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Photo: Kenyan Pharmacy and Poisons Board

Fake drugs

NAIROBI,  – Kenya’s government is scrambling to remove thousands of batches of counterfeit antiretrovirals (ARVs) from circulation after patients and health workers reported irregularities in the appearance and texture of a widely used drug.

In September, nurses working with the medical NGO, Médecins Sans Frontières – which runs HIV and tuberculosis clinics in the capital, Nairobi, and western Kenya – reported irregularities in the appearance of the antiretroviral Zidolam-N, a combination treatment containing the ARVs zidovudine, lamivudine and nevirapine.

The ARVs were found to be falsified versions of a World Health Organization (WHO)-certified generic drug purchased through a distributor endorsed by the Kenya Pharmacy and Poisons Board (KPPB), the country’s drug regulatory authority.

According to the KPPB, one batch of the fake Zidolam-N, with the number E100766, is marked as manufactured in 2009 and set to expire in May 2013, while a second carries the batch number A9366 with manufacture and expiry dates of June 2009 and May 2012 respectively. The main irregularities included discolouration, mould and crumbliness; the packaging is also of varying quality and the text differs in font and colour from the genuine drug.

Certified, generic versions of Zidolam-N distributed in Kenya are manufactured by Hetero Drugs Limited, based in India. WHO’s investigations found that Hetero’s batch number E100766 had been manufactured and controlled according to WHO-recommended specifications and was of acceptable quality and had not been supplied to Kenya.

“We have asked all patients with the said drugs to return them to clinics so we can ascertain if they are the fake ones and supply the patients with fresh drugs,” said Jacinta Wasike, director of surveillance and inspection at the KPPB.

The KPPB estimates that 16,340 batches of the counterfeit drug have been released, 15,000 of which have now been returned.

“We are tracking down some of the patients who may have received them but haven’t returned them,” Wasike said. “The samples of the drugs which were recalled have already been sent to laboratories… Once the results are known, we will be able to know any side-effects they might have on the patients and what remedies to take to minimize these side-effects, if any.”

WHO describes a counterfeit drug as one that is deliberately and fraudulently mis-labelled with respect to identity and/or source. Counterfeiting can apply to both branded and generic products.

It is very scary, especially with a disease whose treatment calls for strict adherence to a regimen

Representatives of people living with HIV in Kenya have castigated the KPPD for allowing the counterfeit drugs to filter into the supply chain and jeopardizing their treatment.

“It is very scary, especially with a disease whose treatment calls for strict adherence to a regimen,” said Nelson Otuoma, coordinator of the Network of People Living with HIV and AIDS in Kenya (NEPHAK).

Senior officials say the government is investigating how the drugs found their way into the country, and is looking into strengthening surveillance systems.

“Investigations are being carried out by relevant authorities, but as a government we take very seriously issues of treatment of HIV and AIDS. Loopholes at times do exist but when we learn our lessons, we work to seal them,” said Anyang Nyong’o, Minister for Medical Services.

NEPHAK’s Otuoma accused the government’s drug procurement system of being riddled with corruption, and said unless this issue was addressed, the risk of fake drugs penetrating the market would remain.

Health experts say it is crucial for the government to urgently address the situation in order to allay patients’ fears and retain the confidence of HIV-positive people in the government’s ability to provide them with effective care.

“News of fake drugs might affect treatment, not just in the possible side-effects but in the sense that patients might shy way from taking drugs because they don’t know who or what to trust,” said Alan Mabeya, a doctor at Kenyatta National Hospital, the country’s largest referral facility.

ko/kr/mw source www.irinnews.org

By API

Photo: Obinna Anyadike/Irin

Food prices remain high for most

HARARE, 20 October 2011 (PlusNews) – Vulnerable people living with HIV in Zimbabwe are benefiting from an electronic voucher scheme being used to fight malnutrition among people on antiretroviral (ARV) therapy and their families by providing them with nutritious food.

The system, introduced by the UN World Food Programme (WFP) and implemented by the health ministry and NGOs, involves identifying malnourished patients who are then given electronic vouchers to buy food at specific shops.

The country’s economic collapse in the past decade has significantly strained the ability of poor HIV-positive Zimbabweans to feed themselves and their families when on ARVs. An estimated 570,000 Zimbabweans are receiving the medication; HIV prevalence – one of the world’s highest – is 13 percent.

Prices remain comparatively high for families with low incomes and little or no access to US dollars, despite the improved availability of food. The Zimbabwean dollar was discontinued in 2009 as a solution to hyperinflation, and replaced by currencies such as the US dollar, South African rand and Botswana pula, but unemployment levels are extremely high and many people do not have access to these currencies.

Two months ago, 42-year-old John Mugove of Rugare, a low-income suburb about 8km to the southwest of the capital Harare, collapsed while seeking medical attention at an opportunistic infections (OI) centre and had to be hospitalized for two weeks, leaving his four children to fend for themselves.

Mugove had long abandoned his small furniture-making business due to recurring illness, and could barely raise money to cover basic family essentials such as food and school fees. He has been looking after his children alone after his wife ran away when he became critically ill and tested HIV positive three years ago.

“Bringing food home is such a big headache. Debt collectors are also demanding the money that I owe the hospital,” Mugove told IRIN/PlusNews.

“My worry has not been to get nutritious food, but just any food that can fill our stomachs. My last-born son, like me, has been diagnosed HIV positive. He is malnourished and easily falls ill, partly because the food I give him is of poor quality,” he added.

Mugove recently visited a clinic and was advised by the nurse to register for the e-voucher food assistance programme at Harare Hospital near low-income suburbs southwest of the capital.

The programme supports about 5,000 patients and their families with essential food items and is operating at seven health facilities in the capital and has been extended to the second-largest city, Bulawayo.

Catholic Relief Services (CRS) and Help from Germany (HfG) are the implementing NGO partners working with the health ministry.

My worry has not been to get nutritious food, but just any food that can fill our stomachs

Patients on ARVs or TB treatment who are malnourished are referred to register with the scheme.

During registration, adults’ weight and height are measured to determine body mass while children have their upper arm circumference measured to determine if they are malnourished. Beneficiaries then have to answer questions that help establish if their households are food insecure.

Patients are given vouchers, in the form of scratch cards similar to mobile phone airtime cards, which they take to designated retail outlets for specific rations that are “good for one month and for a maximum family size of five people”, in addition to 10kg of corn soya blend they receive at registration.

The rations comprise maize-meal, beans and vegetable oil and beneficiaries receive the food aid for six months but that period is extended if they are still malnourished.

“A big number of patients on ARVs come from poor and vulnerable households that cannot afford nutritious food and this makes the e-voucher system very essential,” AIDS activist Martha Tholanah told IRIN/PlusNews.

“But there is a need to go beyond addressing current problems such as malnourishment and ensure that patients receive help that enables them to sustain themselves and their families through income-generating projects,” she cautioned.

fm/kn/mw
source www.irinnews.org

By API

Photo: BBC World Service

Some adults fear teens are not mature enough to use condoms responsibly

KIGALI,  – A proposed initiative to distribute condoms to Rwandan secondary school students has divided parents, teachers and other members of society, with some cheering the plan and others concerned that teens are not mature enough to use condoms responsibly.

Local NGOs, including Health Development Initiative (HDI-Rwanda), Rwanda NGOs Forum on HIV/AIDS and Health Promotion, and Association Ihorere Munyarwanda are fronting the initiative on the grounds that young people must be protected from HIV and other sexually transmitted infections and unwanted pregnancies.

“We developed the idea for this project following numerous secondary school students’ complaints [about lack of access to condoms],” HDI Rwanda’s Cassien Havugimana said during the launch of the campaign in September in the capital, Kigali. “But for effectiveness, behavioural change awareness must accompany access to the materials needed for safe sex.”

In November, the campaign plans to carry out mass mobilization and awareness-raising for stakeholders including school heads, teachers and local officials. If the government gives the NGOs the go-ahead, condom distribution should start in December; the NGOs aim to reach the entire country, but will start with secondary schools in Kigali.

According to HDI-Rwanda’s communications officer Christine Calouro, any distribution would be accompanied by education on abstinence as a preferred choice for young people and with additional reproductive health information.

Some secondary school officials have already expressed their vehement opposition to the idea of condoms being handed out to their students.

Mised response

“I don’t believe in condoms being distributed in secondary schools… It’s a no go zone,” Innocent Nshimiyemungu, deputy head teacher at Kigali’s Lycée de Ruhengeri APICUR, told IRIN/PlusNews. “The children are, in the first place, not mature enough to know how to use condoms.”

We should emphasize postponement of sexual activity by encouraging these young people to embrace abstinence. How do I start encouraging my young girls to engage in sexual activity instead of concentrating on academics?

“We should promote abstinence instead, and introduce condoms at a higher level – say universities and other higher institutions of learning,” he added.

Edward Asiimwe, a father of two girls of secondary school age, is also against the proposal.

“To say that condoms be introduced to these young children means we have lost our sense of direction and morals,” he told IRIN/PlusNews. “We should emphasize postponement of sexual activity by encouraging these young people to embrace abstinence. How do I start encouraging my young girls to engage in sexual activity instead of concentrating on their academics?”

But Jean Marie Twahiirwa, business director at the International School of Kigali, says it is important for young people to be equipped with knowledge of and access to condoms.

“We should educate these young people about condom use and avail them because either way, they engage in sexual intercourse, so the earlier we teach them the better,” he said. “I don’t think this will necessarily push them into early sex because emphasis will be put on the essence of sexuality so that the students understand the rightful purpose of sex and condoms.”

Loretta Umukunzi*, a student at the International School of Kigali, told IRIN/PlusNews she would not object to condoms being dispensed at her school. “I think it’s OK since I see girls getting pregnant and dropping out of school,” she said. “As long as they teach students how to use them properly then we shall not be faced with such problems again.” 

Early sex 

According to a 2009 Behavioural Surveillance Survey, an estimated 6.1 percent of girls and 14.7 percent of boys aged 15-19 had their first sexual intercourse before the age of 15. The survey found that the percentage of comprehensive HIV knowledge among youth aged 15-19 was 9.4 percent for girls and 11 percent for boys.

Young women appear to be at higher risk of HIV, with the government reporting HIV prevalence among young women aged 15-24 at 3.9 percent, compared to 1.1 percent for young men in the same age group. The country’s national prevalence is about 3 percent.

Deputy Speaker of Rwanda’s parliament Jean Damascene Ntawukuliryayo has thrown his weight behind the campaign.

“I support the campaign. This will help us curb unwanted pregnancies in schools – of course not forgetting other solutions like involving parents in reproductive health education of their children and including such issues in the school curriculum,” he said.

Officials at the Ministry of Health say while the distribution of condoms in secondary schools is not official government policy, the issue has been under debate for some time.

“Discussions have been ongoing between the Ministry of Education, the Ministry of Health and the National HIV Control Programme around the issues of the many cases of unwanted pregnancies, a clear indication that unprotected sex is real in secondary schools which could lead to the transmission of HIV,” said Sabin Nsabimana, head of the HIV division at the Institute of HIV/AIDS Disease Prevention and Control at the Ministry of Health’s Bio-Medical Centre.

*Not her real name
source www.irinnews.org