The government is investigating whether a nationwide shortage of antiretroviral (ARV) drugs led to the reported deaths of HIV-positive people in northern Uganda this month.

Health workers in Apac district reported that at least 17 people known to have been HIV-positive died over the past month after failing to receive their life-prolonging medication due to supply shortfalls.

"Investigations are still going on and I am waiting for the report from Apac to confirm if it was a result of a lack of antiretroviral drugs," said Zainabu Akol, head of HIV programmes at the Uganda Ministry of Health.

"We are in touch with our monitoring and evaluation district officer to confirm if the deaths were due to hunger, lack of drugs or other diseases," said Stella Kentutsi of the National Forum of People Living with AIDS Network in Uganda.

Northern Uganda is experiencing food shortages and is also a high-prevalence malaria region; Akol said the government would look into whether either of these factors could have contributed to the deaths.

Health centres around the country are reporting out-of-stock ARVs, which the health ministry attributes to rising numbers of people on the drugs not matched by a corresponding rise in funds to purchase them.

An estimated 170,000 people are enrolled in government ARV programmes. Akol told the media that after a massive countrywide testing drive in January, 100,000 new HIV patients were registered, many of whom needed ARVs; government and donor funding, however, had not increased.

Kentutsi said the Network had received many complaints from clients in several districts where service providers had stopped enrolling people on ARVs.
"Some service providers are only enrolling patients with a CD4 count [a healthy CD4 count is between 500 and 1,500] of 150 and below," she said. "If you initiate someone in the final stages, recovery takes longer and it is more costly."

The UN World Health Organization (WHO) recommends patients are enrolled on ARVs when their CD4 immunity measure falls to 350.

According to officials at the health ministry, funding delays have also contributed to national ARV shortages.

The Global Fund to fight AIDS, Malaria and Tuberculosis last week belatedly disbursed US$4.2 million to the government as part of a $70 million round-seven funding grant. The last round of funding from another major donor, the US President's Emergency Plan for AIDS Relief (PEPFAR), has ended, and according to Akol, the next round of funding will not be disbursed until October.

Uganda's ARV programme is 95 percent donor-funded, with the two main contributors being PEPFAR and the Global Fund.

The national budget for 2008-2009 allocated $38 million to purchasing ARVs - the first such allocation in the country's history. Parliament recently recommended the amount be virtually halved in the 2009-2010 budget.

The country's ARV programme has also been dogged by problems with the supply chain that have, in the past, led to drugs expiring in the National Medical Stores.