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Same-Day Analysis
Sustainability of ARV Access in Question as Number of HIV Patients Living with Disease Grows
Published: 11/12/2009
IHS Global Insight Perspective | |
Significance | Over four million HIV-positive patients currently have access to antiretroviral drugs (ARVs). However, as the number of those infected and the provision of ARV treatment grows, funding responsibilities will represent a challenge in the future. Therefore, changes are required in the strategy used to fight the epidemic, with the backing of donors the crucial element. However, after years of promoting increased AIDS access, the recession has seen many large donors take a step back. |
Implications | Increased access to ARVs has been achieved by commitment from governments, donors, and the pharma industry. However, one year ahead of a G8-agreed goal to provide universal access to ARVs, the world is nowhere near achieving this, with strategies used to fight the epidemic requiring an overhaul. |
Outlook | Preventive strategies, including the creation of an ideal prevention versus treatment spending ratio, and cheaper diagnosis equipment, are likely to reduce the population of AIDS sufferers. Meanwhile, developing economies should not be pressurised into entering the Trade-Related Aspects of Intellectual Property Rights (TRIPS) and TRIPS + agreements. However, to ensure that patenting does not drive innovation, research and development and commercialisation of ARVs should be incentivised by donors. |
ART Access is Increasing, Driving Up Funding Commitments Enormously
Thanks to global political and donor commitments to reducing and averting the HIV/AIDS epidemic, over four million HIV positive patients are living with access to anti-retroviral drugs (ARVs), according to non-governmental organisation Médicins Sans Frontières (MSF). While this is positive news, there is still a large population with no access to these therapies. According to the U.K. All-Party Parliamentary Group (APPG) on AIDS, only one third of adults and 10% of HIV positive children have access to ARVs. Life-long treatment costs for those currently on ARVs, increasing accessibility to ARVs, revision of World Health Organization (WHO) guidelines to increase the CD4 count when ARV treatment can be given, and newer HIV infections are set to see the number of ARV users sky rocket. According to the APPG, by 2030 the number of those needing ARVs is set to jump to 55 million, with the provision of ARVs and maintaining access to these set to be an enormous task.
A Change in Strategy is Required...
In order to ensure that the successes in ARV-provision achieved so far are sustained and built upon, reforms to the way the epidemic is fought are necessary, revealed the APPG. Firstly, to ensure that HIV numbers do not rise to uncontrollably, prevention should be prioritised. To this end, not only should newer diagnostic equipment be rolled out at affordable rates in developing countries, but donor bodies should also work together to devise best-practise recommendations on ideal prevention and treatment-spending ratios.
In terms of treatment, the cost of newer first-line and second-line therapies needs to be reduced, thereby ensuring that HIV patients gain access to the best possible treatments. HIV-positive patients of lower socio-economic status still tend to choose more toxic, older ARV therapies, as they are cheaper than newer ones. For example, the WHO-recommended tenofovir-based combinations are US$129 more expensive (per patient annually) compared to previously recommended stavudine-based combinations. The same trend is seen in the use of WHO-recommended zidovudine in prevention of mother to child transmission (PMTCT). Lastly, costs surrounding drugs for HIV-related infections should also be reduced to ensure better quality of life.
...As Is Guaranteed Donor Commitment
Meanwhile, long-term donor commitment is necessary to ensure that work towards equitable access to ARVs continues. However, recent media reports seem to suggest that commitment towards this is waning. This is a factor of several rich nations and renowned NGOs tightening their belts, given the economic downturn. The Global Fund to Fight HIV/AIDS, Tuberculosis, and Malaria—responsible for disbursing 23% of HIV/AIDs-related international donations—has been unable to keep up with its 2009 grant promises, owing to insufficient donor funding, and has announced a 10% cut in approved grants. Meanwhile, while the United States had promised a total of US$50 billion as part of the President's Emergency Plan for AIDS Relief (PEPFAR) re-authorisation bill, the country seems to have back-tracked on this. In May 2009, President Barack Obama announced a US$63-billion Global Health Initiative, which included PEPFAR as one of the beneficiaries. PEPFAR funding has therefore flat-lined for the first time since inception.
In addition to this, national programmes funding AIDS continue to suffer, given that the prevalence of AIDS is higher in the developing world, where corruption, bureaucracy, and poor health infrastructure add to the problems of financial shortfalls. The government in the Free State of South Africa has yet to enrol any new patients onto its national ARV programme since December 2008.
Outlook and Implications
Globally, the world has made considerable progress in terms of increasing ARV access. Increased access to ARVs has been made possible through price reductions from NGOs like the Clinton Foundation, pharma industry initiatives granting voluntary licences, and individual government decisions not to patent certain AIDS drugs—the rejection of tenofovir patents in Brazil and India. However, a year from the G8 target of providing universal access, only one third of those needing ARVs have still gained access to it. To ensure further improvement, donor bodies purchasing ARVs should continue to assure drug firms of volumes, thereby leading to fall in prices. Meanwhile, for newer drugs, developing economies should increasingly take advantage of patent flexibility and overriding patents on account of public health purposes. The World Trade Organization's Trade-Related Aspects of Intellectual Property Rights (TRIPS), agreement is one barrier to this, as poorer economies are forced to abide by product patent norms, and can even be pressured into going beyond TRIPS, to TRIPS +. Meanwhile to ensure that R&D investment in this condition does not fall, donors can incentivise research by offering funding, tax credits, and other benefits upon achieving commercialisation. Evidently all the recommendations rely highly on donor initiative, without which the world can go back to rationing HIV access. This is why the trend in donor funding is worrying and needs to be corrected immediately.Most Viewed Articles
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