Over the last four years, access to antiretrovirals (ARVs) and diagnostics for people living with HIV/ AIDS (PLWHA) has become easier owing to the availability of more affordable generic products of assured quality supported by public pressure to overcome access barriers. In addition, substantial funding became available through the Global Fund to Fight AIDS, Tuberculosis and Malaria (GFATM).

The World Health Organization (WHO) and its partners have committed to a goal of 3 million people on ARV treatment by 2005 (the 3 by 5 Initiative). This requires massive scale-up in country-level operations. Setting up services providing diagnosis, care and treatment to HIV patients is complex. Continuous supply of ARVs will be crucial to ensure that no treatment interruptions occur.

Three factors are essential to assure success of the 3 by 5 Initiative:

• government commitment to providing ARVs within public health services;
• availability of guidelines for simplified ARV treatment;
• availability of prequalified generic and fixed-dose combinations (FDCs) of ARVs and prequalified diagnostic test kits.

A WHO-UNICEF technical consultation was held in Geneva, Switzerland, 28-29 June 2004. Thirty-two participants attended from 14 organizations to review best-practices and identify common problems in quantifying antiretrovirals and diagnostics for treatment of HIV patients. The overall purpose of the meeting was to support efforts towards better forecasting, and to promote the use of software packages to estimate needs within tight budgets.

The Consultation involved formal presentations and six working groups were established to provide recommendations on:

• central versus peripheral quantification;
• quantification of paediatric ARV needs;
• quantification of HIV diagnostics and laboratory equipment;
• specifications of software tools;
• national quantification policy; and
• implementation and capacity-building.

Three software systems currently under development for forecasting and estimating needs were demonstrated. From different country- and industry-perspectives, a number of points surfaced. Of particular importance is the complexity and scale of HIV infection; its status in different countries and varying capacity within the different levels of health systems. Additional issues are raised by the characteristics of supply management for a variety of products with differing indications, administration and shelf-life. A critical requirement being that a patient’s treatment should not be discontinued.

Price, availability and donor-community views were also addressed. Accuracy of data and market-intelligence were seen to be key challenges for health services and the pharmaceutical industry. Important gap-analysis pointed to the unsuitability of adult formulations for children and recognition that HIV in children cannot be easily diagnosed, beyond reliance on the local mother-to-child transmission rate. The overwhelming policy decision facing health authorities is to determine who should receive treatment.

As an outcome of the meeting, a Forecasting Technical Consultation Group was established to continue working and sharing information through a restricted access website. A five-point action plan was agreed, including field-testing of newly developed software packages for forecasting and estimating needs in two countries by June 2005. Also, on request, WHO will validate existing quantification software packages in the second half of 2005. One important theme of the Consultation was the continued need for networking to share best-practices among all involved, and to develop capacity building and training for health practitioners. A key outcome is expected to be the sustainable availability and uninterrupted supply of antiretrovirals and diagnostics to patients, based upon improved accuracy of forecasting.

Reference: Forecasting of antiretrovirals and diagnostics. WHO-UNICEF Technical Consultation 28-29 June 2005, Geneva. Available on http://whq1ibdoc.who.int/publications or who.int/medicines/library/doseng