New Analysis From 14 Countries Identifies Drug Access Priorities To Achieve 2010 AIDS Treatment Target

The International Treatment Preparedness Coalition (ITPC), a group of 1,000
treatment activists from more than 125 countries, issued its fifth
report on scale up of AIDS services: Missing the Target #5: Improving AIDS
Drug Access and Advancing Health Care for All. The report is available at
aidstreatmentaccess.


The comprehensive report investigates AIDS drug access in 14 countries
and finds that scale up is working but high prices, patent and registration
barriers, and ongoing stock-outs are core issues impeding better and faster
AIDS drug delivery.



"The foundations to make the 2010 target are in place in many
countries. If governments, global agencies, and drug companies focus on
tactically improving AIDS drug access by continually lowering costs, ending
patent and regulatory problems, and fixing drug availability logistics,
while simultaneously strengthening health systems, there is real
possibility for making the 'near universal access' target by 2010," said
Gregg Gonsalves, a coordinator of the project.



Missing the Target teams in nine countries -- Cambodia, Cameroon,
China, Dominican Republic, India, Kenya, Russia, Zambia, and Zimbabwe --
also looked at broader issues in AIDS service delivery in their countries.
"AIDS treatment scale up cannot succeed without stronger health systems,
adequate nutrition, and concerted action against stigma and
marginalization," said Matilda Moyo of the Zimbabwe research team.



"Mobilization around AIDS has opened up fantastic new possibilities in
health service delivery by infusing new resources, intensifying the
engagement of people living with HIV/AIDS, and focusing on specific,
measurable outcomes," said Dr. Jim Yong Kim, Director of the
Francois-Xavier Bagnoud Center for Health and Human Rights (FXB) at Harvard
University. "We must learn from and build on these foundations because they
represent the best chance we've ever had to build comprehensive health
systems in the poorest settings."



"It is irresponsible to get bogged down in debates on simplistic
dichotomies like prevention versus treatment or disease-specific funding
versus strong health systems. We can, and we must, do all of this, better,
for more people, and in an increasingly coherent way," added Chris Collins,
a coordinator of the project.



"The UNAIDS epidemiologic estimates released last week show that we're
getting closer to reaching the goal of treatment for all," said Shona
Schonning of the Russia research team. "The UNAIDS report shows that
prevention and treatment programming have had impact. Now its time to scale
up these programs and continue to make progress on what remains a
devastating epidemic."
















In the report, civil society advocates in 14 countries identify
specific problems and recommend solutions to improve AIDS drug access:



-- In Argentina, high cost and restrictions on some drugs impede access
to some second line and other medicines.



-- In Belize, human resources shortfalls, price increases and
inadequate quality assurance hamper drug delivery.



-- In Cambodia, expanded access to drug resistance and viral load
testing is needed, as is increased attention to drug quality.



-- In China, access to second-line therapy is extremely limited, new
WHO treatment guidelines on improved first-line treatment have not been
widely implemented and patents on key medicines are preventing cost-cutting
generic competition.


-- In the Dominican Republic, new intellectual property laws and patent
enforcement by Merck are leading to higher prices and limited access to
some key drugs.



-- In India, drug stock-outs are reported across the country,
particularly where IDUs require treatment regimens that are not
hepatotoxic.



-- In Malawi, a chronic shortage of health care workers is a major
impediment to drug access; while ARV stock-outs are rare, other important
drugs are often unavailable.



-- In Morocco, new intellectual property laws threaten the provision of
AIDS treatment.



-- In Nigeria, despite a rapid scale up of ARV treatment and a free
treatment policy, treatment sites are not easily accessible in many parts
of the country, and CD4 and other tests are still being offered at a fee in
several locations.



-- In the Philippines, treatment is not yet accessible to all, there is
a healthcare worker shortage and diagnostic testing access is limited.



-- In Russia, ARV stock-outs are a severe and ongoing problem.



-- In Uganda, stock-outs are commonplace, and limited support and care
services undermine drug access.



-- In Zambia, there is concern that AIDS drug access depends on the
work of NGOs and the government is not sufficiently engaged.



-- In Zimbabwe, stock-outs are frequent and the increasingly unfriendly
general policy environment remains a cause for concern.



Action Recommendations for Global Agencies and National Governments


-- The World Health Organization: Take the lead to educate countries
about changes to standard first- and second-line treatment regimens and
lead global efforts to simultaneously expand AIDS services while
strengthening broader care systems.



-- United Nations technical agencies: Clearly and publicly communicate
changes in WHO ARV drug guidelines and provide technical support and
guidance to countries to help implement the changes.



-- The Global Fund: Proactively support grantees in identifying and
correcting procurement bottlenecks and strengthening national procurement
systems for ARVs and other medicines and ensure grantees are procuring
medicines at preferential prices.



-- Bilateral programs (PEPFAR, etc.): Work with national treatment
programs, community organizations, PLWHA and other partners to support
national efforts to switch to optimized first-line treatment.



-- UNITAID (the international drug purchase facility): Work
aggressively to support initiatives to increase competition and further
reduce the price of new standardized treatment regimens.



-- Drug companies: Act with enlightened self-interest to expand access
to products by registering them much more expeditiously and stop
intimidating countries that use flexibilities in trade law.



-- National governments: Build local and regional drug regulatory
capacity, make fuller use of the WHO drug prequalification process, and use
flexibilities in international trade rules to secure the lowest possible
drug prices.



About the International Treatment Preparedness Coalition



The International Treatment Preparedness Coalition (ITPC) was born out
of the International Treatment Preparedness Summit that took place in Cape
Town, South Africa in March 2003. That meeting brought together for the
first time community-based HIV treatment activists and educators from over
60 countries. Since the Summit, ITPC has grown to include more than 1,000
activists from over 125 countries and has emerged as a leading civil
society coalition on treatment preparedness and access issues.


International Treatment Preparedness Coalition

aidstreatmentaccess