By Steve Aborisade
As an organisation we have had reasons to contemplate the colour and shape of silence in the face of crass impunity at play in the Nigeria’s HIV/AIDS corridor and the inherent implication to the individual’s right to health.
Indeed, silence at times thunders so loudly that it hurts the ears. Like Samuel Butler once stated ‘‘it is tact that is golden, not silence’’. It is in this regard that we felt the imperative, once again, to raise a sound of alarm hoping that those at the helm of affairs of our national intervention would see the need to do things right.
A clear narrative of our current concern relates to outcome of a new research effort whose report was released in January 2014 and published in the open access journal PlOS ONE www.plosone.org, January 2014, Volume 9, Issue 1, e87338 which detailed the shamefully high incidence of errors in antiretroviral prescriptions in Nigeria. Errors in antiretroviral prescription ultimately lead to drug resistance, treatment failure, and death.
Result of the research sadly concludes and graphically details the grave implications to treatment outcomes in HIV patients. An important concern to us will be the infringement that this could represent to the right to health of Nigerians who are on HIV medications and on the government programs.
The insights which the report provides represent a dull blight on an already contentious treatment program dangerously buoyed by marked integrity deficits. The report concluded that errors were detected in the prescriptions of almost all adult patients, while commonplace errors included prescribing incorrect antiretroviral drugs or combinations; prescribing drugs that were contraindicated or that interacted with other medications; and inappropriate frequency or duration of therapy.
The study involved 14 HIV treatment centres in Nigeria randomly selected from 69 health facilities that had program for active screening of medication errors and was conducted between 2009 and 2011. Report stated that prescriptions of 6882 HIV-positive patients were checked for errors with a total of 110,000 prescriptions issued representing an average of 16 prescriptions per participant. Total number of drug items dispensed was 306,000.
‘‘Approximately two-thirds (67%) of the participants were women and 94% were over 15 years of age. All the participants were screened for prescribing errors, which were detected for 93% of people aged over 15 years and for 62% of younger people. Over a quarter (26%) of errors involved prescribing incorrect antiretroviral drugs or regimens; a fifth involved possible contraindications or interactions; and 17% involved inappropriate duration or frequency of medication.’’ “The incidence of medication errors was somewhat high,” concluded the authors of the report.
To us at NigeriaHIVinfo.com, the findings become worrisome as it raises serious concerns around the integrity of our ART regime, especially from the research conclusion which suggests that active screening for medication errors is feasible even in resource-limited settings like ours if only we would build the capacity of those manning our facilities.
Our concerns become heightened going by the connection that this report has to the findings of the 2010 Global Burden of Disease (GBD) Study. The global burden of disease Study is a comprehensive regional and global assessment of mortality and disability from major diseases, injuries, and risk factors involving 187 countries of the world from 1990-2010.
In showing how exceptional the AIDS epidemic has become, the 2010 GBD report noted that death and disability due to HIV has increased by 354% during that time with no other disease burden increasing by more than the 69% increase seen in diabetes since 1990. ‘‘The disease burden of tuberculosis and malaria, which are at number seven and number 13 respectively, has fallen by 20% since 1990.’’
HIV is said to be responsible for 3.3% of all the number and proportion of disability-adjusted life-years (DALYs) lost worldwide. It noted that in high-prevalence countries such as South Africa it is responsible for up to 40% of DALYs lost. Interestingly, Nigeria contributes more to the global burden of disease in absolute numbers than it does in prevalence.
The study also sees HIV and AIDS as exceptional for its age profile. ‘‘Whereas most other conditions disproportionately affect the old and the very young, HIV is the number one cause of DALYs lost for women aged 25 to 45 and men aged 30 to 45.’’ Nigeria’s predominantly youthful population to us constitutes a peculiar catchment bracket here, and cause of worry.
The GDB report also identified HIV/AIDS as the worst health problem in the West African countries of Gabon and Equatorial Guinea, ‘‘and number two in the populous countries of Nigeria, Ghana and Cameroon.’’
The forgoing constitutes serious grounds for concerns, and justifiably so considering the gale of recent controversy around the supply and dispensing of a supposedly substandard antiretroviral medication by the Federal Ministry of Health to treatment centres across the country which is yet to abate, coupled with the reality of Nigeria’s inability to treat most of its people requiring HIV treatment and our advertised failure to halt new infections in both children and adults.
This gross shortcoming represents likely factors capable of collapsing the foundation of our ART regime with the modest gains recorded overtime in the light of revelations which question the capability, sincerity and indeed clarity of our policy direction and of our program implementation. It sadly also makes mockery of our president’s avowed commitment which fuelled his declaring last year that no Nigerian life would be lost to HIV/AIDS again.
It is our hope that those directing our intervention will see the urgent need to respond with more clarity of purpose, as we demand that they entrench a new regime driven by accountability and openness even in the midst of constraints to available resources. The Nigerian people deserve an explanation as to how we remain at this junction having in mind the huge investments in tax payers’ money and foreign donor’s grants that the HIV intervention continues to consume.
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