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UNAIDS LAUNCHES INITIATIVE TO HELP BRIDGE GAP IN ACCESS TO HIV/AIDS-RELATED DRUGS IN DEVELOPING WORLD

Multinational Pharmaceutical Companies Already Committed to Making Drugs more Affordable

Pilot Countries Adapting Health Infrastructures to Ensure Appropriate Use

Geneva, 5 November 1997 - The Joint United Nations Programme on HIV/AIDS (UNAIDS) today announced the launch of the pilot phase of the "UNAIDS HIV Drug Access Initiative", a collaborative effort between the public and private sectors to identify strategies to increase access to HIV/AIDS drugs in developing countries. Under the Initiative, the four developing countries involved in the pilot phase will work to adapt their health infrastructures to ensure effective distribution and use of the HIV/AIDS-related drugs, and participating pharmaceutical and diagnostic companies will subsidize purchases of these drugs.

Over 20 million people living with HIV/AIDS now live in developing countries, where resources can be severely limited. As potent drugs to control HIV infection and new sophisticated drugs to treat and prevent AIDS-related illnesses are helping to improve lives in the industrialized world - where, however, fewer than 10% of people with HIV live -, the gap in access to medical care continues to grow.

"The AIDS epidemic defies standard thinking. lts scope and its potential for immense and lasting destruction make the strengthening and updating of systems for health care delivery in the hardest hit countries an ever more urgent priority," said Dr Peter Piot, Executive Director of UNAIDS. "The UNAIDS HIV Drug Access Initiative has been crafted over a year of discussions with pharmaceutical and diagnostic companies, public health and policy officials, researchers and health practitioners, and HIV/AIDS community representatives, from both developed and developing countries."

To date, Glaxo Wellcome plc, F. Hoffmann-La Roche Ltd., and Virco N.V. have confirmed their intention to participate in the Initiative. Companies such as Janssen Pharmaceutica N.V., and Organon Teknika N.V. have expressed interest and are currently reviewing the level of their possible involvement. Discussions are also ongoing with others, and the Initiative is open to all those interested in participating.

According to UNAIDS, multiple barriers block wider access to HIV/AIDS-related drugs. These include insufficient health care structures, the increasing complexity of HIV management and care at different levels, as well as distribution channels, laboratory facilities and health centre technology, costs of treatments, medical training to support complex regimens, and administrative delays.

The pilot phase of the Initiative, in which new strategies for removing obstacles to improved HIV/AIDS-related health care will be implemented and monitored, will be conducted in Chile, C�te d'Ivoire, Uganda and Viet Nam - countries that allow for adequate evaluation of the Initiative in a variety of geographic, social, cultural, economic and structural situations.

Explaining the need for this limited approach in the initial phases and the complexity of some of the situations that the Initiative has been set up to try to address, Dr Piot said: "Our ultimate goal is to provide developing countries with proven strategies to improve care and increase access to the newest and most effective drugs. However, in order to evaluate and perfect the approaches we are trying, we must begin with small-scale pilot programmes, involving tough decisions to determine the limits of participation. But the alternative is to do nothing."

Speaking in Kampala, H.E. Dr Crispus Kiyonga, Minister of Health of Uganda, expressing his support and commitment to implementation of the pilot phase in his country, said: "We warmly welcome this Initiative which is the beginning of an effort to change the situation in which people who have HIV/AIDS cannot get drugs they need because they cannot afford them.'

IMPLEMENTATION OF THE INITIATIVE

Under the Initiative, the pilot countries will adapt their health care infrastructures and drug distribution systems to the HIV context. In each country, two new entities will be created, both of whose activities will be monitored by UNAIDS:

• A national HIV/AIDS drugs advisory board, under the Minister of Health, composed of representatives of the local medical, public health and HIV/AIDS communities. The board will devise a coordinated national policy for the provision of HIV-related drugs - examining the needs, optimizing available resources, identifying the selection of drugs that should be provided and the best ways of making these available to patients. The board will also set criteria for the participation of health centres in the Initiative and for the selection of patients, and will draw up treatment guidelines for the use of physicians when making treatment recommendations.

• A non-profit company, which will act as a clearing house for placing orders on behalf of the government and an import point for bringing drugs into the country, as well as being a recipient and channel for the subsidies from the companies. The entity, which will be funded by the pharmaceutical companies that use it, will also address related business and logistical issues.

The levels of subsidies will be defined separately and independently by each company, following individual discussions with country officials, taking into account the nature of the drugs to be purchased as well as the economic and epidemiological situation of the country.

Companies participating in the Initiative will make available a range of HIV-related drugs, including antiretrovirals to combat the underlying HIV infection, antimicrobials to prevent and treat opportunistic infections common among people with HIV/AIDS, and antibiotics to treat sexually transmitted diseases (STDs), which have been proven to increase the risk of HIV transmission. In addition, diagnostic companies will provide virological services and tests for patient monitoring. Decisions about which drugs are provided will vary from country to country, and will be taken by the advisory board after assessment of the country's specific needs.

FINANCING INCREASED ACCESS TO HIV/AIDS DRUGS

Financing for the pilot phase of the Initiative will come from a variety of existing and new sources:

• Pharmaceutical companies will provide HIV/AIDS-related drugs at subsidized prices.

• Local Health Ministries will both create new sources of funding and build on existing programmes. For example, C�te d'Ivoire, with strong public support for aggressively addressing the AIDS epidemic, is expected to establish a special solidarity fund from corporate contributions, new tariffs, and non-profit insurance systems in order to help defray costs of the HIV/AIDS drugs. In Uganda, funding from a new US$ 70 million World Bank programme to prevent and treat sexually transmitted diseases may be used in part to purchase drugs for STDs and opportunistic diseases at subsidized prices through the Initiative.

• UNAIDS will provide US$ 1 million for oversight of the health advisory boards and non-profit companies, evaluation of the pilot phase, and the dissemination of recommendations for applying the Initiative's principles in other comparable situations.

"This programme will provide the information we need to determine whether HIV/AIDS-related drugs can be obtained and distributed effectively in developing countries," said Dr Joseph Saba of UNAIDS, coordinator of the Initiative. "Armed with this information, countries will then be able to mobilize the necessary resources to treat infected individuals, and to help control the global epidemic."

EVALUATION

UNAIDS will evaluate the Initiative in each of the four pilot countries on an ongoing basis to determine the programme's efficiency, improvements in overall health care delivery, the number of people receiving the drugs, and the impact of the programme

on the demand for emergency care and on HIV/AIDS illnesses and death rates. UNAIDS will make recommendations for adjustments or expansion of the programme, and use the evaluation results to help guide other countries in improving their health infrastructures, setting up evaluation systems and in reforming their drug procurement and distribution networks.

"In developing this programme it was essential to be flexible and to tailor the pilot project to each country's unique needs," said Dr. Saba. 'We are hopeful that this new collaborative approach will bring us a little closer to making treatment for HIV and AIDS a reality for many people in the developing world, who have little or no access to care today."