Left behind by the HIV response

Advanced HIV in the Democratic Republic of Congo: Free care, adapted to patient needs, is essential for survival.

HIV prevalence in the Democractic Republic of Congo (DRC) is estimated to be 1.2%, yet access to HIV testing (50%) and ART coverage (38%) are also among the lowest in West and Central Africa region (PNLS 2016 figures). Consequently, MSF staff treat many patients with advanced HIV or AIDS at MSF’s Centre hospitalier de Kabinda (CHK), where MSF provides the only free, high quality specialised hospital care for advanced HIV in Kinshasa. Due to a host of structural and community barriers, people living with HIV only seek care when they are very ill, and mortality rates remain very high.
 
The Left behind by the HIV response report presents MSF’s clinical experience and epidemiological data from treating advanced HIV at CHK and other supported health facilities, along with recommendations for minimum diagnostic and therapeutic packages for advanced HIV at primary, referral and hospital levels, and costings for hospitalisation. The report calls for the funding and implementation of a referral system and free outpatient care and hospitalisation for advanced HIV in Kinshasa. The report also draws on the available literature and includes testimonies from patients who received hospital care in MSF’s Kinshasa HIV project and healthcare professionals specialized in the treatment of advanced HIV.
 
This report comprises a joint contribution by our multi-disciplinary team and is intended for use by authorities in public hospitals, health care professionals, medical decision makers in the DRC’s Ministry of Health and its partners, political decision makers and the country’s major donors (the Global Fund, PEPFAR and USAID).

Effective and efficient supply systems are essential for a successful HIV response. Yet at the health facility level, MSF staff in Kinshasa, Democratic Republic of Congo (DRC) witness regular stock outs and shortages of drugs and commodities for HIV and TB. For patients, this can cause viral resistance and greatly reduce chances of survival.
 
In 2016, in Kinshasa, a survey was conducted by MSF, the Ministry of Health and two civil society organisations of stock outs of HIV tests, first and second-line antiretrovirals and drugs for treating opportunistic infections among 94 public facilities, 33 zonal and 2 central warehouses in Kinshasa. The survey comprised face-to-face interviews with facility managers, using standardized questionnaires, followed by physical verification of stocks conducted from October to December 2016 by trained investigators.

The findings of the survey showed that on the day of the visit, 50% of visited public facilities had a stock-out of at least one ARV, 45% for at least one paediatric ARV and 38% for at least one adult ARV.  The average ARV stock-outs lasted two months for 70% of the visited public facilities and for one third of the stock outs, patients left the health facilities with no treatment. One in two patients receiving second-line ARVs in the visited healthcare facilities had been affected by stock-outs. This survey also revealed that 13% of health structures had experienced a stock-out of HIV tests. All these commodities were in fact available at the central warehouse, and in 44% of cases, available in the health zone.

This survey report is available in French-only: Etat des lieux sur la disponibilité des intrants essentiels pour la lutte contre le SIDA à Kinshas