For years, patients across the island living with HIV travelled to Mater Dei pharmacy to get their treatment. Supply has always been an issue. Though patients were prescribed medication for three months, the pharmacy at Mater Dei often only dispensed a few weeks’ supply.
Just last December, HIV patients would have gone without medication for several days had NGOs not stepped in and crowdsourced medication from other patients.
The treatment prescribed was no longer recommended by international guidelines. This was all set to change and is changing. HIV clinicians are currently switching patients from old regimens to newer ones with fewer side effects, improving the quality of life of their patients.
This process started last January and it is understood that it will take around six months. Over 500 patients are living with HIV in Malta.
In a 2019 Request for Participation for the provision of service for the treatment of HIV-positive patients, the government was recruiting companies to “provide a holistic service related to this chronic condition with respect to continuous monitoring, follow-ups and education to support adherence – all in line with the protocols used within the HIV clinic.”
The Central Procurement & Supplies Unit (CPSU) within the Ministry for Health also sought to find bidders that “can offer the optimal service with respect to the HIV portfolio, considering drug-drug interactions, patient tolerability issues and also target poor adherence for better treatment.”
There were four bidders, AM Mangion Ltd, Associated Drug Company Ltd, Gera Ltd, and V.J. Salomone Pharma Ltd, and four awardees. How the winners will get involved with the HIV clinic in educating, monitoring and following-up patients remains a mystery.
HIV patients can no longer know for sure how their medical results are being used, whether they are being shared with wholesalers and the pharmaceutical companies they represent.
The awardees are now distributing medication in only a selected number of pharmacies (See map below). Patients living with HIV must now pick up their medication from any of these pharmacies, but not from any of the 19. Your selection is limited to selected pharmacies that stock the treatment you are on. Nineteen of these pharmacies are in Malta and none are in Gozo.
Not only must Gozo-residents living with HIV travel to Mater Dei to see their HIV specialist, but their closest pharmacy to pick up medication is in Mellieħa and only if the pharmacy in Mellieħa stocks your medication. This defies any sense of logic and counters what a fair and proper distribution of medication should be.
The 19 pharmacies were discussed and agreed to by the CPSU and the tenderers; stakeholders were not consulted, and clinicians have their hands tied by the list. Not being able to identify a single pharmacy in Gozo to offer such a service is utter lunacy and it is mind-boggling how the provision of HIV medication was not simply put under the Pharmacy Of Your Choice scheme.
The RFP also mentioned that existing patients will continue to be supplied their medication by the pharmacy at Mater Dei until they are switched to newer regimens. This is only true in so far as the supply of two particular drugs. All others have to be picked up from some of the private pharmacies from the 19 raising the question as to why the government has given up such responsibility.
It is also worth mentioning that the reference budget set was for €1,000,000 per year for five years. But a press release published on 12th December 2020 mentioned that the Government will be spending €3,000,000 a year on the newer treatments. Taxpayers expect to know why and how such a jump has been made.
The negotiated terms between the government and the tenderers have not been made available to the general public. I have, elsewhere, in the past questioned if the RFP was seeking to privatise the healthcare of people living with HIV. Patients living with HIV should be duly informed how this set-up is going to affect the healthcare services they are to receive.
Needless to say, Gozo-resident patients with HIV must have the same access to treatment as other patients on the islands.
Cover photo: Stock image
Mark Josef Rapa is an HIV and gay rights activist and a member of the Nationalist Party’s Equal Opportunities Forum. They have a degree in law and a Masters degree in Health Care Ethics and Law from the University of Manchester.
Lovin Malta is open to external contributions that are well-written and thought-provoking. If you would like your commentary to be featured as a guest post, please write to [email protected], add Guest Post in the subject line and attach a profile photo for us to use near your byline