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Taramasso L, Andreoni M, Antinori A, Bandera A, Bonfanti P, Bonora S, Borderi M, Castagna A, Cattelan AM, Celesia BM, Cicalini S, Cingolani A, Cossarizza A, D'Arminio Monforte A, D'Ettorre G, Di Biagio A, Di Giambenedetto S, Di Perri G, Esposito V, Focà E, Gervasoni C, Gori A, Gianotti N, Guaraldi G, Gulminetti R, Lo Caputo S, Madeddu G, Maggi P, Marandola G, Marchetti GC, Mastroianni CM, Mussini C, Perno CF, Rizzardini G, Rusconi S, Santoro M, Sarmati L, Zazzi M, Maggiolo F. Pillars of long-term antiretroviral therapy success. Pharmacol Res 2023; 196:106898. [PMID: 37648103 DOI: 10.1016/j.phrs.2023.106898] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/20/2023] [Revised: 08/26/2023] [Accepted: 08/27/2023] [Indexed: 09/01/2023]
Abstract
BACKGROUND Meeting the challenge of antiretroviral therapy (ART) whose efficacy can last a lifetime requires continuous updating of the virological, pharmacological, and quality of life outcomes to be pursued and a continuous review of literature data on the efficacy and tolerability of new drugs and therapeutic strategies. METHODS With the aim of identifying open questions and answers about the current controversies in modern ART, we adapted the Design Thinking methodology to the needs of the design phase of a scientific article, involving a team of experts in HIV care. RESULTS Five main pillars of treatment success were discussed: sustained virologic suppression over time; immunological recovery; pharmacological attributes; long-term tolerability and safety of ART; and people's satisfaction and quality of life. The definition of the outcomes to be achieved in each thematic area and the tools to achieve them were reviewed and discussed. CONCLUSIONS Long-term treatment success should be intended as a combination of HIV-RNA suppression, immune recovery, and high quality of life. To achieve this, the regimen should be well-tolerated, with high potency, genetic barrier, and forgiveness, and should be tailored by a person-centered perspective, based on individual needs, preferences, and therapeutic history.
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Affiliation(s)
- Lucia Taramasso
- IRCCS Ospedale Policlinico San Martino di Genova, Genova, Italy.
| | | | - Andrea Antinori
- Istituto Nazionale per le Malattie Infettive Lazzaro Spallanzani IRCCS, Roma, Italy
| | - Alessandra Bandera
- Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico di Milano, Milano, Italy
| | - Paolo Bonfanti
- Università degli Studi di Milano-Bicocca, Fondazione IRCCS San Gerardo dei Tintori - Monza, Monza, Italy
| | - Stefano Bonora
- Ospedale Amedeo di Savoia, Università degli Studi di Torino, Torino, Italy
| | - Marco Borderi
- Azienda Ospedaliero-Universitaria Policlinico S. Orsola-Malpighi, Bologna, Italy
| | | | | | | | - Stefania Cicalini
- Istituto Nazionale per le Malattie Infettive Lazzaro Spallanzani IRCCS, Roma, Italy
| | | | | | | | - Gabriella D'Ettorre
- Department of Public Health and Infectious Diseases AOU Policlinico Umberto I Sapienza, Rome, Italy
| | - Antonio Di Biagio
- Department of Health Sciences, Clinic of Infectious Diseases, University of Genoa, Genoa, Italy
| | | | - Giovanni Di Perri
- Ospedale Amedeo di Savoia, Università degli Studi di Torino, Torino, Italy
| | - Vincenzo Esposito
- UOC di Malattie infettive e Medicina di Genere P.O. Cotugno-A.O. dei Colli, Napoli, Italy
| | - Emanuele Focà
- Università degli Studi di Brescia e ASST Spedali Civili di Brescia, Brescia, Italy
| | | | - Andrea Gori
- Università degli Studi di Milano, Milano, Italy; ASST Fatebenefratelli Sacco, Ospedale Luigi Sacco, Milano, Italy
| | | | - Giovanni Guaraldi
- Azienda Ospedaliero-Universitaria Policlinico di Modena, Università degli Studi di Modena e Reggio Emilia, Modena, Italy
| | | | | | - Giordano Madeddu
- Department of Medicine, Surgery and Pharmacy, University of Sassari, Sassari, Italy
| | - Paolo Maggi
- Università degli Studi della Campania Luigi Vanvitelli, AORN S. Anna e S. Sebastiano Caserta, Caserta, Italy
| | | | - Giulia Carla Marchetti
- Department of Health Sciences, Clinic of Infectious Diseases, University of Milan, ASST Santi Paolo e Carlo, Milan, Italy
| | | | - Cristina Mussini
- Azienda Ospedaliero-Universitaria Policlinico di Modena, Università degli Studi di Modena e Reggio Emilia, Modena, Italy
| | | | | | - Stefano Rusconi
- Ospedale Civile di Legnano ASST Ovest Milanese - Università degli Studi di Milano, Legnano, Italy
| | - Maria Santoro
- Università degli Studi di Roma "Tor Vergata", Roma, Italy
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Parmaksiz K, Pisani E, Bal R, Kok MO. A systematic review of pooled procurement of medicines and vaccines: identifying elements of success. Global Health 2022; 18:59. [PMID: 35690779 PMCID: PMC9188018 DOI: 10.1186/s12992-022-00847-z] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/19/2021] [Accepted: 05/12/2022] [Indexed: 11/10/2022] Open
Abstract
INTRODUCTION Pooled procurement of health commodities has increasingly been promoted as a solution to reduce prices, increase availability, and achieve more efficient procurement processes. However, little is known about what is required to implement pooled procurement mechanisms successfully and how they function under specific circumstances. Therefore, the aim of this systematic review is to synthesize empirically grounded insights by identifying the elements that are essential for setting up and operating pooled procurement mechanisms of medicines and vaccines. METHODS Our review was based on the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines. We searched PubMed, Scopus and Web of Science for empirical studies on pooled procurement of medicines and vaccines using various search terms. Publications were assessed based on predetermined eligibility criteria. RESULTS Our initial search yielded 1596 publications, of which 44 were eventually included in our review. Most of the included articles focused on pooled procurement mechanisms that operated on a sub-national level (43%), procured a variety of products (38%), and were set up with the goal to contain costs (64%). The review identified several elements that are essential for pooled procurement mechanisms to function. We organized these elements around three key actors in the mechanism: buyers, the pooled procurement organization, and suppliers. To participate in pooled procurement, buyers need a sufficient level of technical capacity, financial capacity and compatible laws and regulations. To carry out pooled procurement, the pooled procurement organization needs sufficient financial capacity, technical capacity, and independent operations. To supply the mechanism with health commodities, suppliers need sufficient incentives, such as a sufficient market size and a prompt payment mechanism. CONCLUSION Pooled procurement mechanisms are very diverse. They differ in characteristics and organizational structures and are set up to achieve a variety of goals. While certain essential elements are more likely to increase successful implementation and functioning of pooled procurement mechanisms, the organizational structure must be aligned with the goals of the mechanism, and adapted to the local contextual environment.
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Affiliation(s)
- Koray Parmaksiz
- Erasmus School of Health Policy & Management, Erasmus University Rotterdam, Rotterdam, The Netherlands.
| | - Elizabeth Pisani
- Erasmus School of Health Policy & Management, Erasmus University Rotterdam, Rotterdam, The Netherlands.,Faculty of Pharmacy, Universitas Pancasila, Jakarta, Indonesia
| | - Roland Bal
- Erasmus School of Health Policy & Management, Erasmus University Rotterdam, Rotterdam, The Netherlands
| | - Maarten Olivier Kok
- Erasmus School of Health Policy & Management, Erasmus University Rotterdam, Rotterdam, The Netherlands.,Department of Health Sciences, Vrije Universiteit Amsterdam, Amsterdam, The Netherlands
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Stulens S, De Boeck K, Vandaele N. HIV supply chains in low- and middle-income countries: overview and research opportunities. JOURNAL OF HUMANITARIAN LOGISTICS AND SUPPLY CHAIN MANAGEMENT 2021. [DOI: 10.1108/jhlscm-08-2020-0072] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
PurposeDespite HIV being reported as one of the major global health issues, availability and accessibility of HIV services and supplies remain limited, especially in low- and middle-income countries. The effective and efficient operation of HIV supply chains is critical to tackle this problem. The purpose of this paper is to give an introduction to HIV supply chains in low- and middle-income countries and identify research opportunities for the operations research/operations management (OR/OM) community.Design/methodology/approachFirst, the authors review a combination of the scientific and grey literature, including both qualitative and quantitative papers, to give an overview of HIV supply chain operations in low- and middle-income countries and the challenges that are faced by organizing such supply chains. The authors then classify and discuss the relevant OR/OM literature based on seven classification criteria: decision level, methodology, type of HIV service modeled, challenges, performance measures, real-life applicability and countries covered. Because research on HIV supply chains in low- and middle-income countries is limited in the OR/OM field, this part also includes papers focusing on HIV supply chain modeling in high-income countries.FindingsThe authors conclude this study by identifying several tendencies and gaps and by proposing future research directions for OR/OM research.Originality/valueTo the best of the authors’ knowledge, this paper is the first literature review addressing this specific topic from an OR/OM perspective.
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Evans SE, Harrington T, Rodriguez Rivero MC, Rognin E, Tuladhar T, Daly R. 2D and 3D inkjet printing of biopharmaceuticals - A review of trends and future perspectives in research and manufacturing. Int J Pharm 2021; 599:120443. [PMID: 33675921 DOI: 10.1016/j.ijpharm.2021.120443] [Citation(s) in RCA: 14] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/01/2021] [Revised: 02/24/2021] [Accepted: 02/25/2021] [Indexed: 12/13/2022]
Abstract
There is an ongoing global shift in pharmaceutical business models from small molecule drugs to biologics. This increase in complexity is in response to advancements in our diagnoses and understanding of diseases. With the more targeted approach coupled with its inherently more costly development and manufacturing, 2D and 3D printing are being explored as suitable techniques to deliver more personalised and affordable routes to drug discovery and manufacturing. In this review, we explore first the business context underlying this shift to biopharmaceuticals and provide an update on the latest work exploring discovery and pharmaceutics. We then draw on multiple disciplines to help reveal the shared challenges facing researchers and firms aiming to develop biopharmaceuticals, specifically when using the most commonly explored manufacturing routes of drop-on-demand inkjet printing and pneumatic extrusion. This includes separating out how to consider mechanical and chemical influences during manufacturing, the role of the chosen hardware and the challenges of aqueous formulation based on similar challenges being faced by the printing industry. Together, this provides a review of existing work and guidance for researchers and industry to help with the de-risking and rapid development of future biopharmaceutical products.
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Affiliation(s)
| | | | | | - Etienne Rognin
- Institute for Manufacturing, Department of Engineering, University of Cambridge (UK), UK
| | | | - Ronan Daly
- Institute for Manufacturing, Department of Engineering, University of Cambridge (UK), UK.
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Githendu P, Morrison L, Silaa R, Pothapregada S, Asiimwe S, Idris R, Peterson T, Davidson E, Lesego A, Mwale N, Mwakalobo SM, Bwanakunu LR, Achoki T. Transformation of the Tanzania medical store department through global fund support: an impact assessment study. BMJ Open 2020; 10:e040276. [PMID: 33158832 PMCID: PMC7651727 DOI: 10.1136/bmjopen-2020-040276] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/08/2020] [Revised: 10/05/2020] [Accepted: 10/15/2020] [Indexed: 12/18/2022] Open
Abstract
BACKGROUND The Tanzania government sought support from The Global Fund to Fight AIDs, Tuberculosis and Malaria to reform its Medical Stores Department, with the aim of improving performance. The study sought to assess the impact of the reforms and document the lessons learnt. METHODS Quantitative and qualitative research methods were applied to assess the impact of the reforms. The quantitative part entailed a review of operational and financial data covering the period before and after the implementation of the reforms. Interrupted time series analysis was used to determine the change in average availability of essential health commodities at health zones. Qualitative data were collected through 41 key informant interviews. Participants were identified through stakeholder mapping, purposive and snowballing sampling techniques and responses were analysed through thematic content analysis. RESULTS Availability of essential health commodities increased significantly by 12.6% (95% CI 9.6% to 15.6%) after the reforms and continued to increase on a monthly basis by 0.2% (95%CI 0.0% to 0.3%) relative to the preintervention trend. Sales increased by 56.6% while the cost of goods sold increased by 88.6% between 2014/2015 and 2017/2018. Surplus income increased by 56.4% between 2014/2015 and 2017/2018 with reductions in rent and fuel expenditure. There was consensus among study participants that the reforms were instrumental in improving performance of the Medical Stores Department. CONCLUSION Positive results were realised through the reforms. However, despite the progress, there were risks such as the increasing government receivable that could jeopardise the sustainability of the gains. Therefore, multistakeholder efforts are necessary to make progress and expand public health.
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Affiliation(s)
- Patrick Githendu
- The Global Fund to Fight AIDS Tuberculosis and Malaria, Grand-Saconnex, Genève, Switzerland
| | - Linden Morrison
- The Global Fund to Fight AIDS Tuberculosis and Malaria, Grand-Saconnex, Genève, Switzerland
| | - Rosemary Silaa
- Independent Consultants, Dar es Salaam, Tanzania, United Republic of
| | - Sai Pothapregada
- The Global Fund to Fight AIDS Tuberculosis and Malaria, Grand-Saconnex, Genève, Switzerland
| | - Sarah Asiimwe
- The Global Fund to Fight AIDS Tuberculosis and Malaria, Grand-Saconnex, Genève, Switzerland
| | - Rafiu Idris
- The Global Fund to Fight AIDS Tuberculosis and Malaria, Grand-Saconnex, Genève, Switzerland
| | - Tatjana Peterson
- The Global Fund to Fight AIDS Tuberculosis and Malaria, Grand-Saconnex, Genève, Switzerland
| | - Emma Davidson
- Independent Consultants, Dar es Salaam, Tanzania, United Republic of
| | - Abaleng Lesego
- Africa Institute for Health Policy Foundation, Nairobi, Kenya
| | - Neema Mwale
- Tanzania Medical Stores Department, Dar es Salaam, Tanzania, United Republic of
| | | | | | - Tom Achoki
- Africa Institute for Health Policy Foundation, Nairobi, Kenya
- School of Health Systems and Public Health, University of Pretoria, Pretoria, South Africa
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Diabaté S, Kra O, Biékoua YJ, Pelletier SJ, Osso DG, Diané B, N'Dhatz-Ebagnitchié M, Ahouada C, Kobena AK, Alary M. Pre-exposure prophylaxis among men who have sex with men in Côte d'Ivoire: a quantitative study of acceptability. AIDS Care 2020; 33:1228-1236. [PMID: 32603610 DOI: 10.1080/09540121.2020.1785997] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
Abstract
This cross sectional study was conducted in 2018 in Côte d'Ivoire to assess PrEP acceptability among men who have sex with men (MSM). Two hundred and one men were asked on their intention to use PrEP if made available. Logistic regression accounting for the sampling design was used to analyze associations between high PrEP acceptability and different independent variables including barriers and facilitators. Participants were mostly young (mean age = 25 years), educated (82% with secondary/postsecondary education) and single (95.5%). On average, 3.4 episodes of anal sex were reported monthly and 37.8% of men did not use a condom at last sex. Most MSM (72.6%) had heard of PrEP before enrollment. Overall, 35.3% reported that they would use PrEP very probably if made available. In multivariate analysis, factors associated with high PrEP acceptability were condom use at last sexual intercourse (Odds ratio (OR) = 2.51; 95%Confidence interval (95%CI) = 1.45-4.33); insertive sex as compared to versatile sex (OR = 2.56; 95%CI = 1.14-5.67); free PrEP delivery (OR = 2.45; 95%CI = 1.07-5.59), concerns about side effects (OR = 0.66; 95%CI = 0.48-0.90), and being preoccupied by the fact that post-PrEP antiretroviral therapy could be inefficient (OR = 0.25; 95%CI = 0.14-0.44). PrEP implementation among MSM in Côte d'Ivoire should be accompanied by awareness raising campaigns explaining its utility.
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Affiliation(s)
- S Diabaté
- Département de médecine sociale et préventive, Université Laval, Québec, Canada.,Centre de recherche du CHU de Québec, Université Laval, Québec, Canada.,Université Alassane Ouattara, Bouaké, Côte d'Ivoire
| | - O Kra
- Université Alassane Ouattara, Bouaké, Côte d'Ivoire
| | - Y J Biékoua
- Renaissance Santé Bouaké, Bouaké, Côte d'Ivoire
| | - S J Pelletier
- Centre de recherche du CHU de Québec, Université Laval, Québec, Canada
| | - D G Osso
- Renaissance Santé Bouaké, Bouaké, Côte d'Ivoire
| | - B Diané
- Université Alassane Ouattara, Bouaké, Côte d'Ivoire
| | | | | | - A K Kobena
- Renaissance Santé Bouaké, Bouaké, Côte d'Ivoire
| | - M Alary
- Département de médecine sociale et préventive, Université Laval, Québec, Canada.,Centre de recherche du CHU de Québec, Université Laval, Québec, Canada.,Institut national de santé publique du Québec, Québec, Canada
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Beck EJ, Mandalia S, DongmoNguimfack B, Pinheiro E, 't Hoen E, Boulet P, Stover J, Gupta A, Juneja S, Habiyambere V, Ghys P, Nunez C. Does the political will exist to bring quality-assured and affordable drugs to low- and middle-income countries? Glob Health Action 2019; 12:1586317. [PMID: 30983547 PMCID: PMC6484498 DOI: 10.1080/16549716.2019.1586317] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/21/2023] Open
Abstract
Background: Increased coverage with antiretroviral therapy for people living with HIV in low- and middle-income countries has increased their life expectancy associated with non-HIV comorbidities and the need for quality-assured and affordable non-communicable diseases drugs . Funders are leaving many middle-income countries that will have to pay and provide quality-assured and affordable HIV and non-HIV drugs, including for non-communicable diseases. Objective: To estimate costs for originator and generic antiretroviral therapy as the number of people living with HIV are projected to increase between 2016 and 2026, and discuss country, regional and global factors associated with increased access to generic drugs. Methods: Based on estimates of annual demand and prices, annual cost estimates were produced for generic and originator antiretroviral drug prices in low- and middle-income countries and projected for 2016–2026. Results: Drug costs varied between US$1.5 billion and US$4.8 billion for generic drugs and US$ 8.2 billion and US$16.5 billion for originator drugs between 2016 and 2026. Discussion: The global HIV response increased access to affordable generic drugs in low- and middle-income countries. Cheaper active pharmaceutical ingredients and market competition were responsible for reduced drug costs. The development and implementation of regulatory changes at country, regional and global levels, covering intellectual property rights and public health, and flexibilities in patent laws enabled prices to be reduced. These changes have not yet been applied in many low- and middle-income countries for HIV, nor for other infectious and non-communicable diseases, that lack the profile and political attention of HIV. Licensing backed up with Trade-Related Aspects of Intellectual Property Rights safeguards should become the norm to provide quality-assured and affordable drugs within competitive generic markets. Conclusion: Does the political will exist among policymakers and other stakeholders to develop and implement these country, regional and global frameworks for non-HIV drugs as they did for antiretroviral drugs?
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Affiliation(s)
| | | | | | | | | | | | | | | | | | | | - Peter Ghys
- a Programme Branch , UNAIDS , Geneva , Switzerland
| | - Cesar Nunez
- a Programme Branch , UNAIDS , Geneva , Switzerland
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Suthar AB, Coggin W, Raizes E. Antimicrobial Resistance and Substandard and Falsified Medicines: The Case of HIV/AIDS. J Infect Dis 2019; 219:672-673. [PMID: 30307565 DOI: 10.1093/infdis/jiy557] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/03/2018] [Accepted: 09/18/2018] [Indexed: 01/30/2023] Open
Affiliation(s)
- Amitabh B Suthar
- Division of Global HIV and Tuberculosis, Centers for Disease Control and Prevention, Atlanta, Georgia
| | - William Coggin
- Division of Global HIV and Tuberculosis, Centers for Disease Control and Prevention, Atlanta, Georgia
| | - Elliot Raizes
- Division of Global HIV and Tuberculosis, Centers for Disease Control and Prevention, Atlanta, Georgia
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9
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Liu Y, Galárraga O. Do national drug policies influence antiretroviral drug prices? Evidence from the Southern African Development community. Health Policy Plan 2018; 32:170-177. [PMID: 28207060 DOI: 10.1093/heapol/czw107] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 07/26/2016] [Indexed: 11/14/2022] Open
Abstract
Background The efficacy of low- and middle-income countries’ (LMIC) national drug policies in managing antiretroviral (ARV) pharmaceutical prices is not well understood. Though ARV drug prices have been declining in LMIC over the past decade, little research has been done on the role of their national drug policies. This study aims to (i) analyse global ARV prices from 2004 to 2013 and (ii) examine the relationship of national drug policies to ARV prices. Methods Analysis of ARV drug prices utilized data from the Global Price Reporting Mechanism from the World Health Organization (WHO). Ten of the most common ARV drugs (first-line and second-line) were selected. National drug policies were also assessed for 12 countries in the South African Development Community (SADC), which self-reported their policies through WHO surveys. Results The best predictor of ARV drug price was generic status—the generic versions of 8 out of 10 ARV drugs were priced lower than branded versions. However, other factors such as transaction volume, HIV prevalence, national drug policies and PEPFAR/CHAI involvement were either not associated with ARV drug price or were not consistent predictors of price across different ARV drugs. Conclusion In the context of emerging international trade agreements, which aim to strengthen patent protections internationally and potentially delay the sale of generic drugs in LMIC, this study shines a spotlight on the importance of generic drugs in controlling ARV prices. Further research is needed to understand the impact of national drug policies on ARV prices.
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Affiliation(s)
- Yao Liu
- Warren Alpert Medical School of Brown University, Providence, RI, USA
| | - Omar Galárraga
- Brown University School of Public Health, Providence, RI, USA
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Kim SW, Skordis-Worrall J. Can voluntary pooled procurement reduce the price of antiretroviral drugs? a case study of Efavirenz. Health Policy Plan 2017; 32:516-526. [PMID: 28052986 DOI: 10.1093/heapol/czw165] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 11/13/2016] [Indexed: 11/14/2022] Open
Abstract
Purpose : A number of strategies have aimed to assist countries in procuring antiretroviral therapy (ARV) at lower prices. In 2009, as the Global Fund to Fight AIDS, Tuberculosis and Malaria (GFATM) commenced a voluntary pooled procurement scheme, however, the impact of the scheme on ARV prices remains uncertain. This study aims to estimate the effect of VPP on drug prices using Efavirenz as a case study. Methods This analysis uses WHO Global price report mechanism (GPRM) data from 2004 to 2013. Due to the highly skewed distribution of drug Prices, a generalized linear model (GLM) was used to conduct a difference-in-difference estimation of drug price changes over time. Results These analyses found that voluntary pooled procurement reduced both the ex-works price of generic Efavirenz and the incoterms price by 16.2 and 19.1%, respectively ( P < 0.001) in both cases). The year dummies were also statistically significant from 2006 to 2013 ( P < 0.001), indicating a strong decreasing trend in the price of Efavirenz over that period. Conclusion Voluntary pooled procurement significantly reduced the price of 600 mg generic Efavirenz between 2009 and 2013. Voluntary pooled procurement therefore offers a potentially effective strategy for the reduction in HIV drug prices and the improvement of technical efficiency in HIV programming. Further work is required to establish if these findings hold also for other drugs.
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Affiliation(s)
- Sung Wook Kim
- Clinical Trial Unit, Warwick Medical School, Coventry, UK
- UCL Institute for Global Health, London, UK
| | - Jolene Skordis-Worrall
- UCL Institute for Global Health, London, UK
- London School of Hygiene and Tropical Medicine, London, UK
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11
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Kieran JA, O'Reilly E, O'Dea S, Bergin C, O'Leary A. Generic substitution of antiretrovirals: patients' and health care providers' opinions. Int J STD AIDS 2017. [PMID: 28632475 PMCID: PMC5606299 DOI: 10.1177/0956462417696215] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
There is interest in introducing generic antiretroviral drugs (ARVs) into high-income countries in order to maximise efficiency in health care budgets. Studies examining patients' and providers' knowledge and attitudes to generic substitution in HIV are few. This was a cross-sectional, observational study with a convenience sample of adult HIV-infected patients and health care providers (HCPs). Data on demographics, knowledge of generic medicine and facilitators of generic substitution were collected. Descriptive and univariate analysis was performed using SPSS V.23™. Questionnaires were completed by 66 patients. Seventy-one per cent would have no concerns with the introduction of generic ARVs. An increase in frequency of administration (61%) or pill burden (53%) would make patients less likely to accept generic ARVs. There were 30 respondents to the HCP survey. Concerns included the supply chain of generics, loss of fixed dose combinations, adherence and use of older medications. An increase in dosing frequency (76%) or an increase in pill burden (50%) would make HCPs less likely to prescribe a generic ARV. The main perceived advantage was financial. Generic substitution of ARVs would be acceptable to the majority of patients and HCPs. Reinvesting savings back into HIV services would facilitate the success of such a programme.
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Affiliation(s)
- Jennifer A Kieran
- 1 Department of Genitourinary Medicine and Infectious Disease, St James Hospital, Dublin, Ireland.,2 National Centre for Pharmacoeconomics, St James Hospital, Dublin, Ireland
| | - Eimear O'Reilly
- 3 School of Pharmacy, Royal College of Surgeons Ireland, Dublin, Ireland
| | - Siobhan O'Dea
- 1 Department of Genitourinary Medicine and Infectious Disease, St James Hospital, Dublin, Ireland
| | - Colm Bergin
- 1 Department of Genitourinary Medicine and Infectious Disease, St James Hospital, Dublin, Ireland.,4 Department of Medicine, Trinity College Dublin, Dublin, Ireland
| | - Aisling O'Leary
- 2 National Centre for Pharmacoeconomics, St James Hospital, Dublin, Ireland.,3 School of Pharmacy, Royal College of Surgeons Ireland, Dublin, Ireland
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Abstract
PURPOSE OF REVIEW To review current data on HIV-1 resistance arising from the use of fixed dose combination tenofovir disoproxil fumarate/emtricitabine (TDF/FTC) for preexposure prophylaxis (PrEP) to prevent HIV-1 infection. RECENT FINDINGS Resistance to tenofovir (TNV) or FTC is infrequently selected by TDF/FTC PrEP if started before HIV-1 infection has occurred, but is much more common when inadvertently started during undiagnosed acute infection. Mathematical modeling predicts that the number of HIV-1 infections averted by the use of PrEP far exceeds the increase in drug-resistant infections that could occur from PrEP. Studies in macaques show that TNV-resistant virus but not FTC-resistant virus can cause breakthrough infection despite TDF/FTC PrEP. FTC resistance with M184 V/I occurs more frequently than TFV resistance with K65R in seroconverters from clinical trials of TDF/FTC PrEP. SUMMARY The benefit of preventing HIV-1 infections with TDF/FTC PrEP far outweighs the risk of drug-resistant infection, provided PrEP is not started in persons with undiagnosed HIV-1 infection. We should respect but not fear HIV-1 resistance from TDF/FTC PrEP and recognize that most TNV or FTC resistance will arise from its use for antiretroviral therapy (ART). Preventing ART failure or detecting it early is most important for preventing the spread of HIV-1 resistance to TDF/FTC and preserving its effectiveness for both PrEP and ART.
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Schlatter AF, Deathe AR, Vreeman RC. The Need for Pediatric Formulations to Treat Children with HIV. AIDS Res Treat 2016; 2016:1654938. [PMID: 27413548 PMCID: PMC4927993 DOI: 10.1155/2016/1654938] [Citation(s) in RCA: 44] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/23/2016] [Accepted: 05/25/2016] [Indexed: 11/17/2022] Open
Abstract
Over 3.2 million children worldwide are infected with HIV, but only 24% of these children receive antiretroviral therapy (ART). ART adherence among children is a crucial part of managing human-immunodeficiency virus (HIV) infection and extending the life and health of infected children. Important causes of poor adherence are formulation- and regimen-specific properties, including poor palatability, large pill burden, short dosing intervals, and the complex storage and transportation of drugs. This review aims to summarize the various regimen- and formulation-based barriers to ART adherence among children to support the need for new and innovative pediatric formulations for antiretroviral therapy (ART). Detailing the arguments both for and against investing in the development of pediatric HIV medications, as well as highlighting recent advances in pediatric ART formulation research, provides a synopsis of the current data related to pediatric ART formulations and adherence.
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Affiliation(s)
- Adrienne F. Schlatter
- Department of Pediatrics, Indiana University School of Medicine, Indianapolis, IN 46202, USA
- Academic Model Providing Access to Healthcare (AMPATH), Eldoret 30100, Kenya
| | - Andrew R. Deathe
- Department of Pediatrics, Indiana University School of Medicine, Indianapolis, IN 46202, USA
- Academic Model Providing Access to Healthcare (AMPATH), Eldoret 30100, Kenya
| | - Rachel C. Vreeman
- Department of Pediatrics, Indiana University School of Medicine, Indianapolis, IN 46202, USA
- Academic Model Providing Access to Healthcare (AMPATH), Eldoret 30100, Kenya
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The HIV Treatment Gap: Estimates of the Financial Resources Needed versus Available for Scale-Up of Antiretroviral Therapy in 97 Countries from 2015 to 2020. PLoS Med 2015; 12:e1001907; discussion e1001907. [PMID: 26599990 PMCID: PMC4658189 DOI: 10.1371/journal.pmed.1001907] [Citation(s) in RCA: 40] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/18/2015] [Accepted: 10/16/2015] [Indexed: 12/21/2022] Open
Abstract
BACKGROUND The World Health Organization (WHO) released revised guidelines in 2015 recommending that all people living with HIV, regardless of CD4 count, initiate antiretroviral therapy (ART) upon diagnosis. However, few studies have projected the global resources needed for rapid scale-up of ART. Under the Health Policy Project, we conducted modeling analyses for 97 countries to estimate eligibility for and numbers on ART from 2015 to 2020, along with the facility-level financial resources required. We compared the estimated financial requirements to estimated funding available. METHODS AND FINDINGS Current coverage levels and future need for treatment were based on country-specific epidemiological and demographic data. Simulated annual numbers of individuals on treatment were derived from three scenarios: (1) continuation of countries' current policies of eligibility for ART, (2) universal adoption of aspects of the WHO 2013 eligibility guidelines, and (3) expanded eligibility as per the WHO 2015 guidelines and meeting the Joint United Nations Programme on HIV/AIDS "90-90-90" ART targets. We modeled uncertainty in the annual resource requirements for antiretroviral drugs, laboratory tests, and facility-level personnel and overhead. We estimate that 25.7 (95% CI 25.5, 26.0) million adults and 1.57 (95% CI 1.55, 1.60) million children could receive ART by 2020 if countries maintain current eligibility plans and increase coverage based on historical rates, which may be ambitious. If countries uniformly adopt aspects of the WHO 2013 guidelines, 26.5 (95% CI 26.0 27.0) million adults and 1.53 (95% CI 1.52, 1.55) million children could be on ART by 2020. Under the 90-90-90 scenario, 30.4 (95% CI 30.1, 30.7) million adults and 1.68 (95% CI 1.63, 1.73) million children could receive treatment by 2020. The facility-level financial resources needed for scaling up ART in these countries from 2015 to 2020 are estimated to be US$45.8 (95% CI 45.4, 46.2) billion under the current scenario, US$48.7 (95% CI 47.8, 49.6) billion under the WHO 2013 scenario, and US$52.5 (95% CI 51.4, 53.6) billion under the 90-90-90 scenario. After projecting recent external and domestic funding trends, the estimated 6-y financing gap ranges from US$19.8 billion to US$25.0 billion, depending on the costing scenario and the U.S. President's Emergency Plan for AIDS Relief contribution level, with the gap for ART commodities alone ranging from US$14.0 to US$16.8 billion. The study is limited by excluding above-facility and other costs essential to ART service delivery and by the availability and quality of country- and region-specific data. CONCLUSIONS The projected number of people receiving ART across three scenarios suggests that countries are unlikely to meet the 90-90-90 treatment target (81% of people living with HIV on ART by 2020) unless they adopt a test-and-offer approach and increase ART coverage. Our results suggest that future resource needs for ART scale-up are smaller than stated elsewhere but still significantly threaten the sustainability of the global HIV response without additional resource mobilization from domestic or innovative financing sources or efficiency gains. As the world moves towards adopting the WHO 2015 guidelines, advances in technology, including the introduction of lower-cost, highly effective antiretroviral regimens, whose value are assessed here, may prove to be "game changers" that allow more people to be on ART with the resources available.
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Jotwani V, Scherzer R, Abraham A, Estrella MM, Bennett M, Cohen MH, Nowicki M, Sharma A, Young M, Tien PC, Ix JH, Sarnak MJ, Parikh CR, Shlipak MG. Association of urine α1-microglobulin with kidney function decline and mortality in HIV-infected women. Clin J Am Soc Nephrol 2014; 10:63-73. [PMID: 25370597 DOI: 10.2215/cjn.03220314] [Citation(s) in RCA: 42] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
Abstract
BACKGROUND AND OBJECTIVES Despite advances in therapy, HIV-infected individuals remain at higher risk for kidney dysfunction than uninfected individuals. It was hypothesized that urine levels of α1-microglobulin, a biomarker of proximal tubular dysfunction, would predict kidney function decline and mortality risk in HIV-infected and uninfected women. DESIGN, SETTING, PARTICIPANTS, & MEASUREMENTS In the Women's Interagency HIV Study, urine α1-microglobulin and creatinine concentrations were measured in 903 HIV-infected and 287 uninfected women using stored urine from 1999 to 2000, when prevalence of tenofovir use was <1%. Participants were categorized into three categories by level of α1-microglobulin-to-creatinine ratio, and associations with kidney decline and all-cause mortality over 8 years were evaluated. RESULTS Urine α1-microglobulin was detectable in 60% of HIV-infected and 40% of uninfected women (P<0.001). Among HIV-infected women, there were 177 (22%), 61 (7%), and 128 (14%) patients with incident CKD, with 10% annual eGFR decline, and who died, respectively. Compared with HIV-infected women in the lowest α1-microglobulin category, HIV-infected women in the highest α1-microglobulin category had a 2.1-fold risk of incident CKD (95% confidence interval, 1.3 to 3.4), 2.7-fold risk of 10% annual eGFR decline (95% confidence interval, 1.2 to 5.9), and 1.6-fold mortality risk (95% confidence interval, 1.0 to 2.6) in models adjusting for kidney risk factors, baseline eGFR, and albuminuria. Among uninfected women, the highest α1-microglobulin category was associated with 3% (relative risk, 2.2; 95% confidence interval, 1.4 to 3.5) and 5% (relative risk, 2.2; 95% confidence interval, 1.1 to 4.3) annual eGFR decline relative to the lowest α1-microglobulin category. CONCLUSIONS Proximal tubular dysfunction, indicated by urine α1-microglobulin, was independently associated with kidney function decline in HIV-infected and uninfected women and mortality risk among HIV-infected women.
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Affiliation(s)
- Vasantha Jotwani
- Due to the number of contributing authors, the affiliations are provided in the Supplemental Material
| | - Rebecca Scherzer
- Due to the number of contributing authors, the affiliations are provided in the Supplemental Material
| | - Alison Abraham
- Due to the number of contributing authors, the affiliations are provided in the Supplemental Material
| | - Michelle M Estrella
- Due to the number of contributing authors, the affiliations are provided in the Supplemental Material
| | - Michael Bennett
- Due to the number of contributing authors, the affiliations are provided in the Supplemental Material
| | - Mardge H Cohen
- Due to the number of contributing authors, the affiliations are provided in the Supplemental Material
| | - Marek Nowicki
- Due to the number of contributing authors, the affiliations are provided in the Supplemental Material
| | - Anjali Sharma
- Due to the number of contributing authors, the affiliations are provided in the Supplemental Material
| | - Mary Young
- Due to the number of contributing authors, the affiliations are provided in the Supplemental Material
| | - Phyllis C Tien
- Due to the number of contributing authors, the affiliations are provided in the Supplemental Material
| | - Joachim H Ix
- Due to the number of contributing authors, the affiliations are provided in the Supplemental Material
| | - Mark J Sarnak
- Due to the number of contributing authors, the affiliations are provided in the Supplemental Material
| | - Chirag R Parikh
- Due to the number of contributing authors, the affiliations are provided in the Supplemental Material
| | - Michael G Shlipak
- Due to the number of contributing authors, the affiliations are provided in the Supplemental Material.
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Beck EJ, Passarelli C, Lui I, Guichard AC, Simao M, De Lay P, Loures L. Scaling-up the use of generic antiretrovirals in resource-limited countries: generic drugs for health. Antivir Ther 2014; 19 Suppl 3:117-23. [PMID: 25310477 DOI: 10.3851/imp2906] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 07/14/2014] [Indexed: 10/24/2022]
Abstract
The number of people living with HIV (PLHIV) continues to increase around the world because of the increasing number on antiretroviral therapy (ART) and their associated increase of life expectancy, in addition to the number of people newly infected with HIV each year. Unless a 'cure' can be found for HIV infection, PLHIV can anticipate the need to take antiretroviral drugs (ARVs) for the rest of their lives. Because ARVs are now being used for HIV prevention, as well as for therapeutic purposes, the need for effective, affordable ARVs with few adverse effects will continue to rise. It is important to note that the dramatic growth in treatment coverage of PLHIV seen during the past decade has been primarily due to the increased use of generic ARVs. Thus, there will be a need to scale-up the research and development, production, distribution and access to generic ARVs and ART regimens. However, these processes must occur within national and international regulated free-market economic systems and must deal with increasingly multifaceted patent issues affecting the price while ensuring the quality of the ARVs. National and international regulatory mechanisms will have to evolve, which will affect broader national and international economic and trade issues. Because of the complexity of these issues, the Editors of this Supplement conceived of asking experts in their fields to describe the various steps from relevant research and development, to production of generic ARVs, their delivery to countries and subsequently to PLHIV in low- and middle-income countries. A main objective was to highlight how these steps are interrelated, how the production and delivery of these drugs to PLHIV in resource-limited countries can be made more effective and efficient, and what the lessons are for the production and delivery of a broader set of drugs to people in low- and middle-income countries.
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Affiliation(s)
- Eduard J Beck
- Office of the Deputy Executive Director, UNAIDS, Geneva, Switzerland.
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