Eight districts in eastern and western Uganda have reported stock-outs of septrin and dapsone, both very important drugs used by persons living with human immunodeficiency virus (PLHIV) in public health centres.
There are palpable fears in health centres across Isingiro, Ibanda, Kanungu, Kamuli, Busia, Namutumba, Iganga and Bugiri which have been running without this medication over the last five months. As a result, thousands of poor patients find themselves exposed to potentially life- threatening infections.
A notice to patients at an ARV drug refilling centre in Kamuli general hospital pointedly notes: “Please remember to take your cotrimoxazole (septrin) daily to help prevent opportunistic infections.”
On a recent fact-finding mission organised by Usaid, John Steven Salamuka, the Kamuli district coordinator for people living with HIV, said without septrin, the future looks bleak.
“I have lived with HIV for the last 30 years and I know the importance of septrin in a person living with the virus. The moment you stop taking, the body cannot resist opportunistic infections hence you develop chest pain and several fevers,” he said.
Salamuka said his doctor has told him that antiretroviral medicine performs a different function from septrin.
Septrin is an antibiotic that is given to people with HIV infection to protect them from opportunistic infections, while ARVs reduce HIV in the blood to a point where one’s immune system starts to recover and the virus stops making copies of itself in the body.
The ARVs, therefore, slow down the damage that the virus does to the immune system, and allows people to live longer, productive lives.
Jude Bigirwenkya who works with PATH, a non-governmental organisation that advocates for better health and social services, speaks about the extent of the problem.
“There has been general stock-out of septrin in most health facilities in various districts based on the information gathered from the CBOs that we work closely with and this has been reported in Isingiro, Ibanda, Kanungu, Kamuli, Busia, Namutumba, Iganga and Bugiri, with some districts experiencing stock-outs for more than four months,” Bigirwenkya said.
“As advocates, we want better services for all citizens and stand with the citizens to see that this issue of septrin stock-out is addressed as soon as possible,” he said.
Most Ugandans living in rural areas are low-income earners who cannot afford septrin on a daily basis.
Why must you take septrin
Medical experts say due to suppressed immunity, people living with HIV are more likely to suffer from opportunistic infections and die earlier than HIV- negative people.
Opportunistic infections range from simple to complicated life-threatening infections and their management can be quite expensive and difficult.
Septrin, the brand name for the combination of antibiotics called cotrimoxazole, is the main drug used to treat and prevent a type of pneumonia called PCP (pneumocystis carinii pneumonia, now called Pneumocystis jiroveci pneumonia).
Leaticia Kampi, an enrolled nurse, told The Observer in one of the affected districts that people with HIV are at increased risk of getting PCP if their CD4 cell count falls below 200.
It is recommended that once you start HIV treatment, whatever your CD4 cell count, septrin is mandatory.
“Septrin is the first choice for treating people who do develop PCP, the dose used for treating PCP is higher than that used for preventing PCP. In some cases, if the PCP is more severe, you may be given septrin intravenously,” she said.
After the PCP has been successfully treated, you will need to take PCP prophylaxis to reduce the risk of it recurring.
This is called maintenance therapy or secondary prophylaxis which you should be able to stop once your CD4 cell count has risen and your HIV viral load has been undetectable for some time, Kampi said.
Kamuli District General Hospital
When we visited Kamuli district general hospital’s stores, the storekeeper showed file copies of order sheets made to National Medical Stores (NMS) in December 2017.
According to the document, 4,910 people receive HIV treatment at the facility, of whom 4,480 are adult patients on septrin, (pre-ART and on ART). Another 328 are children under 15 years and 12 who are being given dapsone.
Salamuka added that when they ran out of septrin, he reported to the district medicine management supervisor (DMMS) who is the nearest person who manages the store other than the district medical officer. The official forwarded the request only for NMS to reply that the problem was being encountered nationwide.
Official sources at NMS say the stock-out will persist until the next financial year in August.
“I being the district coordinator, it is not only this referral hospital but all over the district, health centres do not have septrin that includes Namwendwa HC IV, Nakandulo HC IV, Balawoli HC III, Namasagali HCII, Nabirumba HCII, Butansi HCIII, Kyitayungwa HCII, Bulopa HCII, Bugulumbya HCIII, Luliambuzi HCIII, Bupadhengo HCIII, Nawanyago HCIII, Mbulamuti HCIII and Buluya HCII,” Salamuka said.
Dan Kimosho, public relations officer, NMS, agreed that it is true there has been shortage of septrin for the last quarter.
“The septrin supply is under Global Fund [for HIV/Aids, tuberculosis and malaria] which we have not received for the last quarter; therefore, we appeal to people to go to private clinics,” he said.