr Ndapewa Hamunime, head of HIV/AIDS case management in the Ministry of Health, told IRIN/PlusNews that ARVs were available at all 36 of the country's district hospitals and some of the larger health centres; with 55,000 out of an estimated 100,000 people in need of treatment now getting it, the country was on track to achieve the goal of universal access to treatment "very soon".

But Gloria Billy, a UNAIDS programme officer, pointed out that the health sector did not have the systems and medical personnel to ensure that patients stayed on treatment. "Yes, we have people on ARVs," she said, "but monitoring and evaluation is really lacking."

A manual system for tracking patients depends on doctors having time to fill out attendance records, but with a vacancy rate of 35 percent for doctors and 26 percent for nurses, according to a recently released health department report, Billy said that many doctors are having difficulty coping.

The two donors supplying drugs for Namibia's treatment programme - the Global Fund to Fight AIDS, Tuberculosis and Malaria and the US President's Emergency Fund for AIDS Relief (PEPFAR) - have contributed to the record-keeping burden by creating parallel systems, Billy said.

"It's a big problem; we're trying to work closely with the health ministry so we have one system for monitoring and evaluation. At the moment, there's a lot of duplication." She noted that the figure of 55,000 reflected the number of patients who had started taking ARVs, not the number still taking them.

Hamunime said only about five percent of patients had defaulted on their treatment, but Billy suspected that the lack of an adequate monitoring system could be disguising a higher default rate. She said that alcohol abuse and food insecurity could be causing people to interrupt their ARV regimens.

Michael Mulondo, executive director of the Namibian Network of AIDS Organisations (NANASO), an umbrella organisation, also expressed concern about the impact of food insecurity on people taking ARVs. "The challenge many of these communities are having is that when they return from the clinic, they lack nutrition, and that's an issue of poverty."

Namibia, like most countries, has been affected by rising global food prices. Its inflation rate rose to 12 percent in August, the highest in six years, according to the Central Bureau of Statistics. A bumper maize harvest and tax exemptions on staple foods have mitigated costs somewhat, but Baton Osmani, country coordinator for the World Food Programme, noted that "price increases have taken a toll on the most vulnerable."

Lack of funding recently forced the WFP to discontinue many of its programmes in Namibia, including a project for feeding orphans and vulnerable children in six northern districts hard hit by floods and drought.

Hamunime agreed that lack of money for food and transport to hospitals was preventing some patients from staying on treatment. "That's why we must strive to provide treatment at local clinics," she said. Community counsellors recruited by the local Red Cross Society have been trained to trace defaulters and help them adhere to treatment.

The shortage of medical personnel is a problem in countries throughout the region, but Namibia has the added disadvantage of lacking its own medical school. "We still rely on our neighbouring countries like South Africa to train [doctors]," Hamunime said. "We've also recruited a lot of doctors from elsewhere, who are helping us with the [ARV] roll-out."

The health ministry recently embarked on a strategy of "task-shifting" the initiation and management of ARV treatment from doctors to nurses. "We want to follow the lessons learned from countries like Rwanda and Mozambique, where they have nurses prescribing ARVs," said Hamunime. "It's especially important in remote areas where there are no doctors."

With support from PEPFAR, nurses began training in ARV management this month. The task-shifting strategy will go through a pilot phase before being rolled out nationally.

ks/he

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