MELBOURNE/NEW YORK—High prices continue to represent a major barrier to affordable access of both new HIV medicines and viral load testing—which is the best way to monitor whether treatment is working—according to two reports released today by international medical humanitarian organization Doctors Without Borders/Médecins Sans Frontières (MSF).
Scaling up HIV treatment to reach more people in need and ensuring successful treatment in suppressing the virus will require concerted actions by countries to make these critical tools more affordable.
“Nearly 12 million people are now receiving antiretroviral therapy (ART) in developing countries,” said Jennifer Cohn, medical director of MSF’s Access Campaign. “With people increasingly starting treatment earlier and remaining on treatment for life, patients need better-tolerated first-line treatments as well as affordable second-line therapy for when first-line medicines fail.”
Additional tools to support treatment are needed to ensure the best quality of care. Routine viral load monitoring—which measures the level of HIV virus in the blood, and therefore how well someone is responding to treatment—is one of these tools.
“Viral load monitoring detects adherence problems early which, when paired with counseling and support, can help people stay on more affordable first-line treatment for longer,” said Dr. Cohn. “Viral load monitoring also more accurately and rapidly identifies those people who need to be switched to second- or third-line treatment if their existing regimen is failing.”
The new MSF report Getting to Undetectable, which describes access to viral load testing in India, Kenya, Malawi, South Africa, and Zimbabwe, reveals that while these countries aspire to implement routine viral load monitoring, almost none have been able to do this on a wide scale. The report concludes that, among other barriers, the price per test paid by countries is a major obstacle to wider implementation.
The report also outlines steps that countries can take to reduce the cost and complexity of introducing viral load monitoring, including better price negotiation; renting instruments instead of buying them; dropping the more common, but less accurate, CD4 monitoring; and using more efficient sample collection techniques. These steps have been successful in some countries; negotiations have already resulted in price decreases for viral load, with Kenya paying about US$10 per test. Donors, however, need to step up to the plate and provide financing for rolling out viral load in those areas that need it most.
“We know what tools we need to use to help ensure people’s HIV virus can get to undetectable and stay there,” said Dr. Cohn. “But in most of our contexts, they’re priced out of reach.”
Although roll-out of viral load is slow and incomplete, it is expected to uncover many people who are failing first-line treatment and need to be switched to second-line. Thus, the price of drugs for second-line therapy becomes a critical issue.
MSF’s annual drug pricing report, Untangling the Web of Antiretroviral Price Reductions, this year concludes that, while the cost of first- and most second-line regimens has fallen over the last 12 months, second-line regimens are still more than double the cost of first-line treatment. For middle income countries the situation is worse, with some countries paying more than 12 times more than the lowest known price.
“There are millions of people without access to treatment, and many of those on treatment need to be switched to newer regimens,” said Leena Menghaney, manager of MSF’s Access Campaign in India. “If we are to get more people on treatment now, countries need to overcome patent barriers that undermine affordable access to drugs.”
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