Question to the Department for International Development:

To ask the Secretary of State for International Development, what assessment she has made of the use of expired anti-retroviral (ARV) HIV medication in (a) Zimbabwe and (b) other African countries; and what steps her Department is taking to ensure that flows of in-date ARVs are maintained to tackle HIV during the covid-19 pandemic.

DFID Zimbabwe does not bilaterally fund the procurement of ARVs in Zimbabwe. The Global Fund – to which the UK is the second largest donor – does however provide support for the procurement of ARVs in Zimbabwe. In June 2019, concerns were raised over the distribution of expired ARVs, procured through the Global Fund. At the time of procurement, the ARVs expiry date was approaching but ARVS were urgently needed as there was a risk of stocks in country. Assurances were provided by the Manufacturer and the Medical Council Association of Zimbabwe (MCAZ) that the medicines were safe and effective before they were distributed.

DFID’s central teams work closely with the Global Fund to ensure they are actively monitoring supply chain issues at a global level and engage closely with partners. Global Fund Partners are supported in implementing good practices including safeguarding against purchase and use of expired drugs.

The COVID-19 outbreak presents a risk to the ongoing supply and distribution of ARVs. The majority of ARV procurement and distribution in Zimbabwe is funded by PEPFAR and USAID have taken several steps to ensure that patients continue to receive their prescriptions such as providing monthly rather than weekly prescriptions, so patients do not have to visit clinics so frequently. The Global Fund is also flexing to cope with the crisis. It has created up to $1 billion of flexible funding opportunities for countries to re-programme existing grants and apply for additional funding, including in Zimbabwe. This will support countries with their direct COVID-19 response, address critical gaps in health systems, and to adapt their HIV, TB, and malaria programmes, including if needed to reinforce in-country ARV supply chain management.