BONDO, 17 May 2010 (PlusNews) - Maria Obonyo walked 70km from her home to the nearest hospital in western Kenya's Bondo District to seek treatment for an uncomfortable rash but could not afford the US$2 for the ointment the doctor recommended.

"I know I need the drug, but I can't buy it now," Obonyo told IRIN/PlusNews. "The money I have is just enough to buy porridge to give me energy to walk [back home]."

When she can afford it, Obonyo, who has been living with HIV for five years, uses public transport to come for her monthly check-up and a refill of her life-prolonging antiretroviral (ARV) prescription; a one-way trip from her home to the hospital costs a little under a dollar.

"I will just go back home and wait for them [the rashes] to disappear on their own," she said.

The Kenyan government provides free antiretroviral treatment (ART) to more than 300,000 Kenyans and free diagnosis and treatment of TB, which has significantly lightened the financial load of people living with HIV, but for many, the cost of treating opportunistic infections and journeying to and from distant health centres is crippling.

About half the Kenyan population gets by on less than $1 a day; in Bondo, with an HIV prevalence of more than 13 percent, an estimated 41 percent live on less than $1 a day.

Eroding gains

"I think more than 90 percent of the ART patients who come here cannot afford drugs when they are prescribed," said Beatrice Kunya, a nurse at Bondo District Hospital. "Some tell you they have not eaten for some time.

"Those who struggle to buy the drugs might be spending the last coin; it means they have the drug but will walk back home on an empty stomach," she added. "In fact many of these patients decide not to come to the hospital because they know even if the disease is diagnosed, they will not afford the drug, or at times, they are unable to afford even the fees for diagnosis."

"When people cannot afford treatment for opportunistic infections, it erodes the gains already made in giving them free antiretrovirals," said James Kamau, coordinator of the Kenya Treatment Access Movement. "Those opportunistic infections that afflict them must also be treated."

Increase healthcare, reduce costs

According to Daniel Umaya, a community health worker with the Interdiocesan Christian Community Services, home-based care visits can reduce the need for hospital visits by patients and in turn reduce costs; however, he noted that the capacity of lay community workers was often limited.

"As a community health worker you can only visit and recommend referral; our health expertise is limited so they still have to go there [to hospital] physically," he said. "If the government can employ more health workers who can go to homes, then it can work in terms of reducing cost."

A recent study by the International Treatment Preparedness Coalition (ITPC) found that lack of access to adequate nutrition and the personal financial burden of those on treatment made it difficult for many to obtain necessary care.

"Poor patients should be reimbursed for transport costs incurred to travel to and from facilities," the authors recommended. "The Ministry of Public Health and Sanitation should also increase access to treatment services by providing ART services at the health centres, since these facilities are located in rural areas where more ART facilities are needed."

A 2009 study in Cote d'Ivoire found that providing meals, eliminating charges for opportunistic infection-related drugs and reimbursing transport costs significantly improved survival rates and the ability of HIV programmes in resource-limited settings to retain patients.

The ITPC study further recommended that the National Health Insurance Scheme cover all the costs of inpatient health services as part of its standard package for people living with HIV, which would include all medicines to treat opportunistic infections and side-effects.

Funding woes

While the Kenya National AIDS Strategic Plan 2010/13 aims to provide universal access to HIV treatment, including treatment of opportunistic infections, the Kenyan government is unlikely to achieve this because of a financing gap.

The country is dealing with flat-lined funding from the US President's Emergency Plan for Aids Relief and two consecutive rejections by the Global Fund to Fight AIDS, Tuberculosis and Malaria. According to the government, Kenya will have a shortfall of about $1.7 billion for HIV prevention, treatment and care by 2013.

"We are trying to bring [health] facilities as near to people as possible... but we are dragged [down] by inadequate funding and many other competing priorities," said Nicholas Muraguri, head of the National AIDS and Sexually transmitted infections Control Programme.

Source http://www.irinnews.org