New Analysis From 14 Countries Identifies Drug Access Priorities to Achieve 2010 AIDS Treatment Target
Dr. Jim Kim joins teleconference to release report with ITPC. Kim says foundations laid by AIDS response are "the best chance we've ever had to build comprehensive health systems in the poorest settings."
New York and Cape Town -- The International Treatment Preparedness Coalition (ITPC), a group of 1,000 treatment activists from more than 125 countries, today issued its fifth report on scale up of AIDS services: Missing the Target #5: Improving AIDS Drug Access and Advancing Health Care for All. The report is available at www.aidstreatmentaccess.org.
The comprehensive report investigates AIDS drug access in 14 countries and finds that scale up is working but high prices, patent and registration barriers, and ongoing stock-outs are core issues impeding better and faster AIDS drug delivery.
"The foundations to make the 2010 target are in place in many countries. If governments, global agencies, and drug companies focus on tactically improving AIDS drug access by continually lowering costs, ending patent and regulatory problems, and fixing drug availability logistics, while simultaneously strengthening health systems, there is real possibility for making the 'near universal access' target by 2010" said Gregg Gonsalves, a coordinator of the project.
Missing the Target teams in nine countries -- Cambodia, Cameroon, China, Dominican Republic, India, Kenya, Russia, Zambia, and Zimbabwe -- also looked at broader issues in AIDS service delivery in their countries. "AIDS treatment scale up cannot succeed without stronger health systems, adequate nutrition, and concerted action against stigma and marginalization," said Matilda Moyo of the Zimbabwe research team.
"Mobilization around AIDS has opened up fantastic new possibilities in health service delivery by infusing new resources, intensifying the engagement of people living with HIV/AIDS, and focusing on specific, measurable outcomes," said Dr. Jim Yong Kim, Director of the François-Xavier Bagnoud Center for Health and Human Rights (FXB) at Harvard University. "We must learn from and build on these foundations because they represent the best chance we've ever had to build comprehensive health systems in the poorest settings."
"It is irresponsible to get bogged down in debates on simplistic dichotomies like prevention versus treatment or disease-specific funding versus strong health systems. We can, and we must, do all of this, better, for more people, and in an increasingly coherent way," added Chris Collins, a coordinator of the project.
"The UNAIDS epidemiologic estimates released last week show that we're getting closer to reaching the goal of treatment for all," said Shona Schonning of the Russia research team. "The UNAIDS report shows that prevention and treatment programming have had impact. Now its time to scale up these programs and continue to make progress on what remains a devastating epidemic."
In the report, civil society advocates in 14 countries identify specific problems and recommend solutions to improve AIDS drug access:
- In Argentina, high cost and restrictions on some drugs impede access to some second line and other medicines.
- In Belize, human resources shortfalls, price increases and inadequate quality assurance hamper drug delivery.
- In Cambodia, expanded access to drug resistance and viral load testing is needed, as is increased attention to drug quality.
- In China, access to second-line therapy is extremely limited, new WHO treatment guidelines on improved first-line treatment have not been widely implemented and patents on key medicines are preventing cost-cutting generic competition.
- In the Dominican Republic, new intellectual property laws and patent enforcement by Merck are leading to higher prices and limited access to some key drugs.
- In India, drug stock-outs are reported across the country, particularly where IDUs require treatment regimens that are not hepatotoxic.
- In Malawi, a chronic shortage of health care workers is a major impediment to drug access; while ARV stock-outs are rare, other important drugs are often unavailable.
- In Morocco, new intellectual property laws threaten the provision of AIDS treatment.
- In Nigeria, despite a rapid scale up of ARV treatment and a free treatment policy, treatment sites are not easily accessible in many parts of the country, and CD4 and other tests are still being offered at a fee in several locations.
- In the Philippines, treatment is not yet accessible to all, there is a healthcare worker shortage and diagnostic testing access is limited.
- In Russia, ARV stock-outs are a severe and ongoing problem.
- In Uganda, stock-outs are commonplace, and limited support and care services undermine drug access.
- In Zambia, there is concern that AIDS drug access depends on the work of NGOs and the government is not sufficiently engaged.
- In Zimbabwe, stock-outs are frequent and the increasingly unfriendly general policy environment remains a cause for concern.
Action Recommendations for Global Agencies and National Governments
- The World Health Organization: Take the lead to educate countries about changes to standard first- and second-line treatment regimens and lead global efforts to simultaneously expand AIDS services while strengthening broader care systems.
- United Nations technical agencies: Clearly and publicly communicate changes in WHO ARV drug guidelines and provide technical support and guidance to countries to help implement the changes.
- The Global Fund: Proactively support grantees in identifying and correcting procurement bottlenecks and strengthening national procurement systems for ARVs and other medicines and ensure grantees are procuring medicines at preferential prices.
- Bilateral programs (PEPFAR, etc.): Work with national treatment programs, community organizations, PLWHA and other partners to support national efforts to switch to optimized first-line treatment.
- UNITAID (the international drug purchase facility): Work aggressively to support initiatives to increase competition and further reduce the price of new standardized treatment regimens.
- Drug companies: Act with enlightened self-interest to expand access to products by registering them much more expeditiously and stop intimidating countries that use flexibilities in trade law.
- National governments: Build local and regional drug regulatory capacity, make fuller use of the WHO drug prequalification process, and use flexibilities in international trade rules to secure the lowest possible drug prices.