Ugandan sex workers based abroad get ARVs from home

Ugandan sex workers living with HIV and operating abroad have resorted to getting their anti-retroviral drugs from Uganda to circumvent expensive costs in the countries where they operate.
The government supplies ARVs to about 800,000 people living with HIV free of charge unlike in foreign countries where the same drugs are very expensive for non-citizens.
Dr Florence Tugumisirize, the Masaka hospital director, said they have patients as far as Malaysia and the United Kingdom who receive their drugs from the hospital.

Dr Tugumisirize added that the drugs are sent to the sex workers by family members who pick them on their behalf.
“Our furthest client is based in Malaysia,” Dr Tugumisirize said, while explaining the achievements and challenges of treating HIV/Aids in the district.
Without mentioning the patient’s details for matters of privacy and confidentiality, Dr Tugumisirize said the sex worker is very consistent with her treatment despite many other patients dropping out from treatment.

Cost of treatment abroad
It’s very expensive to get drugs in Malaysia or United Kingdom when you are not a citizen,” Dr Tugumisirize said, adding that the ARVs are sent using a shipping firm.
Information obtained from the UK’s parliamentary website indicates that anti-retroviral drugs alone are estimated to cost around £5,500 (about Shs26m) per person per year.
Dr Tugumisirize said the Malaysia-based sex worker comes after every six months for a full body checkup to monitor her viral load and general health.
She added that there is another patient based in the UK, who is also receiving treatment from Masaka hospital.
Dr Tugumisirize observed that HIV/Aids treatment being a free and a personalised service at the hospital, has prompted clients to come from as far as Kampala and outside the country.

Lost follow up/treatment drop out
Despite having patients as far as Malaysia, Dr Tugumisirize said the success story might be short-lived given that patients living in the country are dropping out of the treatment in what is termed as “lost follow up.”
She added that poor adherence and lost follow-up increases the risk of treatment failure and the development of drug resistance.

While addressing officials from the Global Fund Country Coordinating Mechanism (CCM), Dr Tugumisirize said high numbers of pregnant mothers are dropping out of treatment and they are at the same time not delivering in health facilities.
“This is likely to affect the Elimination of Mother to Child Transmission (EMTCT) programme which has yielded more than 70 per cent decline in the number of babies born with the virus,” she said.

Gains in HIV/Aids Prevention and treatment
According to the 2014 Uganda HIV/Aids country progress report, the number of Ugandans who get infected with HIV/Aids declined by 27 per cent, with new infections standing at about 99,000 by end of 2014 from 160,000 in 2010.
The report also indicated that new infections among children declined from about 31,000 infections in 2010 to about 9,000 by end of 2014, representing a 70 per cent decline.

Lost follow up of pregnant mothers
The Masaka District EMTCT focal person, Dr Joseph Kasekende, said the dropout rate of mothers from treatment currently stands at 50 per cent in the district.
“Mothers don’t attend their antenatal visits and some don’t even deliver in health facilities,” said Dr Kasekende, adding that retaining mothers on care and treatment remains a major challenge to the fight against HIV transmission from mothers to children.

Dr Tugumisirize said most of the lost follow up cases at the hospital are mothers from Kalangala District which is challenged by the availability of transport.
“Patients from Kalangala Islands report to hospital when they are very sick due to poor drug adherence,” she said, adding that primary resistance of ARVs is also on a rise.
Dr Tugumisirize noted that they have put a health system in place where patients receive a text message indicating when they should come for a drug re-fill. The messaging system also sends a reminder about their next medical checkup.

She hopes that the communication system can help cut on the number of patients dropping out of the treatment and also encourage drug adherence.
However, Henry Magala, the CCM programme oversight committee chairperson and country programme director, AHF-Uganda Cares, said the issue of lost follow up is very complicated and should be solved through enhanced sensitisation.
“Stigma is one of the reasons people drop treatment because they don’t want to disclose even to their spouses,” Magala said.

He, however, added that lost follow up and treatment drop out in Kalangala is inevitable since the population migrates from one island to another frequently.
Magala said the site visit to Masaka and Kalangala was aimed at overseeing how Global Funds are benefiting the less privileged who are suffering from HIV/Aids, TB and malaria treatment and control activities
Dr Stuart Musisi, the Masaka District health officer, also expressed concern over mothers living with HIV who do not turn up to deliver in health facilities.
“We are working with Village Health Teams (VHTs) by registering the contacts of the expectant mothers with an intention to avail them with a trained midwife at time of birth,” said Dr Musisi.

He said VHTs help in following up on what happened to these mothers and why they are not coming to deliver in health facilities.
According to Dr Musisi, HIV prevalence in the district stands at about 10 per cent, three points higher than the national statistic currently at 7.3 per cent.
“There are many HIV prevention interventions, mainly targeting Most at Risk Populations and our partners, including the Global Fund are supporting us to reach these populations,” Dr Musisi said, adding that there is a notable reduction of the virus prevalence in the district.

Effects of shortage

Absence of diagnostic services
Meanwhile, officials led by Mr Magala, also expressed concern over the breakdown of GeneXpert machine for testing Tuberculosis at Masaka hospital.
The machine has not been working for several months following the collapse of its computer. They also expressed concern over food for multi-drug resistant TB patients that has never been supplied yet the grant money was advanced by Global Fund about three years ago.
The breakdown affects diagnosis of TB, a co-infection normally suffered by HIV patients.

Drug Shortage
In addition, Mr Magala said the issue of drug shortage has been ongoing and the Ministry of Health needs to look into it by engaging the National Medical Stores.
“For instance, Kalangala being a hard to reach area and a hotbed of HIV transmission, its medical access and equity has to be well sought in terms of financing and budgeting,” Mr Magala said.
The National Medical Stores (NMS)General Manager, Moses Kamabare, has continuously downplayed accusations of inadequate drug supplies to health facilities, saying that NMS supplies less medicines depending on their orders.