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

DOMINICAN REPUBLICIn Santo Domingo and throughout the country, lack of access to viral load testscontinues to be a problem. There is no clear national protocol for the use of viralload tests. Guidelines and access to viral load tests vary widely from doctor todoctor and clinic to clinic. In numerous sites, even when tests were ordered basedon urgent clinical considerations, doctors and PLWHA reported that it sometimestook three to four months or more to receive results, delays which can prove fatal.Authorities noted that these delays are due to poor logistics, insufficient lab capacity(which is supposedly being corrected with the purchase of new equipment), andhigh costs (at over $50 per test) for reagents.We also encountered increasing numbers of physicians and PLWHA stressing theneed for drug resistance testing. Resistance tests are available in nearly every majorcity in the US and also an increasing number of countries in Latin America, but arestill lacking in the Dominican Republic. Samples must be sent abroad for testing;however, the $400 cost is prohibitive.According to one government official, reagents for each CD4 test (which aregenerally provided free of charge to PLWHA), cost the government and the GlobalFund project approximately $30. This is almost six times more than the cost oftest reagents available through international suppliers. Even a few local, privatelyrun labs in the Dominican Republic charge less than $30 to perform a CD4 test.The high cost of the reagents is significant given that CD4 tests are recommendedat least twice a year for the nearly 20,000 PLWHA registered in clinical followupor taking ARVs. Unfortunately, the lack of transparency within governmentagencies makes it extremely difficult for all stakeholders—including civil society andpatients—to obtain access to critical information about the negotiations and detailsof the contracts that set the prices. This is not only true for CD4 tests but also in theplanning and procurement for the purchase of first- and second-line ARVs.19