Problems in assuring the availability, affordability, quality, and rational use of drugs are universal, but access to HIV-related drugs in developing countries and underprivileged communities presents particular challenges. In many cases, HIV patients are struggling to obtain even the most basic essential drugs. The Task Team on Access to HIV-related Drugs has adopted a four-part strategy and plan of action to guide and coordinate access to HIV-related drugs:
1. Rational selection and use
HIV/AIDS-related drugs include established essential drugs for prevention and treatment of opportunistic infections, palliative and supportive care, treatment for sexually-transmitted diseases, "lower cost" infections such as pneumonia and tuberculosis, "high cost" opportunistic infections, HIV-related cancers, and antiretrovirals, which may be used for prevention of mother-to-child transmission, needle-stick injuries by health workers, or treatment of clinical AIDS. Use of HIV-related drugs should be based on guidelines which have been locally adapted to achieve the greatest impact with available resources.
2. Affordable prices
Affordable prices are a critical factor given the cost of some HIV-related drugs and are being pursued through a UNICEF/WHO/UNAIDS price information service, support for competitive procurement through generic tendering and therapeutic competition among different single-source drugs, dialogue with pharmaceutical companies to achieve preferential prices for lower income countries, reduction or elimination of import duties for essential drugs (including HIV-related drugs) including local taxes, local production where this results in lower prices and assures drug quality, and application of Trade Related Aspects of Intellectual Property Rights (TRIPS) safeguards as needed - prompt availability of generic drugs, compulsory licensing, and related measures.
3. Sustainable financing
Sustainable financing for HIV-related drugs must be viewed in the context of overall health care financing, financing for HIV/AIDS prevention and care, and financing for essential drugs. Multiple sources of funding are being sought, including a call for increased public expenditure for health, advocacy for coverage of HIV-related drugs through social security schemes (where they exist), special funding facilities from the World Bank, targeted use of debt relief funds, tax incentives in high-income countries, in-kind funding in the form of drug donations, solidarity funds, and some degree of cost sharing if it can help extend access to a larger number of people.
4. Reliable health care services
Important elements to support access to HIV-related drugs include improved care and treatment services (voluntary counselling and testing, laboratory facilities, accreditation of clinicians and nurses, social support to help adherence, and strengthening of health and social services in a continuum of care), reliable supply systems (based increasingly on an effective mix of public, private, and nongovernmental organization procurement, storage, and transport services), and regulatory control (needed to assure quality, to combat counterfeis, and thereby to contain drug resistance).
Tools and resources
Members of the Task Team have developed resource materials to support countries in increasing access to HIV-related drugs. These tools are available from UNAIDS and co-sponsors and include needs assessment instruments, clinical guidelines, drug information, price information, and financing options.
The UNAIDS Drug Access Initiative was launched in 1997 and focused initially on antiretroviral therapy, but has since been a significant initiative to increase access to other HIV-related drugs. In June 2000, a technical meeting on access to drugs for HIV/AIDS within national essential drugs programmes was held in Pretoria, South Africa. This meeting involved national AIDS control programmes, essential drugs programmes, ministries of finance, and nongovernmental organizations from nine African countries.
To support African countries, UNAIDS and WHO are working to develop a network of country drug access advisors to provide policy and technical guidance to governments, nongovernmental organizations, and people living with AIDS (PLWA) groups. Drug access advisors will be able to provide direct assistance or to access external expertise in areas such as drug selection, development of local treatment guidelines, quantification of needs, identification of financing options, price information, procurement, patents, and quality assurance.