A desperate shortage of antiretroviral (ARV) drugs in the West African country of Togo has temporarily eased with the arrival of a two-month supply of the life-prolonging medication.
The stopgap consignment of the generic drug, Triomune, arrived from its Indian manufacturer on 28 November, four months after the original order had been placed; distribution began the next day. "They are making efforts to try to catch up on lost time," said Augustin Dokla, president of RAS+ (the network for people living with HIV in Togo).
Panic over the break in drug supplies had forced around 500 HIV-positive people and AIDS activists onto the streets of the capital, Lome, in mid-November. Many had been without treatment for more than four weeks, and brandished placards proclaiming; "We have been taken hostage" and "No generic drugs = certain death".
"Togo's ARV [supply] has been consistently unstable since January," said Dokla. "There have been five separate breaks in supplies due to CAMEG [Togo's central medicine purchaser] running out of ARV drugs." Once begun, ARV treatment should not be interrupted to avoid a buildup of resistance to the drugs.
"Togo is not a big client for this Indian [manufacturer], which gives priority to countries who make big orders," CAMEG director Dr Maméssilé Assih explained. Togo has around 6,500 people on ARV therapy, with an estimated 18,000 believed to be in need of treatment.
Funding has been a major problem for the small West African country, sandwiched between Ghana and Benin. In 2006 the Global Fund to Fight AIDS, Tuberculosis and Malaria froze treatment financing after it detected "irregularities" in the way its grant was being managed; breaks in ARV supplies began in earnest at the start of 2007.
"The money is just not available to buy the medication when it is required," said Assih.
This November the Global Fund also rejected Togo's grant application for a new round of funding. "It has been two years in a row now that the Global Fund has refused Togo's proposal. [We agree that] the proposal has to be improved, but they have no heart," said Dokla.
At the start of 2007, the government released an emergency budget of 161 million CFA francs (US$365,000) to buy ARVs, giving patients a three-month lifeline.
GIP-Esther (Network for Therapeutic Solidarity in Hospitals), a French initiative working with other European countries, the World Health Organisation and UNAIDS to facilitate access to care for people living with HIV/AIDS in developing countries, provided the equivalent of two months' supply of drugs, while neighbouring Benin and Burkina Faso also chipped in from their national stocks.
But managing the situation on a more or less day-to-day basis is not a sustainable solution. "We suggest that ARV purchases are included in the 2008 [state] budget, and then we will have the money to buy them when they are needed," said Dokla.
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