Frustration mounts as Uganda faces HIV treatment shortages

At health facilities across Uganda, lifesaving HIV treatment is starting to disappear. A pharmacist at Kiboga Hospital in central Uganda said the facility ran out of the preferred medicine for children with HIV last Thursday. Instead, pharmacists are breaking adult formulations of the same drug down to a size they hope children will be able to tolerate. In Kamuli, approximately 148 miles northeast of Kiboga, a remote health center treating 360 people with HIV is completely out of three different adult antiretroviral drugs, and also a primary form of treatment for children. Some of those medicines have been out of stock for more than a month and a half, a health worker told Devex. It is widely understood that this is the result of the Trump administration’s cuts to the global HIV response, which have disrupted the distribution of ARVs and other HIV-related supplies. Health workers, civil society, and patients felt sympathy with government officials as they tried to mitigate the chaos created in the immediate aftermath of the stop-work order freezing U.S. aid. But more than two months later, their patience is wearing thin. “Most of the information is withheld by government officials,” Ziraba Kizita, a Kiboga resident living with HIV, told Devex. “It’s creating a sense where you don’t know what’s going on.” Kizita, who has been on treatment for six years, was coming to pick up a refill of ARVs. He was able to acquire three months’ worth of medication, but worries the drugs will be gone the next time he comes. Ministry of Health officials are aware of the growing frustration. It has spurred them to take action, like writing to American officials about their plans to distribute millions of dollars’ worth of U.S.-purchased medicines and supplies that are currently sitting in a Ugandan warehouse. Still, Peter Mudiope, the HIV prevention coordinator at the Ministry of Health, said the long-term process of taking over U.S.-funded operations, including distributing medicines, will be complicated. “We’re going back to factory settings,” he told a recent meeting of prevention experts, meaning officials are essentially restarting the HIV response. “All those apps you’ve been using have been lost.” In Uganda, ARVs and other commodities are primarily procured, stored, and distributed by two companies — the public National Medical Stores and the private, not-for-profit Joint Medical Stores. Their HIV-related services are partially underwritten by the U.S. President’s Emergency Plan for AIDS Relief, or PEPFAR. Those services were initially suspended during the freeze. Under a waiver allowing lifesaving treatment efforts to continue, the companies’ procurement and storage contracts were restored. But the distribution services were inexplicably canceled, according to both government and civil society representatives. Among the ramifications of this and other contract suspensions and cancelations, $20 million worth of drugs and commodities are sitting in JMS warehouses, Mudiope told the meeting. “They can’t touch anything without authorization from the U.S. government,” Kenneth Mwehonge, the executive director of the Coalition for Health Promotion and Social Development, or HEPS Uganda, told Devex. That authorization has not been forthcoming. Meanwhile, at facilities across the country, health workers running clinics for people living with HIV are watching their supplies dwindle or run out completely. And the situation in Uganda is not even the most dire in the region. The World Health Organization has warned that eight countries could soon run out of HIV treatment, including Uganda’s neighbors Kenya and South Sudan. In Uganda, the ministry has pushed back against reports of disruptions in ARV provision. In late March, officials issued a press release saying that ARVs remain available and free in all public health facilities and that “drug procurement remains unaffected.” While the four facilities Devex visited in Kamuli and Kiboga all had some ARVs, not all of the treatment normally available was in stock. And health workers complained that ministry officials are not updating them on when — or whether — replacements will come. At one Kiboga health facility, the routine delivery of HIV drugs and commodities due March 24 from NMS had still not arrived this week. As stocks run low, health workers are forced to reach out to colleagues at other facilities to see if they can spare some supplies. In some areas, there is nothing left to share. “We have to wait for the NMS to supply,” a government health worker in Kamuli told Devex. He spoke on the condition of anonymity to avoid getting in trouble with the ministry. “If we are not supplied, it means the clients are not having anything to take.” Government officials are aware of the shortages and of the growing anger across the country. Other ARV-related services have also been canceled or suspended by the Trump administration, including funding to support data collection and community outreach efforts around HIV clinics. That has only contributed to concerns about the quality of services currently being provided. “I saw the frustration,” Mudiope said during a meeting last week. “It’s not that the ministry is not talking. I cannot come here and say the ministry is doing nothing.” He said officials are in the process of claiming the JMS supplies and delivering them to facilities before they expire. HEPS Uganda’s Mwehonge said the government is also in the process of reallocating 40 billion Ugandan shillings, or nearly $11 million, through the end of the country’s fiscal year in June to cover the U.S. HIV funding that has been lost. But Mudiope cautioned that the government will struggle to immediately replace the PEPFAR initiatives that have been cut.