KUALA LUMPUR, March 12 — People living with HIV (PLHIV) have complained about a shortage of lifesaving HIV drugs in government health clinics and hospitals for some four months, with smaller supplies necessitating more frequent visits.
The HIV drugs concerned include the antiretroviral therapy (ART) standard treatment, HAART (highly active antiretroviral therapy) – specifically Efamat (efavirenz) 600mg tablets and Tenof-EM (emtricitabine/ tenofovir disoproxil fumarate) 200mg/300mg tablets.
Tenof-EM is a generic combination drug, produced by India’s Hetero Healthcare Ltd, of the branded Truvada that is also used as pre-exposure prophylaxis (PrEP) to prevent HIV. Efamat is another generic produced by India’s Mylan Laboratories Limited (brand names Sustiva and Stocrin).
The Malaysian AIDS Council (MAC) said it was aware of recent issues with the supply of HAART, adding that its community health workers in klinik kesihatan are assisting patients “during this challenging” time to ensure ongoing availability of their HAART medication.
“We have received information from our Ministry of Health (MOH) colleagues indicating that the stock gap issue is temporary and expected to be resolved by the end of this month,” MAC said in a brief statement to CodeBlue yesterday.
HAART, the standard ART treatment, consists of a combination of drugs that suppress replication of the HIV virus. Besides reducing mortality and morbidity rates among HIV-infected people by preventing them from getting AIDS, ART also prevents HIV transmission by suppressing HIV replication in PLHIV, illustrated by the U=U (undetectable equal untransmittable) concept.
A PLHIV, who has been receiving HAART from Klinik Kesihatan Salak in Sepang, Selangor, said the health clinic’s previous one-month supply of Efamat and Tenof-EM per visit was halved to two weeks’ supply from last December, and further cut to one week’s supply from last February.
“Coming to February, it became one-week supply and last week, they supplied again for a week, but changed to another generic (lower dose), of which we have to take three tablets to make it become 600mg,” Azam (pseudonym) told CodeBlue last February 27.
The medication that the patient was referring to was Efamat (efavirenz) 600mg tablets that was changed from a month’s supply to three 200mg tablets for a week’s supply. Dosage of Tenof-EM remained unchanged, but reduced to one week’s supply.
“My major concern is, of course it uses the same formula, but with the side effects that I’m currently coping with (gynecomastia – enlarged male breast), changing to other generics is like a reset for more possible side effects to us,” he said, referring to efavirenz.
MAC, however, maintained that the lower dosage of efavirenz was “not a problem; in fact, it has been recommended for reduced side effects while maintaining similar efficacy in suppressing the HIV virus.”
Azam said he has been taking half-day leave to get his HAART medication more frequently due to smaller supplies, costing him five days of leave already, as he can only visit Klinik Kesihatan Salak during business hours. It’s difficult for him to go during lunch hour because his workplace is in the city centre.
Another PLHIV who goes to Shah Alam Hospital in Selangor for HAART treatment – Efamat and Tenof-EM – told CodeBlue that supply of those drugs was halved from one month’s supply per visit to two weeks since last November.
Nazri (pseudonym), who has a retail job, said it was difficult for him to get his HIV medication because his working hours are generally from 10am to 8pm, with shifts sometimes extending till 10pm.
The MOH acknowledged a “temporary” supply shortage of the efavirenz 600mg tablet from December 2023 until February 2024 due to “problems with supply of raw material at the manufacturer level”, but did not mention Tenof-EM.
Measures to continue supply of the HIV medication to patients include providing an alternative-strength, efavirenz 200mg tablets, after the pharmacist consults the medical specialist, as well as redistribution of available stocks in MOH facilities.
“As of March 8th, 2024, the supply issue has since been resolved and stock levels of HAART medications through concession and central contract at the national level range from one to four months,” MOH told CodeBlue yesterday.
MOH’s statement to CodeBlue on having already resolved HIV drug supply issues slightly contradicts what MOH supposedly told MAC, as per MAC’s statement to CodeBlue, about projecting the shortage to be resolved by month end.
MOH also told CodeBlue that proactive steps are always taken to ensure that buffer stocks at its facilities are maintained at optimal levels, including budget allocation priority in the delivery of public health care services.
The ministry also sets maximum and minimum stock levels in inventory control to ensure that stock is maintained at optimum levels after considering usage patterns, supply duration to patients, stock delivery time by suppliers, and storage capacity.
MOH further conducts thorough monitoring of medicines involved in supply disruptions to identify the root causes early so that immediate action can be taken.
“Alternative sources and redistribution of stock among MOH facilities, including rural areas, will be undertaken in the event of disruptions to ensure the availability of medications throughout Malaysia.”
