UGANDA: Factory to boost ARV rollout

A new Ugandan pharmaceutical factory has begun producing antiretroviral medication drugs locally, something the government says will significantly increase the number of HIV-positive people accessing the life-prolonging drugs across the country and the East African region.

The US$38 million factory is the first in Africa to produce full triple-therapy generic ARVs, and is based in a suburb in the south of the capital, Kampala. In addition to ARVs, it will produce the anti-malaria medication, Lumartem, which contains Artemisinin and lumefantrine, but is significantly cheaper than the World Health Organization-recommended first-line brand of the same ingredients, Coartem.

"Government commits itself to its promise of purchasing the ARVs for AIDS patients and ACTs [Artemisinin-based combination therapies] for malaria from the factory for hospitals," Ugandan President Yoweri Museveni said during the inauguration ceremony on 8 October.

The plant was set up by local pharmaceutical company, Quality Chemicals Limited, with Indian pharmaceutical company Cipla Limited, one of the world's largest producers of generic drugs. It is expected to employ an estimated 500 people, including 200 scientists, and began trial runs after its inauguration; however, it will only be ready to produce for the local market in January 2008.

About 80,000 of the estimated 250,000 HIV-positive Ugandans who need ARVs have access to them at present. Health workers have, in the past, cited the high cost of imported drugs and the country's poor health infrastructure as the main reasons hampering ARV rollout.

"The project offers Uganda a regular and cheap supply of medication - our target is that everybody who requires ARVs will be getting them," Emmanuel Katongole, managing director of Quality Chemicals, said at the launch. "The ARV ingredients will be imported from India [and] the ARVs will be distributed in private hospitals, dispensaries and pharmacies; the cost of the drugs will be $15 per month.

"Two million tablets will be manufactured per day per shift [and] 600 million tablets will be produced per annum. Future targets are 1.2 billion tablets if the plant is fully utilised," he added. "Some of the tablets will be exported to the East African Community countries [Burundi, Kenya, Rwanda and Tanzania], the Democratic Republic of Congo and Sudan."

The inauguration of the plant is seen as a further step in Uganda's fight against HIV/AIDS, for which the government has received accolades in the past. Museveni's aggressive stance against the pandemic in the 1980s and 1990s saw a decline in prevalence from a high of more than 20 percent to 6.4 percent now.

However, chinks remain in the country's anti-AIDS campaign; three health ministers lost their jobs in 2006 following allegations of misappropriation of grants from the Global Fund to Fight AIDS, Tuberculosis and Malaria, and most recently, the government has been criticised for allowing ARVs worth almost $1 million to expire in its national stores.

Improving the supply chain

Analysts say the government must fill gaps in the supply chain if the new factory is to make any impact on ARV rollout across the country.

Health ministry officials say that for outlets to qualify to distribute ARVs, they must be accredited to administer the drugs and must meet other minimum requirements such as the presence of a laboratory, a trained doctor and a counsellor.

"These things take long to put up and the ARVs have a short shelf life of between 18 to 24 months, so by the time these are put in place, some of the drugs had lost some of their lifespan and some expired," explained Uganda National Medical Stores David Bagonza.

The director-general of health services, Sam Zaramba, said recently the government was working on harmonising the entry and exit of drugs into the stores, which would involve quantifying the country's needs at regular intervals. The government is also improving the standard of health centres across the country so more are able to handle ARV distribution.

Other African nations manufacturing ARVs are Egypt, Nigeria and South Africa; Mozambique also plans to start producing the life-prolonging medication.