PrEP Financing: Recommendations from Project Inform

Project Inform recently released a report titled Financing and Delivery Mechanisms to Increase Pre-Exposure Prophylaxis (PrEP) Access in Populations at High-Risk of HIV Infection. Available here, the report discusses issues related to financing for PrEP to ensure that it becomes a viable, accessible prevention method for MSM. Here as an excerpt from the executive summary of the report:

One promising new HIV prevention strategy is the use of ARVs as pre-exposure prophylaxis (PrEP) among high-risk men who have sex with men (MSM). Several clinical and cost-effectiveness studies demonstrate that PrEP has the potential to reduce HIV infection rates for high-risk MSM in a cost-effective way. However, policymakers continue to face questions regarding how to improve drug adherence, offer services to the most high-risk individuals including African-American and Latino MSM and transgender women, and ensure that adequate financing mechanisms are in place to pay for the many biomedical and behavioral components of PrEP.

Policymakers seeking to increase PrEP access must further contend with the current political reality of constrained financial resources for public health assistance, including for state Medicaid programs and for HIV prevention programs that serve individuals at high-risk of HIV infection. Strategic opportunities for financing and delivery still exist, but numerous public and private sources will need to be mobilized for PrEP to reduce HIV infections in significant numbers.

Key financing and delivery opportunities include Gilead’s application for FDA approval of a prevention label for Truvada; National Institutes of Health (NIH) and Centers for Disease Control (CDC) funding for demonstration projects in San Francisco, Boston, and other U.S. cities; private and public health insurance coverage for PrEP; a Gilead-funded Patient Financing and Delivery Mechanisms to Increase PrEP Access 5 Assistance Program to help low-income patients pay for PrEP; and opening the PrEP drug market to non-Truvada PrEP formulations. Given that new clinical and cost evidence for PrEP is expected to arrive from a variety of studies and projects in the coming years, policymakers will need to adapt their implementation of PrEP accordingly.
Policy Recommendations:

The recommendations in this report are designed to help HIV policymakers and advocates like Project Inform improve PrEP access in a manner that is clinically effective, cost-appropriate, and politically feasible in line with existing research and evidence.

Consequently, this report recommends the following:

        1.) Support Gilead’s request for FDA approval of a prevention label for Truvada

        2.) Encourage the NIH and CDC to finance demonstration projects

        3.) Ensure public insurance coverage for PrEP through state Medicaid programs

        4.) Ensure private insurance coverage for PrEP

        5.) Advocate that Gilead develop a Patient Assistance Program (PAP) for PrEP

        6.) Encourage non-Truvada PrEP formulations and promote price breaks for Truvada

        7.) Promote PrEP in tandem with other combination approaches to HIV prevention

[Content that is linked from other sources is for informational purposes and should not construe a Mapping Pathways position.]

More nurses trained to administer ARVs

Via 7th Space, by Gabi Khumalo.

About 1 019 nurses in Gauteng have been trained to initiate ARVs to shorten the waiting period for people who need to be put on treatment.

Gauteng Health and Social Development MEC, Ntombi Mekgwe, announced during the department's budget for 2011/2012 that R1.912 billion has been allocated to strengthen the fight against HIV and Aids.

She noted that by the end of March 2010, a total of 416 941 people were on ARVs, adding that the department's target is to increase this number to 520 000 by March 2012.

"In order to provide treatment closer to where people live, ARV sites will be increased to 385 by the end of March 2012," said Mekgwe.

By the end of June 2010, 286 ARVs sites had been set up in Tshwane, Ekurhuleni, Metsweding, West Rand, Sedibeng and the City of Johannesburg.

Mekgwe also noted that mass education to encourage safe sex through schools, wards and NGOs has already reduced new HIV infections in youth between the ages of 15 to 24 years significantly.

The launch of HIV Counselling and Testing Campaign by President Jacob Zuma last April has begun to bear fruit, as more than 2.7 million people in the province had tested by mid June 2011.

Read the rest here.

[Content that is linked from other sources is for informational purposes and should not construe a Mapping Pathways position.]

The Great Paradox of the HIV Epidemic

Mark Chataway is co-chairman of Baird’s CMC, a Mapping Pathways partner organisation. Here, he discusses the HIV landscape in Botswana and Zimbabwe.

"Every now and then, it strikes me that despite all our progress in the field of HIV, there is still so much for us to find out. This seems most apparent when I consider the HIV situation in two African countries: Botswana and Zimbabwe.

In 2001, Botswana’s then-president, Festus Mogae, said, “We are threatened with extinction. People are dying in chillingly high numbers. It is a crisis of the first magnitude.” The government acknowledged that tackling the epidemic was a matter of national importance, and it acted accordingly – Botswana became the first African country to declare its objective of providing ARV drugs to all its needy citizens. As in so many other fields, Botswana was to become a model for the rest of the world. (Having worked for the Government of Botswana as a consultant, I often wish that we, in the UK, were governed with equivalent honesty, efficiency and vision.)

Botswana has two significant HIV/AIDS-related initiatives with international partners: ACHAP (African Comprehensive HIV/AIDS Partnerships) and BOTUSA. Its own funding for HIV programmes has increased steadily. Botswana has achieved universal treatment access (that means at least 80% of Batswana who need HIV treatment are receiving it). Almost every major political and religious leader has addressed AIDS openly and often. There are enormous, well-financed programmes focussed on behaviour change and risk reduction. Yet, HIV prevalence is not falling nearly as fast as many think it should have done (click here for prevalence details).

On the other hand, there is the puzzling case of Zimbabwe, where HIV prevalence has fallen dramatically over the last decade or so – it peaked at 26.5% in 1997 and, according to government figures, fell to 14.3% in 2010. While this is an excellent development, it is also rather inexplicable. Access to treatment is very limited. A long-serving health minister was accused of sexually molesting adolescents (although he vehemently denied it) and other political leaders have addressed AIDS only sporadically. Sustained persecution of men who have sex with men has driven the gay community underground. Many of the urban poor have been driven from their homes and forced to live as refugees in rural areas. According to everything we know, Zimbabwe’s political upheaval, economic distress, and the collapse of many primary healthcare services should have exacerbated the epidemic. While some researchers claim the declining prevalence is a result of successful public-awareness and behaviour-change programmes, there are many troubling doubts in the international public health community about whether those factors really constitute an adequate explanation. The real explanation is probably complicated and involves the rising mortality from other causes, the inability of people to travel and the disappearance of much of the middle class.

The difference between these two countries brings into sharp relief the great paradox of the HIV epidemic – we just do not know why the epidemic seems intractable in some places but declines rapidly in others (or fails ever to take hold). There is no model that explains Botswana and Zimbabwe. There are similar paradoxes all over the world: for example, in India, Tamil Nadu has more AIDS cases than any other state, but it has an excellent healthcare system, relatively good status for women and very high levels of literacy and health literacy. Bihar is almost the opposite on every count but has very low HIV prevalence.

For me, it highlights how, even after living with HIV/AIDS for nearly three decades, the world still has so much to learn about the dynamics of HIV and how it functions in various scenarios. The need of the hour is well controlled, randomised clinical trials and policy analysis. We can then create more effective programmes based on good science."

[Content that is linked from other sources is for informational purposes and should not construe a Mapping Pathways position.]

Millions will die if India stops AIDS drugs

Via Reuters, by Nita Bhalla.

The EU and India are currently negotiating a free-trade agreement, which campaigners say will restrict India's ability to produce anti-retroviral (ARV) drugs, preventing the world's poor from accessing cheap drugs for their treatment.

"India should resist removing any flexibility because any trade agreement which could lead to India not being able to produce will be terrible for the rest of the world," said Michel Sidibe, executive director for the Joint United Nations Programme on HIV/AIDS (UNAIDS).

"Millions of people will die if India cannot produce and Africa will be the most affected. For me, it is an issue of life or death," he told Reuters in an interview, adding that about 86 percent of people on treatment were taking drugs made in India.

The EU-India trade deal includes measures that could delay or restrict competition from generic medicines by extending patent terms, requiring data exclusivity and tightening border enforcement rules.

Such moves could drive up prices for India's anti-retroviral treatments, limit dosage options and delay access to newer and better drugs, said a U.N. report in September last year.


REVERSING GAINS MADE

Thirty years after the HIV/AIDS virus was first discovered, experts say while substantial progress has been made by the global community in stemming it, only a fraction of those living with the illness are on medication.

At a high level U.N. meeting last month, nations agreed on a set of ambitious targets to rid the world of disease, including scaling up the provision of generics to reach 15 million patients from six million by 2015.
The trade deal, Sidibe said, would reverse many of the gains made in improving the lives of the world's poor.

Read the rest here.

[Content that is linked from other sources is for informational purposes and should not construe a Mapping Pathways position.]

PrEP Forum: Listen Now for Free

Chicago, USA - On June 15, fellow AFC partner organization Lifelube hosted a forum with Feast of Fun podcast hosts Fausto Fernós and Marc Felion. The forum was a discussion on the iPrEx study, and PrEP as an HIV prevention method, and featured scientists, advocates, and real people taking Truvada prophylactically. Please take the time to listen to the podcast for free on Feast of Fun's website, and share your thoughts on the iPrEx study, PrEP, and the forum itself.

Keith Green, Marc Felion, Dr. Bob Grant and Fausto Fernós

[Content that is linked from other sources is for informational purposes and should not construe a Mapping Pathways position.]