British Columbians with HIV have less access to an injectable drug compared to patients elsewhere in the country who can get a shot every two months instead of taking a daily pill, says an infectious diseases specialist.
Dr. Brian Conway questioned why the BC Centre for Excellence in HIV/AIDS, and not the prescribing health practitioner, decides who qualifies for the extended-release injectable drug called Cabenuva.
The centreprocures, distributes and monitors HIV medications in B.C., and also reviews applications from prescribers, unlike in other provinces without such a centralized system.
Conway said the centre declined approval of Cabenuva for all 15 patients he has applied for since the spring. Six of the applicants were rejected simply because they were deemed to be responding well to the drug in a pill form, he added.
“It’s a long process to apply, which in my case has led to zero approvals,” Conway said of the drug that he believes should be prescribed based on discussions between care providers and patients, without “unnecessary” oversight.
“Instead of it just being a regular prescription as it is for all the other HIV medications we have, it’s a 25-question questionnaire and supporting documentation.”
A spokesman for the centre said it has received 39 applications for Cabenuva since last year and 15 of them have been approved while 11 are still pending and 13 were withdrawn or have not been processed for other reasons.
Patients could be denied the injectable for various reasons, including not being able to tolerate one or both of the drugs it contains or having adverse reactions to them, the centre said.
Dr. Julio Montaner, the centre’s executive director, was not available to provide details about the decision-making process.
Conway said 10 of his approximately 500 patients with HIV are taking Cabenuva because they got it in a clinical trial and continued takingitbefore Canada became the first country to approve the long-lasting treatment three years ago.
There are many benefits to the injectable versus a daily pill and patients should have the option without a third party making that decision, he said.
“Some people just don’t want to be reminded every day that they have HIV. They’re afraid people will find their pills,” he said.
Cabenuva is a combination of the drugs cabotegravir and rilpivirine for patients aged 12 and older. Studies have shown it is as effective as oral therapy in treating thevirus that can be transmitted through sexual contact, by sharing drug-injection equipment and to children during pregnancy, delivery and breastfeeding.
The injectable HIV drug is considered a breakthrough in the evolution of medicines for patients with the virus who once had to take multiple daily pills, often with debilitating, visible side effects such as loss of fat and muscle and sunken cheeks.
The BC Centre for Excellence in HIV/AIDS spokesman said the organization has had an administrative role in dealing with HIV medications since the 1990s, based on a decision by the province, which provides funding.
He said in an email that “this is different from other jurisdictions across the country and elsewhere.”
Conway said the centre has cited lack of staff to provide the injection at a doctor’s office or clinic, which must also be equipped with a fridge to store the medication. However, many offices, including his own, have a fridge and administering the shot would not be different from many other types of injections, he added.
The B.C. Health Ministry did not respond to questions about why patients do not have direct access to Cabenuva with a prescription from their doctor. It said the centre establishes guidelines for health-care providers to be involved in prescribing and monitoring of all antiretroviral drugs.
Sarah Chown, executive director of AIDS Vancouver, said members whose applications for Cabenuva have been rejected do not understand why that decision was made by an organization whose decision makers had not met them.
She said applicants who would rather get a shot every couple of months are required to provide a letter describing why they are unable to take a pill every day.
“We don’t believe that patients should have to prove they are unable to continue oral medications in order to access the freedom and the privacy and the flexibility that comes with long-acting treatment,” she said.
“We’re curious and frustrated that here in B.C. people are still getting rejected, especially because we know that some of those folks would be approved in other provinces.”
The Ontario Ministry of Health said any HIV patient whose doctor has prescribed Cabenuva can get it at a pharmacy, the same as any other medication.
“There is no requirement to apply for case-by-case approval,” it said. “As such, there is also no application process or denial.”
Dr. Jonathan Angel, director of the HIV clinic at The Ottawa Hospital, said the prescribing of Cabenuva is an inexplicably “complex” issue for patients in B.C.
“They’re the ones that haven’t had a loud enough or strong enough voice to get these drugs in B.C.,” he said.
Angel, who has prescribed Cabenuva to 127 patients since 2020, said some patients would rather continue taking a daily pill because they don’t like injections but the choice should be theirs.
The cost of Cabenuva is believed to be similar to the most common daily HIV medication, called Biktarvy, so that should not be a factor in not approving it for patients in B.C., he said.
Individual provinces negotiate prices on some medications directly with drug companies, and those costs are confidential.
This report by The Canadian Press was first published Nov. 12, 2023.
Canadian Press health coverage receives support through a partnership with the Canadian Medical Association. CP is solely responsible for this content.
The Canadian government says it will donate up to 200,000 vaccine doses to fight the mpox outbreak in Congo and other African countries.
It says the donated doses of Imvamune will come from Canada’s existing supply and will not affect the country’s preparedness for mpox cases in this country.
Minister of Health Mark Holland says the donation “will help to protect those in the most affected regions of Africa and will help prevent further spread of the virus.”
Dr. Madhukar Pai, Canada research chair in epidemiology and global health, says although the donation is welcome, it is a very small portion of the estimated 10 million vaccine doses needed to control the outbreak.
Vaccine donations from wealthier countries have only recently started arriving in Africa, almost a month after the World Health Organization declared the mpox outbreak a public health emergency of international concern.
A few days after the declaration in August, Global Affairs Canada announced a contribution of $1 million for mpox surveillance, diagnostic tools, research and community awareness in Africa.
On Thursday, the Africa Centres for Disease Control and Prevention said mpox is still on the rise and that testing rates are “insufficient” across the continent.
Jason Kindrachuk, Canada research chair in emerging viruses at the University of Manitoba, said donating vaccines, in addition to supporting surveillance and diagnostic tests, is “massively important.”
But Kindrachuk, who has worked on the ground in Congo during the epidemic, also said that the international response to the mpox outbreak is “better late than never (but) better never late.”
“It would have been fantastic for us globally to not be in this position by having provided doses a much, much longer time prior than when we are,” he said, noting that the outbreak of clade I mpox in Congo started in early 2023.
Clade II mpox, endemic in regions of West Africa, came to the world’s attention even earlier — in 2022 — as that strain of virus spread to other countries, including Canada.
Two doses are recommended for mpox vaccination, so the donation may only benefit 100,000 people, Pai said.
Pai questioned whether Canada is contributing enough, as the federal government hasn’t said what percentage of its mpox vaccine stockpile it is donating.
“Small donations are simply not going to help end this crisis. We need to show greater solidarity and support,” he said in an email.
“That is the biggest lesson from the COVID-19 pandemic — our collective safety is tied with that of other nations.”
This report by The Canadian Press was first published Sept. 13, 2024.
Canadian Press health coverage receives support through a partnership with the Canadian Medical Association. CP is solely responsible for this content.
HALIFAX – The Nova Scotia government says it could be months before it reveals how many people are on the wait-list for a family doctor.
The head of the province’s health authority told reporters Wednesday that the government won’t release updated data until the 160,000 people who were on the wait-list in June are contacted to verify whether they still need primary care.
Karen Oldfield said Nova Scotia Health is working on validating the primary care wait-list data before posting new numbers, and that work may take a matter of months. The most recent public wait-list figures are from June 1, when 160,234 people, or about 16 per cent of the population, were on it.
“It’s going to take time to make 160,000 calls,” Oldfield said. “We are not talking weeks, we are talking months.”
The interim CEO and president of Nova Scotia Health said people on the list are being asked where they live, whether they still need a family doctor, and to give an update on their health.
A spokesperson with the province’s Health Department says the government and its health authority are “working hard” to turn the wait-list registry into a useful tool, adding that the data will be shared once it is validated.
Nova Scotia’s NDP are calling on Premier Tim Houston to immediately release statistics on how many people are looking for a family doctor. On Tuesday, the NDP introduced a bill that would require the health minister to make the number public every month.
“It is unacceptable for the list to be more than three months out of date,” NDP Leader Claudia Chender said Tuesday.
Chender said releasing this data regularly is vital so Nova Scotians can track the government’s progress on its main 2021 campaign promise: fixing health care.
The number of people in need of a family doctor has more than doubled between the 2021 summer election campaign and June 2024. Since September 2021 about 300 doctors have been added to the provincial health system, the Health Department said.
“We’ll know if Tim Houston is keeping his 2021 election promise to fix health care when Nova Scotians are attached to primary care,” Chender said.
This report by The Canadian Press was first published Sept. 11, 2024.
ST. JOHN’S, N.L. – Newfoundland and Labrador‘s chief medical officer is monitoring the rise of whooping cough infections across the province as cases of the highly contagious disease continue to grow across Canada.
Dr. Janice Fitzgerald says that so far this year, the province has recorded 230 confirmed cases of the vaccine-preventable respiratory tract infection, also known as pertussis.
Late last month, Quebec reported more than 11,000 cases during the same time period, while Ontario counted 470 cases, well above the five-year average of 98. In Quebec, the majority of patients are between the ages of 10 and 14.
Meanwhile, New Brunswick has declared a whooping cough outbreak across the province. A total of 141 cases were reported by last month, exceeding the five-year average of 34.
The disease can lead to severe complications among vulnerable populations including infants, who are at the highest risk of suffering from complications like pneumonia and seizures. Symptoms may start with a runny nose, mild fever and cough, then progress to severe coughing accompanied by a distinctive “whooping” sound during inhalation.
“The public, especially pregnant people and those in close contact with infants, are encouraged to be aware of symptoms related to pertussis and to ensure vaccinations are up to date,” Newfoundland and Labrador’s Health Department said in a statement.
Whooping cough can be treated with antibiotics, but vaccination is the most effective way to control the spread of the disease. As a result, the province has expanded immunization efforts this school year. While booster doses are already offered in Grade 9, the vaccine is now being offered to Grade 8 students as well.
Public health officials say whooping cough is a cyclical disease that increases every two to five or six years.
Meanwhile, New Brunswick’s acting chief medical officer of health expects the current case count to get worse before tapering off.
A rise in whooping cough cases has also been reported in the United States and elsewhere. The Pan American Health Organization issued an alert in July encouraging countries to ramp up their surveillance and vaccination coverage.
This report by The Canadian Press was first published Sept. 10, 2024.
