Although the roll out of the new all-in-one ARV formulation commenced on 1 April 2013, the new tender supplier is only able to commit to deliver the required quantity ordered at the end of April. The Western Cape Government Health ARV depot has bought a bridging supply of this item from another supplier to tide the National Department of Health over until such time as the delivery from the new contractor is received.
This is a usual practice in medicine procurement but Western Cape Minister of Health, Theuns Botha, has requested an investigation into the possibility for the Western Cape Government Health to procure medication directly because of national government’s inability to provide stock continuously and reliably. “I have raised the issue with the national minister on various occasions, but have received no response.”
At present Western Cape Government Health has 25 710 units of the all-in-one ARV available at all facilities.
ARV’s will be phased out in phases, starting with new patients eligible for ART. The Western Cape wants to ensure a stable supply before further roll out to other priority patient categories.
We have a three month supply of medicines and when we stabilise the supply we will roll out further. The Western Cape ‘s ARV depot is monitoring the situation and keeping sufficient stock levels of the individual medicines to ensure a smooth transition to the new formulation. The situation is evaluated continuously to avoid patients having to revert back to using the individual medicines.
As per the directive of the National Department of Health, dated 12 February 2013: “As of 1st April 2013, all priority 1 patients are to be initiated on TDF based FDC. The phased approach recommended for new adult and adolescent patients eligible for ART will be according to the following order priority.
1. New patients (adults, adolescents and pregnant women) eligible to start ART.
2. All pregnant women needing triple therapy and breast feeding mothers currently stable on a FDC compatible regimen.
3. Virally suppressed patients currently on 1st line regimen requiring a switch due to toxicity (e.g. stavudine).
4. Patients currently stable on TDF-based regimen, with TB comorbidity
5. Patients currently stable on TDF-based regimen, with other comorbidities (e.g. hypertension, diabetes, mellitus, etc.).
6. Patients currently stable on TDF-based regimen and who request a switch to a FDC.
In total we have 246 Nurse Initiated Antiretroviral Therapy (Nimart) trained nurses as required in the guidelines.