AAI Pharma access programme providing treatment for 36,000 people in Africa
Simon Collins, HIV i-Base
The current status of the Access Alliance Initiative (AAI) was outlined to press and community meetings on 14 January in London. The AAI group is a partnership between five United Nations organisations and six major pharmaceutical companies involved in HIV treatment and diagnostics. [1, 2]
Largely as a response to the heightened political awareness of the inequalities of access to care at the International AIDS Conference in Durban in 2000, but partly also in response to the availability of cheaper generic alternatives, each company has reduced prices of drugs by around 85-95%, and in some cases developed donation programmes and generic licensing agreements.
Accessing treatments at these reduced costs requires active involvement at national level of governmental agencies and a decision from each country to actively tackle HIV. Of 80 countries who have so far approached AAI, 40 have developed plans for action and 19 countries have programmes now agreed and in place.
It was stressed that improving health and life expectancy for people living with HIV in Africa involves developing relevant health infrastructure as well as providing drugs themselves. Individual initiatives developed by many of the pharmaceutical companies in the AAI directly address improving this structure.
On a global scale this initiative has led to access to treatment for perhaps less than 0.5% of HIV positive people in Africa over two years, but it has provided treatment for 36,000 people who would otherwise have gone without. More importantly it has generated a structure upon which increased access to care can be developed.
At the World AIDS Conference in Barcelona in 2002, WHO suggested a goal of three million people on treatment by 2005. This figure is seen as an unrealistically optimistic practical challenge by many agencies aware of the current health care structures that currently exist. It was also seen as appallingly pessimistic given that currently over 40 million people are now infected with HIV.
The Barcelona Conference also contained frequent references to the political will required by Western countries to contribute to the estimated $10 billion-a-year Global Fund to Fight AIDS, TB and Malaria and the difficulties of maintaining a sense of urgency when many people believe the myth that ‘AIDS is over’ whereas the catastrophe is still gaining momentum on a global scale.
Several other practical issues were raised at the meeting, including:
Whether use of triple combination for the final week of pregnancy could be developed by AAI, given that use of single dose nevirapine put mothers at high risk for developing resistance without reducing transmission risk to levels that would be acceptable in Western countries.
Whether individuals from countries working with AAI are able to purchase and access treatment at these reduced prices.
The level of care accessed remains an important issue. Just over two-thirds of people accessing treatment through this initiative are using combination therapy containing three drugs, but this leaves around one third who will obtain much more limited benefit from using two-drug therapy, which is widely accepted as sub-optimal care in the West.
Although the focus for the AAI programme is Africa, high infection rates have recently been recognised in China, India and Eastern Europe.
Manufacturers of generic drugs currently produce triple combinations at less than $300 for a year’s treatment which AAI maintains are close or similar to treatments available under their programme. AAI says that cost is not the only issue. Generic manufacturers have been invited to join the AAI intiative but none have yet done so.
Jeffrey Sturchio, who leads the Merck initiative in the programme recognised that the programme was still just scratching the surface of the problem and that more political will and resources were required. This is “like trying to change a tyre on a car that’s going at 100 kilometers an hour – but you still have to try”.
- UNAIDS Secretariat, WHO, UNICEF, UN Population Fund, World Bank
- Abbott Laboratories, Boehringer-Ingelheim, Bristol-Myers Squibb, GlaxoSmithKline, F.Hoffman La-Roche, Merck &Co.