Missing the Target #5: Improving AIDS Drug Access ... - CD8 T cells

RussiaBy Shona Schonning, Smiljka de Lussigny,and Sergey KovalevskyPharmaceutical managementIn Russia, approximately 30,000 PLWHA are receiving antiretroviral drugs accordingto the Ministry of Health (MoH). This is around 40% of the 70,000 people that theMoH estimates are in need of treatment and is more than 10 times higher thanthe number receiving ARV only 4 years ago. While considerable progress has beenmade in Russia’s effort to scale up access to ARVs, a variety of problems related toregistration, procurement, supply chain management, and drug quality, in additionto multiple problems related to developing adequate services for PLWHA, haveslowed progress and, in some cases, endangered lives.Registration and procurementBefore drugs are purchased in Russia, they must be included in the national registry.But numerous cases of long-term hold-ups in the registration process have beenreported. For some drugs, the process takes only a couple of months, while forothers it takes years. Clear reasons for the delays are not given and corruption issuspected.Drug purchases are arranged through a centralized tender. This is a greatimprovement over the past when drugs were purchased in separate tenders byRussia’s 86 regions, leaving great room for corruption and price manipulation. Newproblems have arisen, however. Although a computerized system for tracking drugrequirements at the country’s AIDS Centers has been developed, through whichAIDS Centers enter the quantities of drugs they require, the Federal standard on thequantities of drugs that should be ordered is often not followed. According to oneauthority interviewed, the training of AIDS Center personnel on quantities of drugsto be ordered has been inadequate. This has resulted in overstocking some drugsand stock-out of others.The tender process in Russia has also been problematic. In 2006, a central tenderfailed to lead to contracts for the purchase of drugs and resulted in stock-outsthroughout the country. In 2006, corruption is suspected as the cause of a situationthat nearly led to the purchase of the very expensive drug, darunavir, in quantitiesinappropriate given the treatment experience of Russian PLWHA. This purchase wasaverted though, as civil society activists rallied to stop the tender. The unreasonablequantities were included in a governmental standard that contradicted existing94