HIV/AIDS in Ethiopia: - Clinton Health Access Initiatives

Initiative 2- adult 2 nd line antiretroviral scale upBACKGROUNDAntiretroviral treatment, once initiated, is a life-long commitment for people living with HIV.Over time, the virus inevitably becomes resistant to the 1st line of prescribed treatment andpatients must move to a newer, more potent class of 2nd line ARV drugs. Unfortunately, at atime when more and more HIV positive patients are requiring 2nd line treatment, the new-tomarketclass of 2nd line drugs remains significantly more expensive than established generic1st line treatments. In early 2007, at the start of the UNITAID/CHAI 2nd line ART scale up, theprice of a 2nd line antiretroviral treatment regimen was roughly 10 times higher than a suitable1st line therapy. Under this type of pricing structure, the ARV treatment cost of a populationdoubles when only 10 percent of patients come to require 2nd line therapy. Recognizing thesituation as untenable, UNITAID and CHAI moved forward with the mindset of altering theexisting pharmaceutical landscape for 2nd line HIV. Putting forward a plan to increase access totreatment in 25 countries, the initiative concentrated on two primary objectives—reducing theprice of 2nd line therapy and increasing the number of suppliers.>50PERCENT DECREASE IN THECOST OF 2ND LINE ARV 13,958ETHIOPIAN ADULTS ON 2NDLINE THERAPY (2007-2010)PROGRAM ACCOMPLISHMENTSREDUCING THE COST OF TREATMENTUnlike the pediatric ARV program, the objectiveof the UNITAID funded and CHAI-Ethiopiaimplemented adult 2nd line ARV initiative was notfocused on placing more patients on treatment.Indeed, the goal of Ethiopia’s nationwide HIVtreatment program is to minimize the numberof patients requiring a switch from 1st to 2ndline ARVs. Notwithstanding, after synthesizingepidemiological data and national protocolsfor ARV treatment, CHAI’s forecasting modelindicated an impending change in the demandfor key 2nd line products as patients migratedin increasing numbers from 1st line to 2nd lineregimens.The need for increased access to 2nd linetreatment was clear; the barrier was price.To overcome this hurdle, the adult 2nd lineARV initiative addressed existing marketinefficiencies, with the intention of minimizingthe cost of treating these patients and enablingsystem-wide savings over time by brokeringsignificant reductions in price. By tappinginto CHAI’s existing global forecasting andquantification system, as well as the existingrelationships formed with governments toplan donations and procurements, UNITAIDcould successfully engage manufacturers of2nd line pharmaceuticals by offering globallycoordinatedbulk purchases that would, ineffect, achieve the overarching objective oflowering prices. Beginning in 2007, UNITAIDfunding served as the impetus to a catalyticshift in the affordability and accessibility ofadult 2nd line ARVs, leading to the followingprice reductions for some of the world’s mostefficacious 2nd line drugs:Tenofovir (TDF) Reduced 63% Abacavir (ABC) Reduced 61% Lopinavir/r (LPV/r) Reduced 20% Note: 1 2007 WHO GPRM pricing for Low Income countries and 2011 lowest UNITAID pricing13 CHAI and UNITAID in Ethiopia14