Assessing the Management of Treatment - HIV and AIDS

Press Release - Performance Audit report

Assessing the efficiency of the management of treatment for people living with HIV and AIDS

The Auditor General has laid before the National Assembly his performance audit report on the efficiency of the management of treatment for people living with HIV and AIDS on Tuesday 3rd December, 2013.

The Ministry of Health has been in the forefront in the national response to HIV and AIDS fight ever since the first HIV case was detected in 1987. Since the introduction of HIV testing in 1987, a cumulative of 542 (311 males and 231 females) HIV and AIDS cases have been detected as at March 2013.

Through its various health centres, the Ministry of Health offers a holistic approach to the services available for HIV and AIDS patients, which includes counselling, treatment and monitoring. These services are provided free of charge. In 2001, Highly Active Antiretroviral Therapy (HAART) was introduced for free in Seychelles and many HIV-infected individuals have accessed treatment. As at March 2013, the number of individuals on HAART stood at 190 (103 males and 87 females).

The Communicable Diseases Control Unit (CDCU) has the responsibility of prescribing a combination of drugs needed depending on the patient’s viral load. Following interviews with health officials at the CDCU and review of statistics published by the Disease Surveillance and Response Unit (DSRU), we found that many individuals were not adhering to treatment. A cumulative of 24 drop-out cases on HAART was reported by the end of 2012. For the first quarter of 2013, there was an additional 13 drop-out cases on HAART reported, totalling to 37 drop-out cases on HAART by the end of March 2013. Similarly, the number of new AIDS cases and the number of AIDS-related deaths have also increased, of which 60 per cent of the new AIDS cases reported for the first quarter of 2013 were known HIV individuals who had not maintained their treatment over the years. Furthermore, a 500 per cent increase in new AIDS cases and a 50 per cent increase in AIDS related deaths were recorded from January to March 2013, as compared to January to March 2012.

The Ministry of Health conducts various sensitisation campaigns on the dangers and prevention of HIV, AIDS, STIs and Hepatitis C to different groups of the population. However, it was found that the Ministry was lacking in activities relating specifically to the adherence of treatment in respect of HIV and AIDS.

The increase in the number of drop-out cases as stated above results in the Ministry of Health having to procure new combinations of HAART, as the previous combination would be ineffective. It should be noted that combinations of HAART are not infinite, and without treatment, the patient would progress to the AIDS stage and consequently, death. This also results in higher costs for the Government to constantly have to procure new combinations of HAART. Since the introduction of HAART in 2001, there has been a gradual decline in AIDS-related mortality compared to the previous years.

As part of the treatment for people living with HIV and AIDS, follow ups should be conducted by the CDCU every three to six months, depending on each individual’s case, whereby numerous tests are performed, including viral load tests. The viral load test monitors the level of virus in a HIV-infected individual on treatment over time. To perform this test, a viral load machine is required. Despite the significance of the viral load machine, it was found that the viral load Cobas Amplicor machine was not operational from September 2012 until May 2013. It was revealed that the machine was not operational, as the reagent needed for the machine was no longer being produced by the supplier. This indicates that there was no proper planning by the Ministry of Health to determine that the reagent for the old machine was no longer being manufactured, and that a new machine would have to be procured, in spite of the Ministry of Health having been informed by the supplier that the reagent would no longer be in production.

Notes to the Editor:

1. Press notices and reports are available from the date of publication on the Auditor General’s website www.oag.sc
2. The Auditor General, Mr. Marc Benstrong, heads the Office of the Auditor General employing some 37 staff. The Office performs the external audit function of public funds on behalf of the National Assembly. The Constitution and the Audit Act provide a broad framework for the role and responsibilities of the Auditor General. The Office is independent of the executive arm of the government. The independence of the Auditor General entrenched in the Constitution is a vital factor in the value and credibility that the public can place on the Office’s work.
3. The purpose of the Office of the Auditor General is not just to identify and report upon shortcomings but also to assist and advise managers throughout the government on how to improve financial performance and ensure good governance. Both the financial and performance audits being undertaken by the Office are geared towards promoting value for money, transparency and accountability within the government.

Press Notice: 11/2013

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