The Minister of Health, Dr Aaron Motsoaledi, announced in
December last year that the department of health will be rolling-out a Fixed
Dose Combination (FDC) antiretroviral pill that combines three drugs into one.
With this FDC many patients will only take one pill, once a day. This one pill
contains the individual medicines Efavirenz (EFV), Tenofovir (TDF) and
The Treatment Action Campaign (TAC) and the National
Association of People Living with HIV/Aids (NAPWA) welcome the introduction of
this FDC into the public health sector. If introduced properly, this will
benefit both patients and health care workers.
Benefits to patients
The FDC will also benefit health care workers because it will make it easier for them to place orders, store and dispense the medication.
- Reduced pill burden – taking one pill is
considerably better that taking up to three to five pills a day. This will be
even more beneficial to patients who have co-infections and those who have
other chronic illnesses.
- May improve treatment adherence – it is easier
to remember to take one pill once a day than it is to remember to take multiple
pills at least twice a day.
The Department announced that the roll-out will be phased in according to priority groups.
- Priority group 1 includes all new patients
starting ARVs for the first time
- Priority group 2 includes HIV-positive pregnant
women and breastfeeding mothers currently stable on 3TC, TDF and EFV
- Priority group 3 includes patients that are
currently on a Stavudine (d4T)-based regime
- Priority group 4 includes stable patients
receiving individual 3TC, TDF and EFV and who have tuberculosis (TB)
co-infection (except drug resistant TB).
- Priority group 5 includes stable patients
receiving individual 3TC, TDF and EFV and who have other co-morbidities (e.g.
- Priority group 6 includes patients receiving
individual 3TC, TDF and EFV and who request to switch to the FDC treatment
- Priority group 7 includes patients receiving
individual 3TC, TDF and EFV and who, after counselling, agree to switch to the
Not all patients will be eligible for the FDC. First line
patients for whom Tenofovir or Efavirenz is not indicated will not be able to
take the FDC. Patients receiving second line treatment are also not eligible
for the FDC.
TAC and NAPWA have some concerns with the way FDCs are being
Communication with patients about the timing of the various
phases of the rollout has been poor. Public announcements created the
expectation that the pills will be widely available from April 1, but
non-priority groups might have to wait many more months before being switched
to the FDCs. Patients have not been given any indication as to when the various
phases will be initiated and how long they will have to wait.
The National Department of Health must provide clear
timelines for the introduction of FDCs. In addition, messages from the National
Department of Health should be supplemented with more locally specific messages
from provincial departments of health to avoid confusion and unmet
The TAC has received reports that some health facilities
have received only between 10 and 28 bottles of these pills. These are low
numbers and raises serious questions about whether all who are eligible will be
able to receive the FDC pills, particularly those in the first two priority
In addition, the TAC continues to receive reports of
medicine shortages in health facilities, most notably from Gauteng and
Mpumalanga. Whereas FDCs should make stock and supply-line management easier,
it will not solve the much more fundamental management problems that are
plaguing these two provinces in particular.
The TAC and NAPWA will continue to monitor the roll out of
the FDC and the availability of this and other medicines in public health
For more information and for more information please
Simonia Mashangoane- Treatment Action Campaign: 083 285 3846
Mluleki Zazini – NAPWA: 072 126 6666