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

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The government’s initial inability to procure sufficient ARVs was due to thefollowing:the essential ARVs were not registered with the Philippines National DrugFormulary;bulk procurement quantities could not be estimated because HIV clinicscould not produce data on the actual number of persons in need of ARVsor those currently receiving them;drug distribution mechanisms were not yet organized;diagnostic tests were unavailable, including those for CD4 counts, viralload, and liver function; andstandard treatment guidelines had not yet been established.The delay was so critical that WHO intervened in the third quarter of 2005 tofacilitate procurement of the needed ARVs. Even then, significant problems arose.Inaccurate estimates resulted in overstocks of Duovir (lamivudine/zidovudine) andnevirapine at the same time that a stock-out of efavirenz occurred.ART in the Philippines todayAs of October 2007, nearly all of the almost 500 people diagnosed with AIDS inthe Philippines are not receiving ART. Many have chosen not to begin treatmentbecause they fear potential side effects, a situation that indicates a lack ofappropriate treatment literacy and education among HIV-positive individuals.Although there are now 11 treatment centers distributed around the country, thenumber of adequately trained and competent health providers capable of providingHIV/AIDS management remains limited.Currently, all ART purchases are supported by the Global Fund, and drugs areavailable free of charge through the government treatment program. Of those onART, the majority are taking efavirenz, which is classified as a first-line medicineand an alternate to nevirapine if patients on the latter develop side effects. A feware taking a second-line drug, Kaletra (lopinavir/ritonavir).Ongoing challenges to effective HIV treatment deliveryHuman resourcesPHILIPPINESRapid turnover of trained health providers at treatment centers hasnegatively affected the quality of service delivery.Many providers at the treatment centers have insufficient knowledgeabout ART.91
Not all treatment centers have community-based partners that canconduct treatment follow-up, counseling, and home visits for those onART.Standards and guidelinesTreatment centers have no single protocol or set of standards regardingtreatment counseling or treatment literacy and education for clients orfamily members. This negatively impacts adherence and understanding ofhow to address side effects.There is no well-established mechanism to refer clients to other potentiallyuseful health and social services.The Global Fund supports only one diagnostic test for free, the CD4count. All other tests, for viral load, liver function, etc., require payment.Screening for TB is by X-Ray only. Such tests are offered infrequently if atall, even if patients exhibit symptoms.Sustainability of access to medicinesCivil societyPHILIPPINESThe Global Fund currently funds all purchases of ARVs. The governmenthas yet to announce how (or even if) it will take on this responsibility afterGlobal Fund support ends in 2010.Except for cotrimoxazole, medicines to treat OIs are rarely availablethrough the public sector. These shortfalls exist because local governmentsin regions with treatment centers are not shouldering their responsibilities.Clients with OIs are therefore forced to purchase drugs with their ownfunds, if they have them.RecommendationsScale up treatment advocacy at different levels among different entities,including other NGOs, in order to generate support for the treatmentagenda.Communities and organizations of PLWHA should seek to further“humanize” the epidemic by discussing HIV/AIDS openly and candidly.Individuals living with TB should be included in these efforts because theirtreatment issues are similar to those facing PLWHA, even when patientsare not co-infected.Support the community-led development of a strategic advocacy agendafor the Philippines.Increase advocacy and education efforts toward universal access.92
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Missing the Target #5:Improving AID
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ArgentinaDr. María Lorena Di Giano
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Executive SummaryAt the G8 meeting
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• UN agencies should provide incr
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Price should not be a barrier when
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The Global Fund and UNITAID: The Fu
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The real cost of free treatmentBy a
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Remaining work for asuccessful prog
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DOMINICAN REPUBLICto access rapid t
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DOMINICAN REPUBLICIn Santo Domingo
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ZIMBABWEtreatment, representing 35
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ZIMBABWEAccording to the Medicines
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ZIMBABWEZimbabwe’s application fo
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ZIMBABWENational government• Addr
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RUSSIAMigrantsRussia, with the seco
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a person with HIV will die very qui
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FamiliesIn Kenya, families are the
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INDIA2. Provide pediatric formulati
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Linking nutrition and treatmentBy W
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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 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 106 and 107: UGANDAExtracts from the MoH’s rep
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
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Missing the Target #5: Improving AIDS Drug Access ... - CD8 T cells

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