WHO declares HIV outbreak in Larkana as emergency

KARACHI: Declaring HIV outbreak in Ratodero, Larkana as a “Grade 2 Emergency”, World Health Organization (WHO) has said the depleting stocks of the critical Antiretroviral Therapy (ART/ARV) medicines has emerged as the major challenge for Pakistan where the current stock of the ARVs is only sufficient to meet the needs of 240 children till 15th July 2019.

“The major challenge is the inadequate stocks of ARVs in the country. The current stocks can only meet the need of 240 children till July 15th, 2019, of which 231 are already getting treatment which means that only 9 additional children can be enrolled on treatment,” says a WHO Situation Report titled “Pakistan: HIV Outbreak in Larkana District Sindh”, released on June 03, 2019.

Demanding immediate availability of ART medicines for the 751 HIV positive people (now 761 as of June 08, 2019), the WHO Situation Report says there is an urgent need of Anti-Retro Viral medicines, Rapid HIV Diagnostic Kits (RDTs), medicines for treatment of co-infections, human resource and training for health workers, provision of psychosocial support and training health workers and strengthening of Infection Prevention and Control at health facilities. Compiled by a Rapid Response Team comprising international epidemiologists, public health experts, infection control specialists who flew to Pakistan from different countries on the request of Federal Ministry of National Health Services, the WHO Situation report says 26,041 people were screened for HIV in Ratodaro Taluka, district Larakana, Sindh. “Around 751 (2.9%) of the people were tested positive for HIV including 604 children, 135 adults while age of 12 was unknown. As many as 531 (70%) are linked to ART centre including 443 children and 94 adults. Only 324 (43.1%) are receiving Anti-Retroviral Treatment at the moment”, the WHO Situation Report says.

The WHO Situation Report says it requires US$ 1.5 million or Rs. 225 million to deal with the health emergency in Ratodero Taluka of Larkana but only US$ 200,000 is available through CFE exposing a shortfall of around US$ 1.3 million or Rs. 195 million in funding. The Global Fund to Fight Aids, Tuberculosis and Malaria has pledged to provide Anti-Retro Viral medicines for the newly-diagnosed HIV positive people but also urged the government of Pakistan start an indigenous plan to provide ARTs/ARVs to cover for their lifelong treatment. It says on Pakistan's request, the WHO constituted an ‘Incident Management Team’ to respond to HIV outbreak in district Larkana, Sindh, helped local authorities in HIV data cleaning and analysis and donated 5 IEHK kits to the district of Larkana for managing opportunistic infections. The international team is investigating the reasons for the outbreak and would make its preliminary report in mid-June 2019, the situation report says.

Expressing dissatisfaction over the standard of screening, the WHO says in some screening camps in Larkana district, WHO recommended standards for testing are not being implemented due to unavailability of recommended test kits, saying the current WHO guidelines on HIV treatment recommends test and treatment strategy. The WHO team urged the provincial health authorities to introduce systematic screening of HIV in the affected areas, conduct awareness and health education sessions in communities about HIV/AIDs targeting at risk groups, linking HIV confirmed cases with available treatment sites and train health workers on management of pediatric cases. Similarly, the WHO calls for immediate procurement and provision of RDTs and ARVs and international support for provision of HIV services targeting the risk groups.