Page 130 - HIVMED_v21_i1.indb

Southern African Journal of HIV Medicine
ISSN: (Online) 2078-6751, (Print) 1608-9693
Page 1 of 3 Scientific Letter

Antiretroviral therapy under the wing of the COVID-19

epidemic: One look, and different solutions

Authors: Introduction
Heba Elsayed 1
Mohamed Hassany Dear editors, we read with great interest the editorial ‘Antiretroviral therapy optimization in the
2,3
1
time of COVID-19: Is it really different in North and South Africa?’ by Cordie et al. and we find
Affiliations: it an excellent opportunity to address some critical issues.
1 National AIDS Program,
Ministry of Health and
Population, Cairo, Egypt With the detection of the first case of the human immunodeficiency virus (HIV) in Egypt in
1986, the Ministry of Health and Population (MOHP) established the National AIDS Program
2 Tropical Medicine (NAP) as the entity responsible for combating the HIV epidemic in the country. This task has
Department, National included prevention and the care and treatment of people living with HIV (PLHIV) and
Hepatology and Tropical coordinating the efforts of stakeholders such as the United Nations (UN) and civil society
Medicine Research Institute,
Cairo, Egypt organizations (CSOs). 2

3 Ministry of Health and Antiretroviral therapy procurement strategies in Egypt
Population, Cairo, Egypt
Antiretroviral (ARV) drugs were first introduced in Egypt in 2008. From 2008 to 2014, these were
Corresponding author: funded from the Global Fund to Fight AIDS, tuberculosis and malaria (GFATM). In 2014, the
Mohamed Hassany,
mohamadhassany@ MOHP took the step to start covering ARV drugs from domestic funding and succeeded from
yahoo.com 2017 until now to cover 100% of Egypt’s needs from the domestic funds. This has been with a view
to ensure ARV-sustainability and avoid the risk of stockouts. This is considered a unique initiative
Dates: amongst all countries in the region. Egypt has given attention to the procurement and supply
3,4
Received: 06 Sept. 2020
Accepted: 02 Oct. 2020 management of ART. Clinic pharmacists were provided with a comprehensive medication policy
Published: 15 Dec. 2020 and capacity-building standards through international experts. The latter were recruited by
UNICEF, the agency that assists the government in the procurement of unregistered ARVs. This
How to cite this article: provides ART clinics with a unique stock management system. In 2018, the MOHP encouraged
5
Elsayed H, Hassany M.
Antiretroviral therapy under local pharmaceutical companies to register all first-line ARVs. This covers approximately 97% of
the wing of the COVID-19 the drugs needed by PLHIV. The remaining unregistered ARVs are procured via UNICEF. 5
epidemic: One look, and
different solutions. S Afr J HIV
Med. 2020;21(1), a1167. National treatment policies and recommendations
https://doi.org/10.4102/ National AIDS Program has expanded the treatment options for PLHIV in accordance with the
sajhivmed.v21i1.1167
World Health Organization’s (WHO’s) guidelines and the national context. The most recent
Copyright: Egyptian National Care and ARVs Guidelines were published in 2015. These were followed in
© 2020. The Authors. 2017 by a summary update. This adopted a ‘Test and Treat/Treat All’ approach that supplies
Licensee: AOSIS. This work
is licensed under the ARVs to all PLHIV regardless of their CD4 count or viral load level. This update included the
Creative Commons introduction of dolutegravir (DTG) as an alternative first-line option to efavirenz (EFV) as per
Attribution License. the WHO recommendations. 6

Tenofovir disoproxil fumarate + emtricitabine (TDF + FTC) is the preferred nucleoside
reverse-transcriptase inhibitor (NRTI) first-line ART backbone. As per our National guidelines,
TDF + FTC + EFV is the currently preferred first-line regimen. An alternative NRTI backbone is the
combination of zidovudine (AZT) and 3TC, which is registered and manufactured locally. 7

The global effect of coronavirus disease on medication
supply chain

With the evolution of the coronavirus disease 2019 (COVID-19) pandemic, all countries have taken
Read online: measures to control the spread of the infection. As a result of the lockdown and the interference with
Read online:
Scan this QR
Scan this QR international flights, global health systems have faced the potential of medicine stock-outs.
code with your 8
code with your
smart phone or
smart phone or Seventy-three countries reported such a risk of ARV stockouts. Based on a recent UNAIDS study that
mobile device explores challenges facing global HIV programmes, reduced production and availability of active
mobile device
to read online.
to read online.
pharmaceutical ingredients (APIs) and issues with transportation have negatively affected dependent
http://www.sajhivmed.org.za 122 Open Access