OBJECTIVES: The spread of HIV/AIDS challenges governments to provide
antiretroviral (ARV) treatment at affordable prices, and various initiatives
have been developed with that intent. In Latin America and the Caribbean, four
subregional negotiations were conducted during 2002-2005 to reduce drug prices
and thus broaden access to ARVs. Studies were carried out to monitor the
negotiations, and the development of a monitoring methodology was recommended.
The objective of the current study was to develop and describe a potential
methodology for monitoring ARV price negotiations.
METHODS: The study, carried out in 2006-2007, consisted of a design phase and
validation phase. The design phase included an extensive literature review and
development of a theoretical framework. Validation was performed using health
professional consensus and pilot studies in three countries-Barbados, Honduras,
and Peru-representing the Caribbean, Central American, and Andean subregions.
RESULTS: The results included a detailed logic model and a 40-indicator
framework. Both were tested in the field. Indicators were evaluated for
feasibility, pertinence, and sensitivity, based on the outcome of the pilot
CONCLUSIONS: This monitoring methodology is designed to help countries
self-evaluate progress toward implementation of ARV price negotiations. The
results of the pilot study indicate that its implementation in the field helped
elucidate the ARV price negotiation process by identifying local conditions and
indirectly measuring countries' negotiating capacities.