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

treatment-naive patients in Europe is available in only one combination in Russia.Few generic ARV drugs are purchased in Russia and some of those that havebeen purchased are of questionable quality. The generic drug Stag (stavudine) iscommonly used as a first-line drug in Russia even though it failed to pass the WHOprequalification test and is no longer recommended for first-line use. Ritonavir to beused in the national program is produced by the Russian company, Makis-Pharma,and is made in Russia using substances produced by the Indian company Hetero,which have also not been prequalified by WHO. 1 In addition to risks involvedwith using non-prequalified drugs, as information about questionable quality andanecdotal stories about side-effects spread within the HIV-positive community,distrust for generic drugs grows, making activists less likely to push strongly for theuse of generics in Russia to reduce pharmaceutical prices.Another dangerous problem with the selection of drugs in Russia is that thenational narcotics policy does not allow for use of narcotics for addiction treatment.Therefore methadone and buprenorphine, which are included in the WHO ModelList of Essential Medicines, cannot be used for opioid substitution therapy. This hashad a disastrous effect on HIV prevention and treatment uptake and adherenceamong IDUs, who are those most affected by the epidemic.PricingRUSSIAMost of the drugs Russia purchases are brand name drugs. Comprehensive andcomparative analysis of the prices of ARVs in Russia has yet to be done. Russia’sgrowing economy led the World Bank to categorize Russia as an upper middleincome country in 2006, and pharmaceutical companies began to use this as anargument to sell drugs to Russia at elevated prices. Prices in Russia are estimatedto be ten times higher than in neighboring Ukraine, which has a comparableprevalence rate. High pharmaceutical prices are taking resources away fromprograms that could combat the many barriers blocking access to treatment inRussia. Throughout the country treatment uptake has been low, and even oncetreatment is initiated, Russia has an unusually high rate of drop-out from treatmentprograms (more than 10%). Considerable work and resources are still needed todevelop integrated treatment facilities, provide comprehensive social and treatmentliteracy services, and provide adequate addiction treatment and other services tosupport successful ARV treatment.1 From an analytical letter to the MoH by the NGO, the Community of PLHIV, on the recall ofViracept, alternative substitution, and the inclusion of atazanavir and darunavir in the list of drugs tobe purchased. July 20,2007.96