Declaring an HIV outbreak in Ratodero area of Larkana a Grade 2 Emergency, the World Health Organization has said that an inadequate stock of antiretroviral therapy medicines has emerged as the major challenge for Pakistan. The current stock is only sufficient to meet the needs of 240 children till July 15 of which 231 are already getting treatment. This which means that only nine more children can be enrolled for treatment, says a WHO situation report titled, Pakistan: HIV Outbreak in Larkana District Sindh. The report was released on June 3.
Calling for immediate availability of ART medicines for 751 documented HIV-positive people (761 as of June 8), the report says there is an urgent need for anti-retro viral medicines, rapid HIV diagnostic kits, medicines for the treatment of subsequent infections, training for health workers, provision of psychosocial support, training health workers and strengthening infection prevention and control at health facilities.
Compiled by a rapid response team comprising international epidemiologists, public health experts, infection control specialists and others who flew to Pakistan from different countries on the request of Ministry of National Health Services, the report says 26,041 people have been screened for HIV in Ratodero.
Out of these 751 (2.9 per cent) of the people tested positive for HIV. This included 604 children, 135 adults and 12 patients whose age was not documented. As many as 531 (70 per cent) were linked to the ART centre, including 443 children and 94 adults. Only 324 were receiving treatment at the moment.
The HIV outbreak in Ratoderoa area of Larkana is just a symptom of a deeper crisis
Expressing dissatisfaction with the screening standards, the report says in some screening camps in Larkana district, the WHO recommended standards for testing were not being followed due to lack of recommended test kits.
The WHO team believes the possible drivers of the outbreak could be unsafe blood transfusion practices, re-use of injection needles and syringes, mother-to-child transmission, improper disposal and reuse of hospital waste, tattooing using unsafe needles, circumcision in male children using unsafe blades and ear and nose piercing using unsafe needles.
The report says $1.5 million or Rs 225 million is needed to deal with the health emergency in Ratodero Taluka. The amount available through CFE was only $200,000, thus the gap stood at $1.3 million or Rs 195 million.
The Global Fund to Fight Aids, Tuberculosis and Malaria has promised to provide anti-retro viral medicines for the newly diagnosed HIV positive people. It has also urged the government of Pakistan to start an indigenous plan to provide the treatment for their rest of their lives.
The Fund says it is worried about a possible spread of HIV into the general population in Pakistan as the recent outbreak in Ratoderoa was a symptom of a deeper crisis.
The spread of HIV in Pakistan is worrying. For years it was believed to be limited to high-risk groups, notably injecting drug users. However, it is now on the verge of spilling into the general population. There is no reason for panic, but also no justification for denial, said Dr Werner Buehler, the senior Fund portfolio manager in Geneva.
He confirmed that the Fund had started procurement of paediatric antiretroviral therapy medicines for children infected in Ratodero through its rapid supply mechanism.
The Fund is so far the only funding source for the treatment in Pakistan. There is an urgent need for the government to plan and pay for domestic drug procurement. There is also a need to decentralize HIV service delivery (and testing) as much as possible. Only then can we overcome distance, one of the biggest obstacles to treatment.
The Government of Pakistan had earlier requested the WHO to support the provincial Health Department in conducting a comprehensive investigation into the outbreak. “As a follow up to this request, the WHO constituted and deployed a team of experts comprising among others an epidemiologist, paediatric HIV treatment experts, supply chain management experts and laboratory experts,” the report says.
The team currently in the field; only a preliminary report has been issued.
The team has urged the health authorities to introduce a systematic screening of HIV in the affected areas, conduct awareness and health education sessions in communities about HIV/AIDs targeting at-risk groups, linking HIV confirmed cases with available treatment sites and train health workers on paediatric case management.
The WHO has also called for immediate procurement and provision of RDTs and ARVs and international support for the provision of HIV services targeting the at-risk groups.
The writer is a freelancer