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How Fixed-Dose Combinations improve the rational use of antiretroviral therapy

How Fixed-Dose Combinations improve the rational use of antiretroviral therapy. MSF experience in 10 countries over 3 years. MSF ARV PROGRAMMES. MSF started HIV programs in low-resource settings in 1997 ART programs started in 2001

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How Fixed-Dose Combinations improve the rational use of antiretroviral therapy

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  1. How Fixed-Dose Combinations improve the rational use of antiretroviral therapy MSF experience in 10 countries over 3 years

  2. MSF ARV PROGRAMMES • MSF started HIV programs in low-resource settings in 1997 • ART programs started in 2001 • To date, 39 ART programs in 19 countries in Africa, Asia, Latin America • Over 10,000 patients

  3. BACKGROUND

  4. BACKGROUNDd4T/3TC/NVP • Bidaily fixed-dose • WHO recommended first line • WHO pre-qualified • Most commonly used in MSF programmes

  5. METHODOLOGY • ADHERENCE: pill count • EFFICACY: VL (when available), CD4 • PRICE: Survey of prices among our projects

  6. ADHERENCE

  7. EFFICACY

  8. PRICES • FDC remains the least expensive option compared to originator drugs • Second line drugs are still very expensive

  9. PRICES FIRST LINE

  10. PRICES FIRST LINEINTERNATIONAL OFFERS

  11. PRICES SECOND LINE

  12. CONCLUSIONS • MSF aims to have 80% of patients treated in its projects receiving a triple-FDC regimen as of January 2004. • Currently, 70% of patients and 9 out of the 10 largest MSF projects are using triple FDCs as their first-line treatment

  13. CONCLUSIONS FDCs (d4T/3TC/NVP) are essential tools for scaling up: • effect on adherence and resistance (impossible to take partial dose) • ease of use (2 tablets per day) • distribution advantages • Efficacy • Less expensive

  14. CONCLUSIONS But still many efforts to be done: • Still room for improvement in 1st line (EFV containing FDC, paediatric FDCs) • Second line still very expensive • Need for affordable and simple tools to monitor treatment failure

  15. REFERENCES • Surmounting challenges: Procurement of Antiretroviral Medicines in Low- and Middle-Income Countries (MSF, WHO, UNAIDS, 2003) • Untangling the web of price reductions: A pricing guide for the purchase of ARVs for developing countries (MSF, 2003) • Addison A. Taylor, Omar Shoheiber. Adherence to Antihypertensive Therapy With Fixed-Bose Amlodipine Besylate/Benazepril HCI Versus Comparable Component Based Therapy www.accessmed-msf.org

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