Access to drugs for HIV/AIDS patients. What are the REAL issues?
Int Conf AIDS 2002 Jul 7-12; 14:(abstract no. G12523)
Laing RO Boston University SPH, Boston, United States
Millions of people in developing countries lack access to OI & ARV drugs. The Declaration of Doha has resolved patent issues meaning that the other obstacles to access now need to be addressed. Selection involves both "who" will be treated and "with what?" Choosing which patients to treat is difficult where diagnostic tests (CD4 & viral load) are unavailable. The risks of creating resistance by providing single dosage form products may be prevented by using Fixed Dose Combination products. Procurement of ARV and OI drugs provides complex choices for countries and organisations between international and generic companies. Non profit suppliers may be the best alternative. Distribution of these drugs may involve multiple channels including private sector. Governments face particular problems in distributing such drugs as rationing decisions have to be made and governments usually ration by shortage. Rational Use depends on having trained staff, evidence based guidelines, informed patients and a support structure. Techniques which have been effective with other diseases in improving use and adherence may be used in AIDS. Regulation and Quality Assurance require that a country have a functioning Drug Regulatory Agency (DRA), legislation & regulations in place and regulators, with access to basic testing services, capable of enforcing standards. Financing requires that funding mechanisms exist to sustain ongoing treatment. While models exist of national funding e.g. Brazil, varied mechanisms may be required. Deciding how donor funds can be most effectively spent will be a major challenge. As drug prices decrease, governments, donors and the GHF will face the challenge of deciding how to provide drugs to HIV/AIDS patients. While solutions exist to each individual obstacle, deciding which combination of solutions will be most effective in differing circumstances will be the ultimate challenge.
Keywords: AEGIS, Acquired Immunodeficiency Syndrome, HIV Infections, Pharmaceutical Preparations, HIV Seropositivity, Developing Countries, Private Sector, Brazil, Human
