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

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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
Delivering services amidst turmoilBy Matilda Moyo, Carol Mubaira, and Martha TholanahZimbabwe has reported a steady decline in adult HIV prevalence, currentlyestimated at 15.6 percent in the 15–49 year age group, compared to 18.1 percentlast year. 1 Dr David Parirenyatwa, the Health and Child Welfare Minister, notedthat although this was a significant decline, the figure was still too high and therewas still a lot of work to be done, as more than 2,214 people die of AIDS-relatedillnesses, including TB, on a weekly basis.Although the country has made considerable progress towards improving accessto AIDS treatment in 2007, even with significant changes, including scrapping userfees for patients on the government treatment program and introducing providerinitiatedcounseling and testing (PICT), access to treatment still remains a majorchallenge, especially for the poor majority.Among the negative developments that continue to hamper adequate accessto treatment for PLWHA are the sale of fake ARVs, the consequences of policiessuch as price controls, and the popularization of a new herbal remedy called“Gundamiti,” the promoters of which claim it reverses the symptoms of HIV.Similarly, the overall economic environment has continued to deteriorate,thereby reducing the number of patients who can afford private sector care, andconcurrently increasing demand for the over-subscribed government program.Inflation, currently at over 8,000 percent, has pushed basic commodities, includingARVs, further beyond the reach of most people. The government treatmentprogram, which had been catering to vulnerable groups such as women andchildren, has temporarily halted taking on new patients.Major improvements in treatment deliveryDespite the challenges the country faces, it is important to acknowledge theincremental gains that have been made toward improving treatment access toPLWHA. By the end of October 2007, 91,000 2 PLWHA in Zimbabwe were on1 Minister of Health and Child Welfare, Dr. David Parirenyatwa, at the launch of the new HIVprevalence estimates, the Ante-Natal Care (ANC) Survey 2006, and the Zimbabwe DemographicHealth Survey (ZDHS+) 2005-06 on October 31, 2007.2 Ibid.20
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 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
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ChinaBy anonymous Missing the Targe
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CHINAThe current process for regist
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Dominican RepublicBy Eugene Schiff
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IndiaBy Abraham KK, Celina D’Cost
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MalawiBy Lot Nyirenda and Grace Bon
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MALAWIStock-outsAccording to an ext
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MoroccoBy Othman MelloukMorocco has
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Determine the patent status of all
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MOROCCOThe shortage occurred becaus
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As of November 2007, the unit cost
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NIGERIADiagnostic testsDiagnostic t
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The government’s initial inabilit
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Increase training and capacity buil
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treatment practice. The Minster ann
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Ugandaby Richard Hasunira, Prima Ka
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UGANDAExtracts from the MoH’s rep
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ZAMBIAIn gathering this information
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However, since manufacturing prices
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105SHORT SUMMARY
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PAKISTANAccess for marginalized gro
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