[Lac] DIA MUNDIAL DEL SIDA
Lady Murrugarra
lady at viabcp.com
Mon Dec 1 00:47:57 GMT 2003
> ELDIS HIV/AIDS REPORTER
> 1 December 2003
> ------------------------------------------------------------
>
> To coincide with World AIDS Day 2003, this special reporter
> from Eldis highlights the role of anti-retrovirals (ARVs) in
> the fight against the HIV/AIDS epidemic.
>
> The reporter links to a new guide on ARVs on the Eldis site
> covering issues such as patents and generic drugs, scaling up
> accessibility and the limitations of ARVs. A selection of the
> resources available from the Eldis ARV guide are also listed
> in this reporter.
>
> The documents are available free on the web. If you are
> unable to access any of these materials online and would
> like to receive a copy of a document as an email attachment,
> please contact our editor at the email address given below.
>
> [NOTE: Some links in this bulletin are long (wrapping onto
> two lines) and therefore may not link correctly. Copy and
> paste the entire link into your browser to get to the
> intended page.]
>
>
> NEW DOCUMENTS:
> ------------------------------------------------------------
>
> 1. New Eldis key issues page: Anti-retrovirals
> 2. Demystifying antiretroviral therapy in resource-poor
> settings
> 3. Expanding access to Antiretroviral Therapies in Chile:
> economic and financial issues for patients and the health
> system
> 4. Drugs in development: new promise [ACRIA Update, vol 12]
> 5. Antiretroviral treatment can be cost-saving for industry
> and life-saving for workers: a case study from Côte
> d'Ivoire's private sector
> 6. Intellectual property rights, anti-AIDS policy and generic
> drugs: lessons from the Brazilian public health program
> 7. The costs of anti-retroviral treatment in Zambia
> 8. Surmounting challenges: procurement of antiretroviral
> medicines in low- and middle-income countries
>
> ------------------------------------------------------------
>
> 1. NEW ELDIS KEY ISSUES PAGE: ANTI-RETROVIRALS
>
> Author(s) A. Marriott (Eldis)
>
> Anti-Retrovirals (ARVs), where accessible and affordable,
> have had a significant impact on HIV/AIDS related
> morbidity and mortality.
>
> This guide from Eldis, launched to co-incide with World
> AIDS Day 2003, outlines the key issues related to ARVs
> including generic drugs vs. patents, scaling up access to
> ARVs, as well as the limitations associated with anti-
> retroviral therapy.
>
> Available online at:
> http://www.eldis.org/hivaids/ARVs/ARVindex.htm
>
>
>
> 2. DEMYSTIFYING ANTIRETROVIRAL THERAPY IN RESOURCE-
> POOR SETTINGS
>
> Author(s): Access to Essential Medicines Campaign, Médecins
> Sans Frontières (MSF)
>
> Produced by: Access to Essential Medicines Campaign, MSF
> (2003)
>
> This paper uses the example of a poor township 30 kilometres
> outside Cape Town to find out if antiretroviral therapy is
> possible in severely resource-constrained environments and to
> discover the best ways to deliver these drugs.
>
> Zidovudine (AZT, first became available in Khayelitsha
> township's two maternity wards in early 1999, and the
> programme has subsequently become one of the continent's
> biggest. Treatment was initially limited to opportunistic
> infections, but in May 2001, this was broadened to include
> antiretroviral therapy (ART), making the project the first to
> use antiretrovirals in government health facilities outside
> the context of clinical trials.
>
> In analysing the programme's success to date and assessing
> the possibilities to use it as a model in other settings,
> three key aspects stand out:
> * the drugs must be affordable. In this case, it meant
> beginning with brand-name drugs which, although
> considerably cheaper than in developed countries (or,
> indeed, in South Africa a few years earlier), were still
> much more expensive than generic versions produced in
> countries such as Brazil, India and Thailand
> * the involvement of the community. This was facilitated by
> giving all treatment at primary health care level, rather
> than at a large reference hospital. The community was also
> integrally involved in the process of selecting patients
> for ART, which played a major role in guaranteeing local
> ownership over the project as a whole
> * the involvement of the patients themselves has been
> essential. They are genuine partners in the project at a
> number of levels:
> * the political level, when politicians have questioned
> the validity of using ART in resource-poor settings, it
> was the patients who responded, writing letters to
> newspapers and speaking out in the media
> * at the community level, they play an important role in
> the support groups run for patients on ART, with those
> who have been on therapy for longer periods of time
> helping mentor those beginning. Also, a number of
> patients work with a South African NGO, the Treatment
> Action Campaign, on a major community education
> Initiative
> * at the individual level, patients have educated
> themselves on the importance of adherence, allowing them
> to take responsibility for their own therapy, making it
> unnecessary to use medical staff to observe them taking
> their pills
>
> The project has revealed a number of important lessons:
> * ART can be safely and effectively used in resource-poor
> settings, and the time has come to scale up from pilot
> projects widespread access
> * Managing patients on ART is often easier than managing
> patients not taking antiretrovirals due to a lesser need
> to diagnose and treat opportunistic infections. A decrease
> in hospitalization of patients also off-sets a
> considerable percentage of the costs incurred by drug
> purchases
> * The availability of ART bolsters the entire health system
> as it enables the staff's role to shift back from care of
> the dying to being able to help patients return to good
> health, with an obvious improvement in morale
> * Access to ART has ensured retention of patients. In
> Khayelitsha, not a single patient on antiretroviral
> Therapy has been lost to follow up, in marked contrast
> with the general experience in this highly mobile
> township
> * In Khayelitsha, the availability of treatment has provided
> a powerful incentive to learn one's status. Thus
> demonstrating the synergy between treatment and
> prevention
>
>
> Available online at:
> http://www.accessmed-msf.org/documents/EDMARVkhayelitsha.pdf
>
>
>
> 3. EXPANDING ACCESS TO ANTIRETROVIRAL THERAPIES IN
> CHILE: ECONOMIC AND FINANCIAL ISSUES FOR PATIENTS
> AND THE HEALTH SYSTEM
>
> Author(s): Morales, C.; Cid Pedraza, C.; Souteyrand, Y.
>
> Produced by: International AIDS Economics Network (IAEN)
> (2003)
>
> The main goal of this paper is to describe the Chilean
> experience in improving the accessibility to ART, in order
> to identify the problems more clearly and to assess the
> consequences both for patients and their caregivers and for
> the health system. The paper specifically focuses on 4 key
> issues:
> * the selection of the patients having access to ART in a
> context of limited resources;
> * the transfer of the patients from the private system to
> the public health system (PHS);
> * the financial burden for patients;
> * the impact of expanding ART on the current organization
> of ART distribution
>
> For the purpose of the study two data sources were used: a
> quantitative survey of people living with HIV/AIDS (PLWA)
> and two series of structured interviews with key actors of
> the Chilean Health System. The main results of the research
> are:
> * apart from medical criteria, socioeconomic factors
> introduce a significant bias in the selection of patients;
> * due to better cover, 30% of patients switched to the
> Public Health System before accessing ART;
> * patients have to use different strategies in order to
> access ART, including paying for treatment out-of-pocket
> and taking out loans;
> * due to the complexity of the distribution process, stocks
> frequently run out, with consequences on the patients'
> health status and the quality of work in the health
> centers, as well as creating tension among the various
> health institutions involved
>
> Success in effectively maintaining the Chilean strategy of
> universal cover will further depend on the appropriateness
> of the needs assessment, on the involvement of the private
> sector, on the efficiency of the distribution process and,
> above all, on the ability of the PHS to mobilize funds.
> Mobilization of national funds will be the key to
> substituting in the mid-term those recently obtained from
> the Global Fund to Fight AIDS, Malaria and Tuberculosis and
> also to sustaining future therapeutic guidelines regarding
> new generations of more expensive ART.
>
> Lessons from the Chilean experience should be useful not
> only for the Chilean health authorities in their efforts to
> develop evidence-based interventions to fight HIV/AIDS, but
> also for other countries of Latin-America, Eastern Europe
> and Asia that may share similar epidemiological, economic
> and social characteristics.
>
> Available online at:
> http://www.iaen.org/files.cgi/11127_part_2_n9_Morales.pdf
>
>
>
>
> 4. DRUGS IN DEVELOPMENT: NEW PROMISE [ACRIA UPDATE,
> VOL 12]
>
> Author(s): The AIDS Community Research Initiative of
> America (ACRIA)
>
> Produced by: The AIDS Community Research Initiative of
> America (ACRIA) (2003)
>
> This issue of ACRIA Update focuses on antiretrovirals that
> are being developed to deal with problems of new
> formulations of old drugs, second generation drugs in
> existing classes, drugs like entry inhibitors that target
> HIV at different points in its life cycle, and drugs that
> are in very early stages of development.
>
> The paper demonstrates that we may never hear of some of
> these drugs again; the promise that some have shown in test
> tube and animal studies won't achieve similar results in
> people. Others may be discontinued as pharmaceutical
> companies merge and corporate priorities change. Knowing
> about drugs in the pipeline can spur us to take action when
> development stalls. It's equally important to understand
> that new drug development is ongoing and that the pipeline
> is filled with candidates that offer promise.
>
> The paper concludes that new classes of anti-HIV drugs, and
> new drugs in existing classes, represent the best hope for
> people with HIV, especially those who have exhausted
> current therapies. Even people whose HIV is resistant to
> drugs in all three existing classes stand to benefit from
> new agents now in the pipeline. And drugs that work by
> different mechanisms may produce fewer side effects. But
> even with the best new agents, resistance remains a major
> concern. It will likely remain the case that the best
> treatment strategy involves use of multiple drugs that
> attack HIV from different angles.
>
> Available online at:
> http://www.acria.org/treatment/acriaupdatewinter2002.pdf
>
>
>
>
>
> 5. ANTIRETROVIRAL TREATMENT CAN BE COST-SAVING FOR
> INDUSTRY AND LIFE-SAVING FOR WORKERS: A CASE
> STUDY FROM CÔTE D'IVOIRE'S PRIVATE SECTOR
>
> Author(s): Eholie, S-P.; Nolan, M.; Gaumon, A.P.; Mambo, J.;
> Kouamé-Yebouet, Y.; Aka-Kakou, R.; Bissagnene, E.; Kadio,
> A.
>
> Produced by: International AIDS Economics Network (IAEN)
> (2003)
>
> This paper aims to describe the health and economic impact
> of comprehensive HIV care with Anti-Retroviral Treatments
> (ART) within a private enterprise in Côte d'Ivoire.
>
> It describes how an "HIV solidarity fund" is used to
> finance ART to HIV-infected workers in Côte d'Ivoire. The
> treating physicians abstracted data from medical and
> company records including the year before and the two years
> after the introduction of comprehensive HIV care with ART.
> The human resources department estimated direct costs
> associated with morbidity and absenteeism.
>
> Findings:
> * from 1995 to 1999 HIV was the leading cause of death for
> employees
> * comparing the 12-months period before and 24-months
> period after the introduction of comprehensive HIV care
> with ART, there was a fivefold increase in company-based
> voluntary testing among HIV-infected persons, a 94%
> decrease in HIV-related absenteeism, an 81% decrease in
> HIV-related hospitalisations, a 78% decrease in new AIDS
> cases, a 58% decrease in HIV related mortality
> * this resulted in dramatic health and survival benefits to
> HIV infected workers and an estimated 2-year net direct
> profit of US$558,000 over the 2-year period. The HIV
> solidarity fund contributed US$217,000 and the program made
> a saving of US$287,000 due to reduced absenteeism
> * A saving of US$294,000 related to health care costs and
> US$194,000 in funeral costs was also made
>
> Available online at:
> http://www.iaen.org/files.cgi/11116_part_2_n4_Eholie.pdf
>
>
>
> 6. INTELLECTUAL PROPERTY RIGHTS, ANTI-AIDS POLICY
> AND GENERIC DRUGS: LESSONS FROM THE BRAZILIAN
> PUBLIC HEALTH PROGRAM
>
> Author(s): Orsi, F.; Hasenclever, L.; Fialho, B.; Tigre, P.;
> Coriat, B.
>
> Produced by: International AIDS Economics Network (IAEN)
> (2003)
>
> The paper analyses Brazil's national anti-Aids programme.
> The focus is on the main choices that have governed the
> Programme's preparation, the obstacles it has faced and how
> it has overcome them. By doing so, the paper also
> identifies some remaining limitations that may undermine the
> programme's long-term sustainability in its current form.
>
> The paper specifically highlights the contradiction that
> exists between a public health goal of ensuring the lowest
> possible prices of ARVs for a maximum number of patients,
> and the way the means used to achieve this goal have made
> it harder to implement autonomous and competitive local
> production, notably in the field of active principles.
>
> The paper concludes with the key elements provided by the
> Brazilian experience for the debate on TRIPS.
>
> [Author]
>
> Available online at:
> http://www.iaen.org/files.cgi/11074_part_1_n4_Orsi.pdf
>
>
>
> 7. THE COSTS OF ANTI-RETROVIRAL TREATMENT IN ZAMBIA
>
> Author(s): Kombe, G.; Smith, O.
>
> Produced by: Partners for Health Reformplus (PHRplus) (2003)
>
> This report analyzes the costs and resource requirements
> associated with the provision of antiretroviral (ARV)
> therapy in the public health sector in Zambia. It provides
> per-patient cost estimates for highly active anti-
> retroviral therapy (HAART), voluntary counselling and
> testing, several opportunistic
> infections, and prevention of mother-to-child transmission
> services.
>
> These per-patient cost estimates are used to project total
> program costs, which are then compared to currently
> budgeted resources with an emphasis on financial
> sustainability.
>
> The report also explores a range of policy issues,
> including:
> * the importance of human resource constraints
> * the implications of alternative monitoring protocols and
> drug regimens
> * opportunities for resource mobilization
> * targeting issues
>
> The provision of ARVs in Zambia is a dynamic issue: certain
> programmatic decisions have yet to be made, and both prices
> and technologies are changing rapidly. Thus, the purpose of
> this report is to highlight the key questions related to
> HAART costs, rather than to propose any definitive answers.
> [author's abstract]
>
> Available online at:
> http://www.phrplus.org/Pubs/Tech029_fin.pdf
>
>
>
> 8. SURMOUNTING CHALLENGES: PROCUREMENT OF
> ANTIRETROVIRAL MEDICINES IN LOW- AND MIDDLE-
> INCOME COUNTRIES
>
> Author(s): MSF; WHO
>
> Produced by: Access to Essential Medicines Campaign, MSF
> (2003)
>
> As the price of antiretrovirals (ARVs) in low- and middle-
> income countries has fallen in recent years, governments,
> international agencies and non-governmental organisations
> have been able to start developing treatment programmes for
> people living with HIV/AIDS (PLWHA). Procurement strategies
> are a key element in this global scaling-up process.
>
> This report, produced by Médecins sans Frontières (MSF) and
> the World Health Organization (WHO) and based on MSF's
> experience over the past two years, outlines the major
> parameters that ARV procurement agents need to consider.
> Ten country case reports illustrate how challenges were, and
> continue to be, overcome in specific contexts. This report
> also shares observations about how government and market
> dynamics impact drug availability in poor countries. The
> report finds that procurement works best when there is a
> national HIV/AIDS strategy that includes ARV treatment, and
> that is supported by government commitment and political
> will. Sufficient funding is crucial to implement national
> action plans. [adapted from author]
>
> Available online at:
> http://www.accessmed-msf.org/documents/Finalpre-publversionSept17.pdf
>
>
>
>
> ----------------------------------------------------
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