[e-drug] New article on ARV Delivery in South Africa (2)

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E-drug: New article on ARV Delivery in South Africa (2)
-------------------------------------------------------
[There are very fast developments in ARV treatment in South Africa. See for
example, the long-awaited Treasury-DOH report, which is now available online
at http://www.gov.za/issues/hiv/ttr/index.html.
The 82-page report itself is at
http://www.gov.za/reports/2003/ttr010803final.pdf
Below also a review of just 2 weeks ARV discussions in South Africa -
crossposted with thanks from DRUGINFO. WB]


Hi all

This HEALTH-E story by Anso Thom neatly captures the extraordinary shifts
that have occurred in the past few weeks - it's worth reflecting for a
moment on how this impacts on the very core of the drug policy process: many
of the issues flagged for attention in the operational plan are in fact
those that the 1996 National Drug Policy sought to address; the drug price
issues will now really test the impact of Act 90. The one element that still
concerns me is the degree to which the national medicines selection
structures seem to have been sidelined - as with the post rape PEP
decisions, the power seems to reside in the vertical programme, not in the
EDL Committee. How HIV is catered for in the amended PHC level EDL/STGs
(soon to be released) and in the hospital level books that will follow is
going to be a crucial test. Top management from that Cluster is certainly
well positioned - Ms Hela on the HIV treatment task team (together with Ms
Matsoso from the MRA), Dr Zokufa on the Pricing Committee.

regards
Andy Gray
~~~

http://www.health-e.org.za/view.php3?id=20030817
Making history in two weeks
by Anso Thom
21-08-2003

South Africa has possibly just experienced the most significant two weeks in
the some 20-year history of the AIDS epidemic. It all began on Monday, July
28 when Medicines Control Council registrar, Dr Precious Matsoso, made the
sudden and shocking announcement that nevirapine might be deregistered for
use to prevent the transmission of HIV from mother to child.

"Here we go again!" screamed the headline of one South African daily.

After more than four years of often acrimonious public bickering between
Government and a variety of interested parties, high profile court cases,
civil disobedience and seemingly endless delays around the rollout of a
national ARV treatment plan, the exasperated, cynical tone was hardly
surprising.

Then, almost unbelievably, twelve days later on the afternoon of Friday,
August 8, long after many newsrooms had packed up for the pub, a cabinet
press release was issued by the GCIS (Government Communication and
Information System). No fanfare, no drum roll, whistles or bells. Just the
usual press statement with GCIS head Joel Netshitenzhe's name and cell
number at the end of it.

About three quarters of the way into the officialese was the nugget:
"Cabinet decided that the Department of Health should, as a matter of
urgency, develop a detailed operational plan on an antiretroviral treatment
programme..It is expected that this detailed work would be completed by the
end of September 2003".

Radio, television and print journalists had little time to pick up on or
digest the meaning of it all that particular weekend. And while everyone was
trying to come to terms with what it all meant, other significant
developments seemed to slip by almost unnoticed.

A few days after Matsoso's announcement, the first national AIDS conference,
hosted in Durban, saw more than 2 000 scientists, researchers, activists,
health professionals and government officials gathered under the same roof.

The networking that took place outside the main sessions was extraordinary
with intense discussions and debates around tables or in the passages of the
International Convention Centre.

Politicians were noticeably absent except for the host province's health
MEC, Zweli Mkhize, who kept a low profile until the last day of the
conference when he offered a hint of things come.

He ended his speech with the statement that it was no longer a question of
"whether" government would be providing anti-retrovirals, but rather "when".
He clearly had inside information but at that stage everyone was too
battle-weary to really hear it.

Health minister Dr Manto Tshabalala-Msimang and Deputy President Jacob Zuma
had both left after giving unremarkable speeches at the opening of the
conference on the Sunday.

The conference ended with a sense of goodwill with Matsoso and the
scientists making a commitment to finding further studies required to verify
the efficacy of nevirapine so as to ensure that the drug continues to be
registered for use in PMTCT.

In another significant development the MCC announced that it had registered
several generic anti-retrovirals paving the way for local manufacturers to
develop and produce cheaper versions locally.

SA Medical Association chairperson Kgosi Letlape received the loudest
applause at the Durban conference when he appealed to President Thabo Mbeki
to take the lead in fighting the epidemic.

Letlape's words had hardly been uttered when the President, after months of
dithering, added his signature to the Global Fund to Fight HIV/AIDS,
Tuberculosis and Malaria agreement, injecting a massive U$41-million over
two years into the South African coffers for treatment and prevention of
HIV/AIDS and TB.

Then came August 8 when a special Cabinet meeting confirmed it had seen the
much debated task team report costing the rollout of anti-retrovirals.

Significantly the Treatment Action Campaign immediately suspended their
civil disobedience campaign.

"There is cause for optimism and celebration," they opined.

But judging from some of the debates and discussions that have taken place
since the announcement, it is clear that many South Africans are still
sceptical, preferring to "wait and see."

The British journal, The Lancet, summed up the feeling: "many South Africans
with HIV/AIDS have waited a long time while being repeatedly disappointed by
their government leaders, many have died. South Africans are understandably
impatient and sceptical. But now there is a real chance to leave the past
behind and move swiftly forward to a better future for the people of South
Africa. We urge the government to put the recommendations into practice."

The real challenges and work begins now and it will no longer be appropriate
to apportion all the blame and responsibility at government's door. Those
with skills will have to come to the party. Sitting on the sidelines and
shouting the odds is no longer appropriate. But it is also important to
acknowledge that much work has already been done - thousands have been
treated for opportunistic infections, there is an attempt to address poverty
by increasing access to grants, prevention efforts are being stepped up and
government is elevating the critical importance of nutrition.

Civil society will have to step forward, playing a role in ensuring that the
40-million South Africans who are not infected are well informed and
educated about the importance of preventing new infections. We need to stem
the tide.

As Letlape said: "Time is not on our side.the fight against HIV/AIDS should
become a 24 hour job, not an eight to four job."

Access Essential Drugs Monitor #32 at http://www.who.int/medicines/mon/mon32.shtml

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