More than 100,000 Ukrainian HIV patients are in peril of having their antiretroviral therapy interrupted in October due to delayed medical procurement rules.
The Ministry of Health delayed signing several important orders.
Because of that, Medical Procurement of Ukraine, the state body responsible for nearly half of the medical procurement portfolio, has not been able to start its work, officials and nonprofits told the Kyiv Post. Their duties include buying HIV treatment drugs.
Antiretroviral drugs are a lifelong commitment. An interruption in treatment may lead to the illness getting worse and may let the virus become more resistant to the drugs.
There are two possible ways to get around the situation, but neither is without challenges. One way is to use $3.3 million of the United Nations Children’s Fund (UNICEF) funds that were left over from buying antiretroviral drugs for Ukraine in 2017. If only $1.2 million could be used to buy this year’s supply of antiretrovirals, that would be enough.
However, since the contract with UNICEF is expired, it would be necessary to amend a Cabinet of Ministers resolution to allow this money to be used.
“Everything is ready for this,” said Sergiy Dmitriev, head of policy at Ukrainian patient nonprofit CO 100% Life, which supports people with HIV. The amendment has already been approved by a group of experts and passed on to the ministry’s permanent working group for approval, after which it would be passed on to the Cabinet.
“If this happens, if (the Cabinet) gives consent, the problem will be solved,” said Dmitriev.
The Ministry of Health has taken Kyiv Post’s questions but repeatedly delayed responding, despite multiple reminders.
Although it’s unlikely that the Cabinet would be willing to take that step, as it is technically a violation of the budget code. Dmitriev, however, claims there has been a precedent – using leftover funds from the past in this manner has been done before, to procure vaccines.
Another method would be to rely on the Global Fund to try to buy the antiretrovirals, but there may not be enough money to afford the drugs that all Ukrainian HIV patients need.
Ukraine primarily uses dolutegravir as a first-line antiretroviral drug for HIV, recommended by the World Health Organization as recently as 2019. This drug replaced the costlier lopinavir/ritonavir produced by U.S. pharmaceutical AbbVie.
Ukrainian pro-patient groups have waged a long battle against AbbVie’s patent monopoly on its antiretroviral drugs. Lopinavir, marketed by AbbVie as Kaletra, once ate up about half of Ukraine’s annual HIV budget, which is $16 million in 2019-2020.
The pharmaceutical renounced its patent last month, as lopinavir/ritonavir is undergoing clinical trials as a possible COVID-19 treatment in multiple countries including Ukraine.
At least 260 patients were forced to be switched from dolutegravir to other treatments due to the fact that the health ministry did not issue its orders in time. While Ukraine has a supply of dolutegravir for now, it had been sitting in warehouses for weeks, unable to be distributed.
Unplanned switching of antiretroviral medications may affect the health of people with HIV. It is also likely to be a significant drain on state budgets.
