HARARE, Zimbabwe — Efforts to get lifesaving antiretrovial drugs to HIV-positive patients in many sub-Saharan African countries are routinely failing at “the last mile,” an international medical group said Monday. Despite stocks being available, the drugs often do not reach clinics because of “cumbersome procedures, logistical challenges or lack of resources,” Doctors Without Borders (also known by the group’s French acronym, MSF) said in a report released at the International Conference on AIDS and sexually transmitted infections in Africa in Harare. Nationwide surveys conducted in South Africa showed that between 20 and 25 percent of local health centers were unable to dispense the complete amount of one or more HIV or TB medication. In 80 percent of the cases, the drugs were available in the country but did not reach the clinics. “National and international shortages of medicines do get donor and government attention, but the availability of medicine in local health centers is not routinely monitored,” said Tinne Gils, MSF’s regional pharmacist. Similar problems affecting an even larger percentage of clinics were experienced in the Democratic Republic of Congo and Mozamique, MSF surveys found. “Improving medicine delivery to the last mile will require the commitment of countries and international donors,” the report said. “Antiretroviral treatment needs to be taken for life, without interruption,” said Gilles Van Cutsem, MSF’s medical coordinator in South Africa.
“But how can patients be expected to remain adherent to their treatment if their medicines are not available when and where they need them?”