Should African governments consider alternate distribution channels for ARVs due to COVID-19?

In April 2020 hundreds of thousands of Africans may have missed their appointments to collect their antiretrovirals (ARVs). Right to Care Chief Executive Professor Ian Sanne told the African News Agency that data shows increasing numbers of missed appointments to collect treatment. This reporting is corroborated by data collected in the COVID-19 Tracker by FinMark Trust i2i facility.

Data collected in April 2020 on the COVID-19 Tracker shows that 13% of Kenyans did not access medicine that they needed in the past seven days, and 25% have changed the way in which they receive chronic care. 5% of Nigerians did not access medicine they needed and 4% have changed the way in which they receive chronic care. 7% of South Africans have not been able to access medicine and 11% have changed their chronic care routines. These percentages may not sound very high but 11% of the adult population in South Africa amounts to nearly four million people. The reasons cited by people for not being able to access medicine vary. South Africans have found clinics are too crowded. Some Nigerians claimed they are scared to go and buy medicine and the prohibition of travel limits their access. Many Kenyans and Nigerians did not have enough money for their medicine. In all three countries many people found the medicine they needed was unavailable.

For people living with the human immunodeficiency virus (HIV) the fear of going to clinics, hospitals and pharmacies is likely to grow as the COVID-19 pandemic develops. As a vulnerable group, not only in contracting COVID-19, but in that regular and consistent use of medication is key to a successful medication regime, there are dire implications should they decide to forego ARV treatment in lieu of going to their usual ARV distribution point, over concerns of contracting COVID-19.

In the short term COVID-19 is having a far greater impact on the lives and livelihoods of people across the world than HIV/AIDS healthcare concerns, and Africans are particularly vulnerable to the economic impacts of the global pandemic. The economic impact of COVID-19 comes from the need to slow the spread of the virus through government lockdowns and social distancing. These measures are in place to slow the infection rate so that the healthcare system has adequate time to prepare for the peak of the disease. Adequate planning and distribution of personal protective equipment and appropriate tools for the treatment of COVID-19, such as ventilators, needs to be prioritised in order to prevent needless deaths from COVID-19. Healthcare concerns, such as HIV/AIDS, need to be considered in light of the effects that COVID-19 is having in accessing medicines and the added concerns it adds to someone who is already coping with behavioural and life changes from the HIV virus.

The health implications of COVID-19 go beyond the threat it poses itself as an illness.

ARVs and the widespread and affordable distribution of them has arguably reduced HIV from being one of the greatest threats to the lives and livelihoods of young Africans, to a manageable chronic condition. ARVs both prevent HIV from becoming acquired immune deficiency syndrome (AIDS) but also inhibit the risk of transmission of HIV, thus slowing the spread of the virus and allowing infected individuals who are on treatment to continue living relatively normal lives. Working age people, particularly women, are the group of people who are most vulnerable when it comes to HIV infection. We need to be vigilant of those with HIV/AIDS to ensure there is not a flare up as people lose focus of their regimes and daily needs to be able to cope with HIV.

Prior to the widespread use of ARVs, Christine Oramasionwu, Kelly Daniels, Matthew Labreche and Christopher Frei (2011) found that the contraction and spread of the virus diminished the workforce in Sub-Saharan Africa, increased poverty rates, reduced agricultural productivity, and transformed the structure of many rural households with older females having to assume the role of providers and caretakers for dependent family members as working age adults suffered and or died from HIV and AIDS related illnesses.

The health implications of COVID-19 go beyond the threat it poses itself as an illness. There is the obvious concern, that other medical procedures are being delayed, and supply chains for medication not prioritised due to hospitals and clinics focusing on COVID-19, but in addition to this existing healthcare programmes are seeing declines in patients due to people avoiding clinics or they are being refocused on COVID-19. Tuberculosis testing is a prime example of this. Daniel Steyn (2020) reported that in March TB testing in some clinics was approximately half of what it typically is. There are both immediate healthcare concerns coming from the COVID-19 crisis and longer term concerns as other illnesses are potentially not screened and treated as normal and the chronic management of HIV therefore suffers. Missing a month of ARVs will not necessarily result in the development of AIDS or AIDS-related illnesses but it can increase transmission rates, and skipping ARV treatment has been shown to increase drug resistance, thus diminishing their long term efficacy.

In the wake of COVID-19 Governments should consider allowing ARV prescriptions to be filled for 3 or 6 months to reduce the need for HIV infected people to go to high risk areas for the contraction of COVID-19. If possible, the use of channels that are not being used for COVID-19 treatment could also reduce the risk for COVID-19 contraction, and eliminate some of the fear of seeking ARV treatment for individuals living with HIV. Some mobile clinics could be repurposed for this, or, if that is not realistic given the need for all medical facilities to focus on the treatment of COVID-19, alternative government infrastructure such as the post office should be used to manage the distribution of ARVs.

Written by

Shirley Jeoffreys-Leach
Survey and Data Researcher
Tel: +27 (0) 11 315 9197