At least 18 clinics and hospitals in Limpopo are without HIV testing kits as months-long shortages of the HIV diagnostics continue in the province, say activists from Aids lobby group the Treatment Action Campaign (TAC).
TAC provincial chairperson Moses Makhomisane says he fears rape survivors might miss out on preventative treatment because of the shortage of HIV testing kits.
“Somebody who has been raped only has a 72-hour chance to prevent themselves from getting infected with HIV and for them to access PEP [post-exposure prophylaxis], they need to be tested,” he explains.
People who have been raped can get antiretroviral (ARV) medication within 72 hours of the attack to prevent HIV infection as part of post-exposure prophylaxis (PEP). Because the ARVs used in the PEP may not be the same as those needed to treat HIV, rape survivors must first test HIV-negative before they start taking PEP.
But TAC and medicine-monitoring organisation Stop Stockouts Project say facilities in two of the province’s five districts have been running low on testing kits since July.
And on Twitter, activists warn the problem could be more widespread. Other Twitter users say it’s not the first time they have heard reports of HIV testing kit stock-outs.
TAC Limpopo only has branches in Mopani & Vhembe currently which is why the focus is there. It’s likely the problem is more widespread..
— TAC (@TAC) September 8, 2017
New tender, new problems
The Limpopo health department admits that HIV testing kits ran low in July and August, but says the kits were reshuffled between facilities and provinces to avoid stock-outs.
“At no time was the Limpopo health [department] completely out of stock. Currently, Limpopo has sufficient stock to service all clients visiting our health facilities,” says provincial health department spokesperson Derick Kganyago.
The country recently began purchasing testing kits from new suppliers as part of a new national tender, according to national health department director of communications Foster Mohale. He explains that there was a delay in delivering tests to provinces as newly procured kits were being quality assured, but says provinces should have ordered enough stock under the old tender to see them through the change in suppliers.
“There is no national shortage of test kits. All provinces are going through a transition period from the previous expired tender to the current one. The procurement of the test kits is decentralised to provinces and each province has to make projections and manage their stock based on their targets,” Mohale says.
He says the provinces began ordering testing kits for October in August under the new tender.
Health MEC Phophi Ramathuba has yet to respond to a TAC letter about stock-outs, she has pledged to investigate the issue via social media.
The issue willl be duly investigated
— Phophi Ramathuba (@PhophiRamathuba) September 8, 2017
No test? No treatment
In September last year, South Africa began allowing anyone who had tested HIV-positive to begin treatment almost immediately — an approach often called “test and treat”. In the past, most people would have had to wait until their CD4 counts — a measure of the immune system’s strength — fell to low levels before they started taking ARVs.
But Stop Stockouts Project manager Glenda Muzenda says tests are the crucial first step in getting more people onto treatment. She warns that if people come to test for HIV at a clinic and find there are no diagnostics, they may leave and never return: “In reality, people make such a life-changing decision [when they decide] to test and it is really difficult when you are not able to get test kits on the day.”
The testing kit shortage may also imperil South Africa’s progress towards achieving the latest round of international HIV goals, says Makhomisane. Under the “90-90-90” targets, South Africa has committed to ensuring 90% of all people living with HIV know their status by 2020 and 90% of people diagnosed with HIV infection are on ARVs. Of those on treatment, 90% should be well enough to bring the amount of HIV in their blood down to almost undetectable levels.
People who have been virally suppressed for at least six months have an extremely low risk of transmitting the virus to their sexual partners, according to a July statement released by global health experts and heads of more than 400 organisations.