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

CHINAStock-outsWhile some stock-outs of ARVs have occurred, they have usually been localized (inone city or province), and information about such incidents is limited. It is thereforeunclear how seriously shortages are impacting the national treatment program.A centralized procurement and distribution system run by the national Centersfor Disease Control (CDC) until mid-2006 allowed for rapid adjustments to coverstock-outs. However, that fallback guarantee at the national level ceased whenprocurement of ARVs was delegated to individual provinces in mid-2006. At thelocal (provincial or city) level, ARV shortages or stock-outs are more common. Therewas one well-known incident of stock-out of lamivudine in Guangzhou province in2006. In response, patients were being switched instead to didanosine, but strongadvocacy and action on the part of a local PLWHA group—including borrowingmedicine from another site and communicating directly with Beijing authorities—ensured that the problem was quickly rectified.It is likely, however, that the overall problem may be more serious than thisincident suggests. PLWHA from different provinces have been told that certainARVs, in particular efavirenz, are “not available,” and they have been forced topurchase their own supply. In late 2006, MSF reported that many shortages orstock-outs have occurred in sites where they work in China, with patients oftenresorting to purchasing the ARVs at market prices (which are much higher than thegovernment’s procurement prices 1 ).Recommendations to improve drug accessPursue compulsory licenses for generic versions of second-line ARVs,notably lamivudine (3TC) and efavirenz (EFV). WHO and relevant UNagencies should strengthen assistance to the Chinese government to dothis, but the decision ultimately rests with the government.The Chinese government should urgently register FDCs of first-line ARVsand use these in the national treatment program.The Chinese government should speed up the new drug approval processto ensure timely access to newer and cheaper ARVs.1 Reported market prices for ARVs included the following: lamivudine (3TC), 1,300 yuan ($175) amonth; and efavirenz, 619 yuan ($83) a month. According to the MSF report, “a one-year supply ofd4T (Chinese generic), 3TC (GSK), and nevirapine (Chinese generic) costs 18,000 yuan ($2,400) atthe market price.”72