First-line ART drops below US $45 a year for low-income countries

Polly Clayden, HIV i-Base

The Global Fund recently announced a 25% price reduction for tenofovir disoproxil fumarate, lamivudine and dolutegravir (TLD) – now below US $45 per person, per year for eligible governments and other implementers.

The World Health Organisation (WHO) has recommended TLD as the preferred first-line ART since 2018 for adults and adolescents. It is also used second-line for people who used efavirenz-based ART first-line.

This price reduction builds on work done in 2017, when Indian generic manufacturers, with support from UNAIDS, Unitaid, PEPFAR, the Bill & Melinda Gates Foundation, the Global Fund and other partners, made TLD available for low-income countries at a ceiling price of around US $75 per person, per year.

According to the Clinton Health Access Initiative (CHAI)  about 19 million people living with HIV in low-income countries are now receiving TLD.

The Global Fund uses its Pooled Procurement Mechanism to order volumes on behalf of participating grant implementers and to negotiate prices and delivery conditions with manufacturers. Antiretrovirals make up about 40% of the mechanism’s annual spend.


Global Fund press release. Global Fund agreements substantially reduce the price of first-line HIV treatment to below US$45 a year. 30 August 2023.

First published online 17 October 2023.

Links to other websites are current at date of posting but not maintained.