Improved access to care means more local action and less administration

[21 August 2009 - 09h40]

The Three by Five initiative launched by UNAIDS and the WHO has been valuable in providing quantified targets for international cooperation against AIDS. True, the objective of 3 million patients being treated in 2005 was not achieved at that time, but it has now been substantially exceeded. Has the structuring of action helped to get the system moving? Not completely. Out in the field, many deficiencies are still being identified and local action is key to success.

“In 1997, as a doctor in Kinshasa, I had patients (infected with HIV) to whom I was unable to offer affordable treatment. I was reduced to giving support only. And then we reached an initial agreement with CIPLA.”

The Indian generic pharmaceutical giant was one of the first on the “market” in the fight against HIV, though not always at modest prices, Dr Tuna Lukiana explained to us at the 5th International AIDS Society (IAS) Conference in Cape Town. Furthermore, the debate over the question of the prices being levied by this industry is always very heated, with health professionals criticising generic producers for being too greedy.

50% of funding unused

Now a doctor at the Avicenne Hospital in Bobigny, France, Dr Lukiana is scientific attaché within the framework of the cooperation programmes being led by Boehringer-Ingelheim and AXIOS in Africa, because direct local action remains very important. “In Kinshasa, more than 50% of the annual Global Fund (against AIDS, Tuberculosis and Malaria: ed. note) budget is not used because of the administrative constraints (reporting, dossier construction, planning, etc) that burden health teams”, he admitted. On the positive side, thanks to multisectoral cooperation, the price of treatment is falling.

“In 2000, CIPLA made treatment available to us for 100 dollars a month. But in countries without any social security system, nobody suffering from illness has this sort of money. Today, fortunately, the major international agencies’ access to care programmes purchase the drugs directly”. And not at the prices charged by generic producers. “Thanks to donation programmes set up locally, the same treatments are now available at 85% to 90% of the original price. For example, the cost of nevirapine treatment which is 1,000 euros in the North is now down to 60 euros in the South”.

More than sixty of these donation programmes are operating in Africa, in countries of central and eastern Europe such as Ukraine and Russia, as well as in China. “We provide the aid downstream, locally”, points out Dr Lukiana. “The drugs are supplied directly to the patients who need them.” In the case of prevention of mother-to-child transmission (MTC) of HIV, for example, “more than 60% of women only see a gynaecologist once during their pregnancy, so they must be given everything they need there and then, well packaged, so that it can be used by the midwives”, at the time of birth.

Source : from our special correspondents at the 5th IAS Conference, Cape Town, 19-22 July 2009; interview with Dr Tuna Lukiana, 21 July 2009.

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