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

More documents

Recommendations

Info

UGANDAExtracts from the MoH’s report on the supervision of ARV supply chain management(third quarter of 2007)DistrictSironkoButalejaKapchorwaNakapiripiritKumiAbimName offacilityBudadiriHC IVMayembeHC IVBusolweHospitalKapchorwaHospitalTokora HCIVAtutur HCIVAbimHospitalNumber ofpatients oncotrimoxazoleprophylaxisNumberof patientson firstlineARTMaximumcapacitythat can behandled atcenterDays outof stockin last sixmonths148 66 0–99 60 days1,650 32 100–199 30 days516 103 100–199 0298 51 100–199 15 days91 15 0–99 45 days1,434 408 300–399 0131 43 0–99 30 daysSource: Uganda MoHThe underlying cause of drug stock-outs has a lot to do with demand outstrippingsupply. As noted previously, the number of people currently on ART was less thanhalf of those estimated to be in need. The situation has been made worse by aninefficient procurement and distribution system, which on occasions has resultedin the expiry of ARVs in the national stores as well as at district levels. This hasoccurred even as ART centers reported stock-outs, and resulted in acknowledgementof the need to monitor third party–supplied ARVs.The stock-out problem has reached such critical levels that the National Forumof People Living with HIV/AIDS Networks in Uganda (NAFOPHANU) and theConsortium of Advocates for Access to Treatment (CAAT) led a public demonstrationand presented a petition to the MoH in August 2007, pleading for consistent andimproved supply of ARVs to all the accredited 212 ART centers across the country.1 Annual Health Sector Performance Report 2006/2007, October 200799
ZambiaBy Felix Mwanza and Paul KasonkomonaZambia has a standard first-line regimen composed of nevirapine (NVP) +lamivudine (3TC) + stavudine (d4T, 30mg). Efavirenz (EFV), zidovudine (AZT),and now Truvada (tenofovir/emtricitabine [TDF/FTC]) are also used. Second-lineregimens are mainly composed of Kaletra/Aluvia (lopinavir/ritonavir [LPV/r]);abacavir (ABC); Truvada (TDF/FTC); tenofovir (TDF); didanosine (ddI). There isno standard salvage therapy and most health care providers are not trained toadminister it.Zambia is somehow in a unique position especially when it comes to the purchasingof ARVs. The government does not purchase ARV drugs using locally mobilizedresources. ARVs are purchased through John Snow, Inc. (JSI), which procures ARVsin bulk on behalf of the MoH, Catholic Relief Services, the Center for InfectiousDisease Research in Zambia (CIDRZ), a PEPFAR program, and MSF; in short alldispensers of ARVs procure them through this process.The most commonly purchased ARVs and/or groupings are nevirapine (NVP),Combivir (lamivudine/zidovudine [3TC/AZT]), efavirenz (EFV), Kaletra (lopinavir/ritonavir [LPV/r]), abacavir (ABC), and didanosine (ddI).The drug registration process is mostly handled by the NGOs that dispense thedrugs, which causes concern that if these NGOs pull out, then problems can arise.The foreign NGOs that are in the forefront have their way of doing things andgovernment okays this process and is very reluctant to take ownership. Therefore,if an NGO suggests that such a drug requires to be registered there is really noobjection from government.Newer drug products that have been registered include: tenofovir (TDF); efavirenz(EFZ); emtricitabine (FTC); lopinavir/ritonavir (LPV/r, as Aluvia tablets or Kaletracapsules); ritonavir (r, separately); Atripla (EFV+FTC+TDF); and new Indian genericpediatric FDCs of stavudine/ lamivudine/ nevirapine (d4T/3TC/NVP). Zambia isalready procuring and using all of these drugs. The challenge is accessing them,especially in rural areas and in other districts due to other factors such as lackof qualified medical personnel to dispense the drugs. Atripla is used to replacecombinations containing stavudine 40mg (Triomune 40).100
Page 1 and 2:
Missing the Target #5:Improving AID
Page 4 and 5:
ArgentinaDr. María Lorena Di Giano
Page 8 and 9:
Executive SummaryAt the G8 meeting
Page 12:
• UN agencies should provide incr
Page 16 and 17:
Price should not be a barrier when
Page 18 and 19:
The Global Fund and UNITAID: The Fu
Page 20 and 21:
The real cost of free treatmentBy a
Page 22 and 23:
Remaining work for asuccessful prog
Page 24 and 25:
DOMINICAN REPUBLICto access rapid t
Page 26 and 27:
DOMINICAN REPUBLICIn Santo Domingo
Page 28 and 29:
ZIMBABWEtreatment, representing 35
Page 30 and 31:
ZIMBABWEAccording to the Medicines
Page 32 and 33:
ZIMBABWEZimbabwe’s application fo
Page 34 and 35:
ZIMBABWENational government• Addr
Page 36 and 37:
RUSSIAMigrantsRussia, with the seco
Page 38 and 39:
a person with HIV will die very qui
Page 40 and 41:
FamiliesIn Kenya, families are the
Page 42 and 43:
INDIA2. Provide pediatric formulati
Page 44 and 45:
Linking nutrition and treatmentBy W
Page 46 and 47:
Most people living with advanced HI
Page 48 and 49:
only available in the capital, Yaou
Page 50 and 51:
ZAMBIAFindings in particular provin
Page 52 and 53:
The DACA for Chadiza District was a
Page 54 and 55:
Many health care workers are inadeq
Page 56 and 57: DRUG REGISTRATION BARRIERS & LOGJAM
Page 58 and 59: Country ATV RLPV/rLPV/r(HS)TDFArgen
Page 60 and 61: development and registration. Likew
Page 62 and 63: Capacity issues and delays in the W
Page 64 and 65: Lack of post-approval quality assur
Page 66 and 67: ARV PROCUREMENT, REGISTRATION,AND S
Page 68 and 69: ARGENTINAParallel importingRelating
Page 70 and 71: ARGENTINAAccess to ARVsNo difficult
Page 72 and 73: Viral load tests are available, but
Page 74 and 75: Cambodiaby Mony PenOnly pharmacists
Page 76 and 77: ChinaBy anonymous Missing the Targe
Page 78 and 79: CHINAThe current process for regist
Page 80 and 81: Dominican RepublicBy Eugene Schiff
Page 82 and 83: IndiaBy Abraham KK, Celina D’Cost
Page 84 and 85: MalawiBy Lot Nyirenda and Grace Bon
Page 86 and 87: MALAWIStock-outsAccording to an ext
Page 88 and 89: MoroccoBy Othman MelloukMorocco has
Page 90 and 91: Determine the patent status of all
Page 92 and 93: MOROCCOThe shortage occurred becaus
Page 94 and 95: As of November 2007, the unit cost
Page 96 and 97: NIGERIADiagnostic testsDiagnostic t
Page 98 and 99: The government’s initial inabilit
Page 100 and 101: Increase training and capacity buil
Page 102 and 103: treatment practice. The Minster ann
Page 104 and 105: Ugandaby Richard Hasunira, Prima Ka
Page 108 and 109: ZAMBIAIn gathering this information
Page 110 and 111: However, since manufacturing prices
Page 112 and 113: 105SHORT SUMMARY
Page 114: PAKISTANAccess for marginalized gro
show all

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

You also want an ePaper? Increase the reach of your titles

Delete template?

Save as template?