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Expired HIV medication distributed in Cambodia

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Living with AIDS people prayed at anti Aids/HIV day. Photograph supplied

Expired HIV medication has been distributed through a government-run and Global Fund-sponsored initiative, a health expert with knowledge of the case said yesterday.

Government officials said they were investigating the claim, but admitted nearly expired antiretroviral drugs were being distributed in Banteay Meanchey province and perhaps elsewhere.

The discovery has prompted the National AIDS Authority to convene a high-level meeting of government and NGO representatives today.

Tim Vora, executive director of the HIV/AIDS Coordinating Committee (HACC) – an umbrella network of 120 local and international NGOs – said the organisation confirmed that at least one clinic had distributed expired anti-retroviral medication and expected there to be more.

“Local NGOs in Banteay Meanchey raised concerns that the ARV drug being used by some people was expired, while others were almost expired.

After we learned this, we went to collect the medication from the patient and found that, in fact, the ARV was expired. We went to interview with them on February 12. The drugs expired in January.”

Vora said only a single case involving four drugs had been confirmed, but expected there would be others. Early next month, HACC will dispatch an investigative team to provinces across the country to meet with patients and determine whether they are using expired or nearly expired drugs.

According to government figures released at the end of last year, just over 70 per cent of the nearly 78,000 people living with HIV/AIDS are on antiretroviral therapy. Those medications are provided almost entirely by the Global Fund at an estimated cost of $8 million each year.

In Banteay Meanchey alone, 3,000 people are on antiretroviral therapy, said provincial health department deputy director Ung Sophirum, who is in charge of the province’s HIV/AIDS program.

Dr Sophirum said he was aware of the claims, but insisted only “nearly expired” medications had been found.

“There are not expired medications. Just nearly expired medication, so it’s OK to use,” he said, adding that a new shipment was expected to arrive in five days, after which the provincial health department would clear clinics of the old medication and remit them to the Ministry of Health.

“The ministry and province are working hard to pay attention to this problem. However, it’s fine, because we have new medication coming,” he said.

Dr Teng Kunthy, secretary general of the National AIDS Authority, said today’s meeting would examine evidence provided by HACC to see whether expired drugs had in fact been distributed.

“We set up a meeting [today] at the NAA to discuss that and to look at clear evidence and figure out what happened in the field. This includes looking at some pictures of the ARVs,” he said. Additionally, the working group will gather technical experts to determine how long past the expiration date the drugs could be used without lessening their effect.

“As I’ve learned in past experience, even if something expires today, it doesn’t mean they cannot use it. This is a specific technical topic to look at,” he said.

Dr Kunthy said he could not estimate how many nearly expired drugs were in circulation, but said that topic would be discussed at the meeting, which will include officials from the Ministry of Health, National Centre for HIV/AIDS, Dermatology and STDs, civil society and aid organisations.

Asked how medication could have been permitted to stockpile for so long that it was on the verge of expiry, Dr Kunthy said it was most likely because, at the local level, “the knowledge of the people is still limited”.

“Technically, we are also discussing how to manage the drugs from the Ministry of Health. We do not want this kind of situation to happen in the field.”

Dr Mean Chhi Vun, director of the NCHADS – the government body in charge of ARV procurement and distribution – said he was too busy to speak.  

Seth Faison, spokesman for the Global Fund, said yesterday that the fund was investigating the situation.

“We are aware of reports that some patients on ARV treatment have been given medication that recently expired,” he said. “We are looking into the matter. We continue to work to ensure health facilities have the drugs they need.”

A more than 18-months-long internal investigation into the Global Fund’s Cambodia programs was expected to be finalised by the end of the year, but has not yet been released to the public “because following due process with witnesses is taking longer than expected”, Faison said in January.

Late last year, the fund admitted the investigation had uncovered “serious financial wrongdoing, on procurement and other issues”.

HIV medication is not among the topics covered in the report, Faison said yesterday.

With assistance from Chhay Channyda

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