New health rules throw Kenya’s Aids budget into distress

Kenya must double its spending on the life-saving anti-retroviral drugs for Aids patients in the next 12 months, health agencies said, citing the World Health Organisation’s new guidelines on treatment of the disease that are expected to increase the number of beneficiaries and a shift to more expensive drugs.

The organisation last month announced that it had raised the threshold for commencement of antiretroviral (ARVs) treatment to reduce the burden of opportunistic infections associated with late start.

Aids patients are put on ARVs based on their CD4 count — the white blood cells that protect the human body from disease-causing pathogens such as bacteria and germs.

In Kenya, only those whose counts have dropped to 250 qualify for treatment but WHO now includes those with a tally of 350.

The WHO country representative, Dr David Okello, calls on the government to more than double its HIV/Aids budget with the change of treatment guidelines.

“We have amended the guidelines because early initiation of treatment will combat the rise of opportunistic diseases,” he said.

Tuberculosis (TB) is the leading opportunistic disease that kills more than half of Aids patients.

Kenya has 320,000 patients on ARVs based on the old CD4 cell count threshold, half of whom are beneficiaries of government funded drugs.

The new treatment guidelines mean that more 600,000 patients need to be put on the drugs immediately.

But doctors say the national ARV stocks can only last until February 2010.

Financing Aids treatment in Kenya is also expected to be complicated by the WHO’s other recommendation that Stavudine (d4T), a key ARV drug, which has been a critical component of Aids treatment in Kenya, be withdrawn from the market.

The drug’s long term use, according to WHO, causes irreversible side effects that leaves patients with dire complications.

Kenya is estimated to have 1.4 million Aids patients.

The high toxicity level in Stavudine destroys body fat, especially in the legs, arms and face, causing what would seem like dents, affecting body shape, according to the medical services director Francis Kimani.

The drug is also known to cause a buildup of lactic acid in the blood, which is a by-product of abnormal energy production and nerve damage that leads to numbness or a sharp burning sensation in the feet, legs, or hands.

“We plan to gradually phase out the use of Stavudine as a preferred first line therapy and go for less toxic alternatives such as Tenofovir (TDF) or Zidovudine (AZT),” said Dr Kimani. The transition period is expected to last three years.

Stavudine is a preferred option in many countries because it is much cheaper than the alternatives, costing about Sh7,000 per month per patient compared to Tenofovir (TDF) or Zidovudine (AZT) that are priced at Sh11,700 and Sh17,000 respectively.

Zidovudine is preferred because of its effectiveness in reducing the viral load to exceptionally low levels, while increasing CD4 cell counts.

Change to these alternatives means the government will have to nearly double its spending on the treatment of each of the 320,000 patients currently on ARVs.

NASCOP’s chief executive officer, Nicholas Muraguri, says the new WHO recommendations will more than double the financial cost of treatment to an estimated Sh12.2 billion annually.

In the current financial year, the government allocated only Sh500 million to ARVs — an amount that can only finance treatment for 10,000 people, including support services in a year.

The government spends Sh20,000 on each of the 320,000 patients on ARVs annually.

The new guidelines and the heavy financial burden they impose on the government come at a time when Kenya is hard pressed for money to fight the scourge, having lost the support of key financiers such as the Global Fund for Aids, TB and Malaria.

The country recently failed to clinch the Sh24 billion it was to get from Round Nine of the Global Fund disbursements, dealing a major blow to its budget.

Mr James Kamau, the head of the Kenya Treatment Access Movement, told Business Daily that although the country has lodged an appeal, the process takes long, leaving a big hole in the budget in the coming months.

Of the total Sh28.2 billion received since Round 2, only 22 per cent of it was utilised — translating to Sh6.2 billion, while the balance was recalled by the fund, said Mr Kamau. 

The country also failed to clinch Round 8.

Major blow

Should Kenya fail to put up a strong defence for Round 9, the next application for Round 10 comes in 2011, leaving the future of thousands of patients already on ARVs, who cannot stop using them in the balance.

Kenya also suffered a major blow on HIV/Aids funding after US President Barack Obama capped his budget for the President’s Emergency Plan for AIDS Relief, (PEPfAR) at Sh27.5 billion ($366 million).

This means that the 15 countries that receive PEPfAR funds including Kenya will see no increase on their budget.

“Health is not a priority for the government as it is highly dependent on donor finding. The major risk Kenya faces with such a model is that we are left venerable at such a time when the global crisis has threatened such funding,” said Eve Odete, Pan Africa Policy Officer- Social Justice, Oxfam GB.

Analysts say PEPfAR has been affected due to other hard pressing priorities for the American government.