Archive | August 2013

Cameroon Grapples With Antiretroviral Stockout

By Leocadia Bongben

Anti-retroviral drugs are known to prolong the lives of persons living with HIV/AIDS but epileptic supplies have led to fears that patients may be dying faster due to lack of drugs.

HIV/AIDS is an infectious disease that is transmitted sexually and through contact with contaminated blood.

Following the 2011 Demographic and Health Survey, 860,000 Cameroonians are living with HIV/AIDS. Only 150, 000 of them were on anti-retroviral drugs in 2013. The number if projected to surge to 220,700 in 2014.

Martin Nsame, 35, has been on the anti-retroviral drug Stokrin for the past six years. In June, when there was a stock-out, his doctor replaced Stokrin with Aluvia and later Rotonavir, a measure to ensure continuation and avoid resistance.

Different molecules were proposed to Nsame and other patients some who at time developed side effects such as allergies and had to stop the drug, though experts said changing molecules does not affect the patients.

Cameroon is known for intermittent supply anti-retroviral drugs, which has often forced patients to organise street protests. Authorities say the country lacks the financial resources to pay for the drugs.

The Global Fund for Malaria, Tuberculosis and HIV/AIDS and the US President’s Emergency Plan for AIDS Relief (PEPFAR) intervened and Cameroon got the anti-retroviral drugs in July to last for six months.

The Minister of Public Health, Andre Mama Fouda admitted Cameroon was forced to ration drugs.

“The difficulty in mobilising funds in the past 18 months led to a tight management of stocks of anti-retroviral drugs by the National AIDS Control Programme- in charge of coordination of decentralised technical units in the national response,” Fouda said. “This resulted in tensions and stock-outs of some molecules in some health facilities in the country”.

The Minister of Public Health also attributed the situation to the ever growing number of persons living with HIV/AIDS on anti-retroviral treatment.

In 2007, government rendered free treatment for patients and subsidised biological follow-up. More patients are now placed on drugs earlier than before, that is from 2007 to 2010, and treatment was for patients whose CD4 count was 200. But, patients with a CD4 count of 350 are now given anti-retroviral drugs and the active file on anti-retroviral drugs is expanding.

Also, the contribution of the Global Fund, initially at 50 per cent has dropped to 36 per cent since 2012 with government contribution increasing when the budget of the Ministry channeled to the purchase of drugs remained at FCFA 6 billion from 2011-2012, Mama Fouda said.

Bernard Kampoer, president of the “Fund Inter-universitaire Contre Le Sida et MST”, an NGO, said that the bigger part of resource mobilisation used to be from the Global Fund. But, at the beginning Cameroon took a formal engagement to provide 60 per cent of country contribution and the Global Fund, 40 per cent.

Then the country opted to get the money to purchase the drugs with the argument that this would beef the capacity of the national drug store, CENAME but the interest is on commissions and percentage from transactions.

President Biya Releases FCFA 5 billion To Purchase ARVs

As government response, President Paul Biya released FCFA 5billion to purchase ARVs, though this can only buy anti-retroviral drugs for four months given that Cameroon spends FCFA 1,2billion every month to on drugs.

However, with firm pledges from key partners to the tune of FCFA 5.2 billion, the 2013 budget line of FCFA 9.8 billion, the 2013 public investment budget and airport tax FCFA 5.8 billion, Global Fund Round 10, FCFA 4 billion, government hopes with a total amount of FCFA20 billion anti-retroviral drugs would be available until October 2014.

Challenges

The problem of antiretroviral drug stockouts is not only related to finances. The 2011 Cameroon US President’s Emergency Plan for AIDS Relief, PEPFAR operational plan report indicates that Cameroon has a problem of managing stock: the National Drug Store CENAME does not have the capacity to stock drugs from donors.

Also, the public health management system is chaotic as healthcare systems in Cameroon suffer from inadequate resources, absence of trained clinicians and insufficient infrastructure, poor coverage and quality service, which are worse outside Yaoundé and Douala.

The country also had a problem of estimates, but, PEPFAR is helping the country to make a table of estimates per region, per molecule.

Kampoer criticised government policy in resource mobilization for being less aggressive, and rigorous and blame government for depending more on donors to treat its patients.

“A parent having a child who has to go to school, but thinks that the neighbour should pay the fees”, that is the situation of ARV.

Health Support Fund

In the long term, government plans the creation of a Health Support Fund, a disposition to mobilise classical resources and finances, with different units to enable major interventions.

But, with the level of corruption in Cameroon where a former Health Minister, Olanguena Awono is in prison for mismanaging money from the Global Fund for HIV/AIDS, many are sceptical of how such a fund would work and if the money not embezzled.

Government has been exploring private/public partnership with business persons to get finances to buy antiretroviral drugs.

In order to provide a technical tool to evaluate the magnitude of the anti-retroviral dug challenge, a technical group is putting in place planning and programming of the country needs.

The government and the Global Fund have agreed on making projections.

Strategic Plan

As one of the big three infectious disease programmes of the Ministry of Public Health, national response to HIV/AIDS is supervised by the National AIDS Control Committee.

Strategic planning for the 2011-2015 has three themes-prevention, management, and support and protection of people living with HIV/AIDS.

The Permanent Secretary of this committee has, DR Jean Bossco Elat projecting into 2020, said the programme needed finances to sustain the fight against HIV/AIDS.

Government has been doing much in the prevention of mother to child transmission, the treatment of patients by providing antiretroviral drugs and taking care of co-infections.

However, much still has to be done to make laboratory examinations pegged at FCFA 150,000 accessible to patients.

Also, government look inward rather than depending on donors to implementing the Abudja Declaration that requires that countries put aside 15 per cent of their budget to the health sector.

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Hepatitis Is Treated In Hospital-Prof. Oudou

Professor Oudou Njoya, Hepatitis Expert, Former Dean in charge of Research at the Faculty of Biomedical Sciences, University of Yaoundé 1, has debunked allegations that viral Hepatitis cannot be treated in the hospital. Cameroon joined the international community to the World Hepatitis Day on July 28 with 4, 5 million Cameroonians suffering from hepatitis which Njoya has said is a serious public health issue that needs to be addressed. Against the backdrop of the high prevalence, he advises that the population get vaccinated against Hepatitis. After writing a book in French on Hepatitis he is translating the book into English to help the population learn more.
He Spoke to The Post’s Leocadia Bongben

The Post: What is hepatitis?

Prof. Oudou Njoya: Hepatitis can be described as the inflammation of the Liver. When we say inflammation, it means there should be a cause of that inflammation. When the cause is a virus, therefore we talk of viral Hepatitis. So commonly, when people talk of hepatitis, they most of the time refer to viral hepatitis. In summary, viral hepatitis refer to an inflammation of the liver secondary to an infection by a virus.

How is hepatitis contracted?
There are many ways of contracting viral hepatitis. First of all there are two big categories of hepatitis. Those that can be contracted through sex, blood and other biological liquids; hepatitis B, C, and D; and those that can be transmitted through food, Hepatitis A, E. That is two main categories of hepatitis, two main ways of contracting hepatitis. Then, for hepatitis transmitted through sex, blood and biological liquids, there is also transmission from mother to child, during delivery.

How does hepatitis manifest itself, in children first?
Be it in children or in adults, hepatitis manifests itself in two ways. There are really no specific clinical signs for viral hepatitis. Viral hepatitis can present malaria-like, flu-like and other cold-like symptoms. It means that it can resemble these diseases without being malaria, flu or cold. People are going to suffer from fever, joint pains, muscle pains and at times diarrhea and vomiting when it is hepatitis A, which I diagnosed in a young boy recently.

How can we then suspect hepatitis before going to the hospital?
It is true that it is rare for a patient to suspect hepatitis except in a situation where the person comes in contact with someone suffering from hepatitis and after that the person starts having signs. Most of the time, it is rare for a patient to come for hepatitis, nevertheless, you can have a situation where people become yellow, with yellow eyes and hands and skin, and then we talk of jaundice and that situation can push the patient to come to the hospital.

Then, how do we prevent viral hepatitis?
Prevention of hepatitis, there again, there are two ways: one is, vaccination, immunisation. There is vaccination for hepatitis, A, B, and E whereas hepatitis C does not have any vaccination for now. But, hygiene measures can be taken-not sharing cutting material and toilet with neighbours to avoid hepatitis.

In Cameroon what is the state of hepatitis?
The state of hepatitis in Cameroon is serious because we can say that the average prevalence for Hepatitis B is 10 per cent and the average prevalence for hepatitis C is 13 per cent.

That means hepatitis A, D and E added together is more than B and C in numbers?
Hepatitis B and C are those which we are afraid of. A and E are not harmful, whereas B, C and D can give way to what we call chronic hepatitis and later on to liver cirrhosis and cancer of the liver.

So many people are dying of hepatitis and I want to know why it is killing more than HIV/AIDS?
It is more important than HIV/AIDS, which is pegged at 5.5 per cent, whereas hepatitis B is 10 per cent, it means that it is two times more serious than HIV/AIDS. But, since it is a silent disease, people do not think about it and it can lead to complications for which there is no real treatment –cirrhosis and cancer of the liver.

Is there any research correlating HIV/AIDS and hepatitis?
Yes, it is possible because we can have what is called co-infections. It means that a person can have at the same time HIV/AIDS and viral hepatitis because they share the same route and are viruses, and a so rampant that one can have HIV/AIDS and viral hepatitis. Concerning research, it is going on, maybe not really fast but progressively in Cameroon. But, at the international level there is a lot of work done in other areas. What we should do is emphasize and enhance research in our country because there is a need to know the epidemiology- how it presents itself, the different sources of re-infection and the natural history of infection, so we still need more research. I am honoured to lead a group of researchers working progressively on hepatitis at the faculty of Biomedical Sciences and the Chantal Biya Foundation.

Do HIV/AIDS patients forcibly have hepatitis?
No, not forcibly, even though they are two different diseases that share the same route of transmission, that is why they can come together, but, not forcibly, because one can have Hepatitis and not have HIV/AIDS.

What is the advice for someone having hepatitis?
The first thing to do for someone suspecting hepatitis is to go to the hospital. I emphasize on this because I hear so many things said, that hepatitis is not treated in the hospital, that is not true. If you are suspecting hepatitis, go and consult a doctor who is going to guide and help you.

How much does it cost for an adult to get vaccinated against hepatitis?
It is not really expensive, at FCFA 5,500 you can get one injection and you have to take one per month for three months and a booster one year after.

Vaccination for children?
They have their vaccine six weeks after birth, free of charge since 2005.

For how long does it protect the children?
For long, it is really accurate, it means that it can protect for 10 years or for life without one having hepatitis , but, it is always advisable to go for control to see if there is need for a booster or not.

Is the population advised to go for screening to see if they have hepatitis?
Yes, I will advised the population to go for screening after get vaccinated if there is an indication.