TB drug shortage redux

I wrote about the TB drug back in December: https://healingnumenor.wordpress.com/2008/12/10/tuberculosis-medication-shortage/.

I wish I could report the situation was improving. In fact, it has worsened. Yesterday, one of the doctors mentioned at a research meeting that the drugs were out in the National TB/Leprosy Control Programme (NTLP). Some of our doctors have dual roles in our research center and at the NTLP. Our research participants have access to medications. However, most TB patients are not enrolled in studies.

I’ll briefly explain the regimens and then the shortages.

TB medications: S=streptomycin; E=ethambutol; H=INH; R=rifampin; Z=pyrazinamide

New TB patients get either: (1) 2 months E+H+R+Z then 4 months H+R; or (2) 2 E+H+R+Z then 6 months H+E.

Retreatment TB cases typically get: 2 months S+E+H+R+Z then 1 month E+H+R+Z then 5 months E+H+R.

Mulago Hospital TB Wards 5&6/NTLP Clinic see about 25% of the nation’s TB burden and about 200-250 TB patients per month. The shortage is especially worse in Kampala then in some rural areas. (We’re ranked 16th in the world for TB burden in the 202/212 countries that report TB cases.)

As of this morning we had:

(1) NO R+H+E formulation for pediatric TB patients.

(2) 2-month initial phase of E+H+R+Z for only 12 patients.

(3) Only 15 one-month boxes of E+H+R for the retreatment TB cases.

(4) Hundreds of H+E but…..they were all expired.

(5) 1300 vials of streptomycin. However, given that it would have to be taken with E+H+R+Z (see #2 above) in the retreatment regimen, the surplus is of practically no use.

Later in the day, I found out that the Daily Monitor had a blame-game story on this: http://www.monitor.co.ug/artman/publish/news/Uganda_in_TB_drugs_shortage_81681.shtml.

I’m not in the position or have the knowledge to offer more on who is at fault than the story does, but off the record I have some hunches. Anyhow, the focus needs to be on the solution and future prevention of shortages as numbers of patients continue to suffer.

I emailed two human rights organizations after my tour of the NTLP pharmacy with one of the doctors and the pharmacist there. Tomorrow morning I am going to the NTLP clinic to see what it is going to be like to tell patients they have TB but that we can’t give them the medications. Tomorrow afternoon I am talking with a reporter and on Thursday there will be a press conference on drug shortages in general. I’ll post how these all go. Click on the comments below for an update.

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2 Responses to “TB drug shortage redux”

  1. healingnumenor Says:

    There has been much action since I wrote this post on March 17th. On Thursday, the Stop the Stockouts! public campaign launch took place at the National Theatre led by a group of 5 Ugandan civil society organizations – HEPS (http://heps.org/), AGHA – Action Group for Health, Human Rights, and HIV/AIDS (http://www.aghauganda.org/), AIDE – Alliance for Integrated Development and Empowerment, National Forum of People Living with HIV/AIDS Networks in Uganda (http://www.nafophanu.org/), and ACFODE (http://www.acfode.org).

    Spokepersons from these organizations gave moving testimonies and statements on essential medicines – medicines that are supposed to be made available at no charge in low-income countries. Of eye-opening statistics I heard, about 9 million Ugandans (~30% of the population) live on less than $1 USD a day.

    One patient shared her story about difficulty accessing costly cancer drugs and radiotherapy for cervical cancer. According to the CSOs in collaboration with a Ministry of Health task force, 32-50% of public health facilities in Uganda lack essential meds. Ugandans spend about 70% of the cost for a medication…put that in the context of living on less than $1/day and the public health problems and resultant social costs are evident.

    I gave a testimony on the TB drug shortage at Mulago Hospital during the press conference/public forum. If you are interested, I can send you the press statement I made.

    A series of articles have come out on the shortage and TB in general as March 24th is World TB Day. Today’s article quoted me in a few instances: http://newvision.co.ug/D/9/34/675465. I want to make a few clarifications to a good article highlighting problems. Although the shortage was ongoing in January, I said “during my visit in March” in the first quote. Also, although treatment interruptions may be associated with risk of transmission theoretically, my original quote referred to delayed initiation of TB treatment due to shortage as a cause of increased transmission. I am thankful that the news is publicizing this important issue. Hopefully, patients will have access to drugs soon.

    Additional related article on the Stop the Stock-outs! campaign at: http://www.newvision.co.ug/D/8/13/675331.

    Powerful quote from the event:
    “A sick country cannot develop. We are losing as a country. We are quiet about it.”

  2. healingnumenor Says:

    As of Friday, no new TB drugs had been received. So the call to stop the stock-out of anti-TB meds by World TB Day (March 24, 2009) went unrealized for the moment. There is a chance medication will come this week. But that message has been heard before.

    Follow-up media (also international such as in The Guardian and Physicians for Human Rights) reporting occurred including the following two articles in The Observer, which demonstrate good health reporting of the situation:

    1) http://www.observer.ug/index.php?option=com_content&view=article&id=2805:chronic-drug-shortage-cripples-health-system&catid=34:news&Itemid=59

    2) http://216.67.241.45/~observe1/index.php?option=com_content&task=view&id=2800&Itemid=61

    3) http://www.theeastafrican.co.ke/magazine/-/434746/556826/-/15mg5d5/-/index.html

    4) http://africasciencenews.org/asns/index.php?option=com_content&task=view&id=1110&Itemid=2

    I am going to post soon about the East Africa Health and Human Rights Leadership Institute on 2-4 April 2009. The Minister of Health spoke and demands for essential medications were brought to his attention by Ugandans. Additionally, a participant resolution from the conference included among its 8 resolutions a right to freely, consistently available essential medicines (which should already be both per the definition of essential medicines that Uganda had agreed to many years ago).

    Today I went to visit a boda boda driver at Mulago Hospital after the boda I took home from the gym asked me if I was a doctor. After I hopped off his motorbike he told me the location of Musoke. Finding him would be an ordeal, but other boda boda drivers I use for motor rides were there around his bed. The comraderie touched me. What didn’t touch me was when boda driver Henry said that Musoke Ronald needed to be transferred because Mulago didn’t have available the needed medication to treat the pneumonia diagnosed.

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