CHAI 2022 report on global access to ART
Simon Collins, HIV i-Base
On 13 November 2022, Clinton Health Access Initiative (CHAI) published their annual global HIV market report, with UNITAID and the Bill & Melinda Gates Foundation.
These organisations continue to play a leading role in global access by using economies of scale and bulk purchasing agreements to negotiate lower prices for better HIV medicines in lower and middle-income countries (LMICs).
Globally, 95:95:95 targets by 2025 are currently at 88:90:92, with COVID-19 leading to fewer HIV tests for 2019 and 2020.
Key highlights include:
- Only 52% of children are on ART (880,000/1.7 million) compared to 76% adults in LMICs.
- Only 40% on ART have undetectable viral load
- There are still 160,000 new paediatric infections each year
- Only 30% of children in LMICs access early infant diagnosis (EID) – and many children with positive results are lost to care within the next year..
- 98,000 children died of HIV-related causes.
- Undiagnosed syphilis during pregnancy still causes 200,000 preventable stillbirths or newborn deaths.
- Deaths from advanced HIV (AHD) are not dropping quickly enough. Although 650,000 people (11% children) died of AHD in 2021, this is only 6% per each year compared to the 20% annual drop needed to reach the 2025 target of 200,000.
- One-third of deaths are related to TB (incluiding 11% of children).
- COVID-19 disproportionally affects people living with HIV, but by July 2022, only 21% of people in Africa had completed a primary course of vaccines (and coverage wanes after 6 months). CHAI and partners negotiated for a course of Paxlovid to be available for high risk patients at $25.
- Continued investment is still needed to enable access to latest and upcoming HIV drugs. Most people globally are treated with generic medicines which has a market of US$1.2 billion.
- Generic TLD (tenofovir D/lamivudine/dolutegravir) is now available for less than US$ 50 per year using 6-monthly 180-pack cartonless packs. (By comparison, people living in the US are often still restricted to having to get a new prescription every month).
- 80% of people in LMICs now use DTG-based ART, although differentiation between first/second-line and adult/paediatric data are unclear, making monitoring difficult.
- Generic darunavir/ritonavir (400/50 mg) is now US$ 17.50 per month. This is less than lopinavir/r although WHO still lists LPV/r as a second-line option). This is WHO approved but not available for PEPFAR because it is expected to be FDA prequalified until 2024.
- Generic paediatric dolutegravir is US$ 4.50 for 90-pill pack.
- HIV self-testing now US$ 1.00 per test for public purchasing in 140 LMICs including a dual HIV/syphilis test.
- Generic TDF/FTC for oral PrEP is US$ 4.00 a month.
- Point-of-care CD4 test to diagnose advanced HIV (Visitect, with a 350 c/mm3 threshold) is < US$ 4.00 and available for public purchasing in 130 LMICs.
- Low pricing agreements have also been negotiated for TB preventative treatment preventive therapy three‐month weekly rifapentine and isoniazid (3HP) and one‐month daily rifapentine and isoniazid (1HP).
- Access programmes for liposomal amphotericin B (L-AmB) for cryptococcal meningitis are also being developed. This includes the important example of an FDA-approved generic biosimilar formulation of a liposomal nanomedicine.
Information is also included on long-acting cabotegravir and rilpivirine. Also for lenacapavir and islatravir, although neither compound has been included in a generic access option.
The report also highlights increases in global uptake of PrEP and developments for access to injectable PrEP.
CHAI 2022 HIV Market Report: The state of the HIV market in low- and middle-income countries
https://www.clintonhealthaccess.org/webinar/2022-hiv-market-report (report )
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