HARD TO CONCEAL

ARVs to come in larger containers, HIV+ people, activists angered

The President's Emergency Plan for Aids Relief, the US lobby that funds most of HIV treatment in Kenya, is cutting costs

In Summary

• Pepfar argues that it is cheaper to package and distribute the free drugs larger containers. 

• Most of those opposed to bigger containers are adolescents and young people, and discordant couples because they might be exposed as HIV- positive.

The small container for a month's ARV supply and the larger one for three months. The six-month container is is three times bigger. but cheaper to manufacture.
TOO CONSPICUOUS? The small container for a month's ARV supply and the larger one for three months. The six-month container is is three times bigger. but cheaper to manufacture.
Image: COURTESY:

ARVs will soon be dispensed in larger containers that carry enough free pills for six months to save money for packaging.

The move has been rejected by people living with HIV and activists who say larger containers will be more conspicuous and expose them to scrutiny, identification and stigma.

Currently, ARVS are dispensed in small plastic containers for 30 pills.

But the President's Emergency Plan for Aids Relief (Pepfar), the US lobby that funds most HIV treatment in Kenya, is cutting costs and has asked the Health to prepare for two larger containers of 100 and 180 pills.

Pepfar has announced it will slash the financing to Kenya from Sh50.5 billion this financial year to Sh35 billion next year.

Pepfar argues that it is cheaper to package and distribute larger containers and he US has cut funding. 

This means patients will only need to visit health facilities once in three months or once in six months to get the larger containers.

Head of the local HIV lobby Nephak Nelson Otuoma said the bigger containers are a bad idea.

"Adolescents and young people are strongly opposed to bigger drug containers than the older PLHIV. HIV-positive partners in a discordant relationship are also strongly opposed to the change," he said. 

The announcement was made last week at a meeting convened by the Ministry of Health.

"This will start with the adult first-line ARVs, which is for the majority of Kenyans living with HIV," Dr Maureen Kimani said. She is the head of treatment at the National Aids and STIs Control Programme,

However, most MoH officials and the Kenya Medical Supplies Agency also favour the small tins. 

Otuoma said they reached out to more than 500 people through social media and email.

"Most of them preferred the monthly dosing and monthly packaging, even if it means carrying many of the smaller tins and the pillboxes," he said.

However, the Kenya Treatment Access Movement, one of Kenya's oldest Aids NGO, supports the large containers.

"This is the best thing that ever happened. People living with HIV need to understand they are part of society and should understand economies of scale," James Kamau, the head of Ketam, said. 

"Funds are dwindling and the long-term cost overruns of packing in small containers are high."

Kamau said those opposed to big containers can simply pick them and later repackage into smaller tins that are easier to carry around. 

"This is self-stigma. When someone says, 'Oh I will be seen carrying it', but no other person knows what you're carrying'," Kamau said. 

No major study has been done on ARVs' packaging and adherence.

However, some people say they are annoyed by the noise the tablets make inside the bottles, especially when using public transport. 

About 1.5 million Kenyans are living with HIV, according to the National Aids and STIs Control Programme. 

About one million are on ARVs, at an annual cost of Sh8 billion, 20 per cent financed by the government and the rest paid for by Pepfar and the Global Fund.

 

Edited by E Kibii

The three containers displayed during the meeting between Ministry of Health and local NGOs.
The three containers displayed during the meeting between Ministry of Health and local NGOs.