Eswatini has been hit by a shortage of ARVs amid reports that the Ministry of Health is using them as a remedy to cure the coronavirus on confirmed positive patients.
As of Tuesday, Eswatini 520 confirmed cases, 259 recoveries and four deaths from coronavirus related illness.
An investigation launched by Independent News has unearthed that government has been keeping the shortage of ARVs after reports started infiltrating to the media that the drugs were being used to treat Covid-19 patients both hospitalised and those who are treated at home. Information has also reached this publication that the Ministry of Health is working with Parliament and the Finance Portfolio Committee in a bid to replace the replenished stock of ARVs.
Fear for complications.
Some people living with HIV told Independent News that they now fear for complications as they had been told by nurses of their nearest clinics that the pills were running out and might not be able to be provided for next month if government doesn’t buy the stock.
Director of Health Dr Vusi Magagula did not want to come out clear whether the ARVs were running short, but pointed to the fact that the health Ministry was working with Parliament and the Finance Portfolio Committee in a bid that the drugs does not run out at the height of the Covid-19 pandemic.
Swaziland Democratic Nurses Union (SWADNU), President, Bheki Mamba, said, as a union, they were aware of the serious shortage of not only the ARVs but other core tablets such as those used to treat TB and diabetes, shortly before the coronavirus outbreak in the country.
Mamba went on to say that as a union, they were also aware that the ARVs were diverted to the treatment of Covid-19 patients who at the time were admitted at the Lubombo Referral Hospital in Siteki. In addition, the nurse’s union president said unless government promptly responds to the shortage of the core tablets, patients suffering from these chronic diseases would die. Mamba said with the over 300 000 patients enrolled for HIV treatment there was a risk of relapse on their part, which may lead to their untimely death.
Mamba said government has a habit of disguising the purchase of the core tablets like ARVs by the acquisition of supplements like multivitamins.
International clinical trial
“By comparison, multivitamins are cheaper and one wonders what happens to the money approved by Parliament to purchase core tablets,” said the president. He said from past dialogues with government, they have condemned the purchase of supplements instead of the core tablets.
The Ministry of Health admitted that they have continued to administer ARVs to Covid-19 patients despite the serious shortage.
Minister of Health, Lizzie Nkosi, admitted to Independent News that they have been using the antiretroviral tablets, specifically Lopinar/Ritovinar, on the first Covid-19 case, in March, and continued to do so until three weeks ago when an international clinical trial called Solidarity Trial, which has the full backing of WHO and other partners, ruled for the termination of the use of ARVs.
Nkosi explained that Eswatini had been trialling the ARVs but did not subscribe to the Solidarity Trial, which is currently doing studies on what prescription can be used to fight the virus.
“The ministry only stopped administering the ARVs three weeks ago and awaits the outcome of the Solidarity Trial study, which will publish a comprehensive report on the treatment of Covid-19 patients,” submitted the minister.
Stopping the use of the ARVs and other treatment methods has to do with nothing but is part of Solidarity Trial’s swoop on countries, which tend to adopt their own ways in an effort to constrain the virus, said Nkosi.
The use of the HIV inhibitors, Lopinar/Ritonavir, to treat Covid-19 was thought to have the same effect on Covid-19 patients as it does on HIV, hence its adoption by the ministry of health. However, WHO issued that it has been demonstrated that these HIV inhibitors have no significant effect on the protection against or the cure of COVID-19.
Even though a cure for COVID-19 could still come from HIV inhibitors, other existing medication is being investigated. The World Health Organisation stated that until they have compiled a comprehensive report, countries that are signatories to the world body cannot continue administering ARVs on Covid-19 patients.
WHO also said that there could be side effects associated with administering ARVs on Covid-19 patients, especially those that are HIV negative. WHO stated that randomised clinical trials normally take years to design and conduct, but the Solidarity Trial will reduce the time taken by 80 percent due to pressure on health systems exerted by Covid-19 across the world.
As of June 3, 2020, more than 3 500 patients have been recruited in 35 countries, an exercise done by 400 hospitals. The WHO reported that over 100 countries have indicated their interest in taking part in the trial exercise being carried out by the Solidarity Trial.
A statement released on the Solidarity Trial’s web page says the trial treatment will compare four treatment options against standard of care, to assess their relative effectiveness against COVID-19.
It says by enrolling patients in multiple countries, the Solidarity Trial aims to rapidly discover whether any of the drugs slow disease progression or improve survival. Other drugs can be added based on emerging evidence.
The WHO also issued that there is a much higher rate of reported side effects on HIV negative people who take ARVs, such as nausea, vomiting and kidney or liver abnormalities for HIV people that administer antiretroviral tablets.
“When a HIV-positive person is given ARVs, it boosts their immunity, but when a HIV-negative person takes them, it just undermines their immunity and interferes with their body organs,” said a statement from WHO, which is concerned by the potential harm that may be caused by administering random trials on Covid-19 patients.
“Until there is sufficient evidence, WHO cautions against physicians and medical associations recommending or administering these unproven treatments to patients with COVID-19 or people self-medicating with them,” said a statement from the world health body, while adding that it is concerned by reports of individuals self-medicating with chloroquine and causing themselves serious harm.
The effectiveness of the ARVs (lopinavir/ritonavir), which until now, Eswatini had been administering on Covid-19 patients, is being researched by other countries, and as yet, its efficacy has not yet been proven.
On March 19, 2020, Chinese scientists reported that, in a study of 199 patients, they had not observed a significant effect of lopinar/ritovinar on the disease course and mortality of COVID-19.
At this moment, a large international study on these drugs is being conducted which includes the participation of Dutch hospitals.
No complications – Deputy Health Director
Deputy Director Clinical Services in the Ministry of Health, Dr Velephi Okello, said Covid-19 patients that had been taking ARVs as treatment for Covid-19 would present no difficulties should they later on, contract HIV and require the mandatory administering of the HIV treatment. “For those patients who were treated with the ARVs at the Covid-19 holding hospitals should stand assured that administering medication long after they have left the hospitals will not be affected,” said the deputy director.