Page 131 - HIVMED_v21_i1.indb

Page 2 of 3 Scientific Letter

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regions. Remedial action has been required by countries and the end of September 2020, the number of COVID-19 cases in
stakeholders. Africa has approached a million and a half with nearly 35 000
deaths. A WHO modelling study projects that the number of
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National response during COVID-19 cases in the first year of the pandemic in Africa will
coronavirus disease 2019 reach between 29 and 44 million and of this between 190 000
and 290 000 will die. These data suggest a continuous
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The Egyptian NAP has taken steps to support PLHIV reappraisal of the effects of COVID-19 by African government
during the COVID-19 epidemic. These include prolonging and the possible ART shortages.
ARV-dispensing intervals beyond a month, strengthening
teleconsultation services, ensuring ongoing follow-up of Key challenges (Figure 1)
COVID-19-infected PLHIV and assisting with their admission Overlapping challenges that may affect the ARVs supply chain:
to isolation hospitals and subsequent care. Since the start of
the pandemic and the confirmation of Egypt’s first COVID-19 • Countries’ lockdown measures
case in February 2020, a ‘partial-lockdown’ model has • Economic challenges because of the reduction or stoppage
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allowed continued access to medication via a medicines of all the economic activities
stockpile, the government’s cargo fleet and airline support. • The subsequent decrease in API and intermediate
These measures protect Egypt from exposure to a significant pharmaceutical ingredients’ production capacities lead to
stockout or delayed ARV access. increased API costs
• Slow shipments and reduced access to medicines.
Africa between the hammer of
HIV and the anvil of coronavirus Key solutions
disease 2019 With the easing of the lockdown measures the following
solutions are surfacing:
Africa has a large HIV burden: ongoing new HIV infections, • Alternative procurement sources and long-term
approximately 500 000 HIV-related deaths in 2018 and at least forecasting plans to enhance drug stocking
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a third of PLWH still not accessing ART. Multiple factors • Manipulating different ways of shipping
have undermined the continent’s ability to end the HIV • Resource mobilisation and the waiving of national taxes
epidemic. Some of these factors are persisting civil wars, tribal to maintain stable pricing levels
conflicts, natural disasters, poor health systems and weak • Support from global funding agencies and concerned
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infrastructure. These factors have created an ART coverage- UN agencies.
gap of 59% in Eastern and Southern Africa, 79% in Western
and Central Africa and 89% in North Africa. This situation The African Medicine
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has worsened subsequent to the COVID-19 epidemic. Agency Treaty
Nonetheless a number of North African countries have low
HIV prevalence rates, namely less than 0.1% and have been The establishment of the African Medicine Agency
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‘protected’ from these COVID-19-related ART problems. At (AMA) Treaty may assist countries in Africa cope with

Increase Drug stock
Countries API costs GFATM
lockdown Extra-funding
measures

Produc on
sites closure Mul -faceted
Economic (China) resilient country
Increase crisis ac ons
UN
shipment agencies
costs
Produc on sites
Supply chain low opera on
• Domes c funding and taxes slow (India)
waiving • Alterna ve API sources
• Long term forecast movement • Alterna ve shipment ways

API, active pharmaceutical ingredients; GFATM, Global Fund to Fight AIDS, Tuberculosis and Malaria.
FIGURE 1: Challenges and solutions in the medication supply chain under coronavirus disease 2019 pandemic.

http://www.sajhivmed.org.za 123 Open Access