Africa’s new affordable HIV treatment deal under threat from US budget cuts

The Independent

A “best in class” HIV/Aids treatment drug will now be be more affordable to African nations, but proposed budget cuts by the US could make ending the epidemic difficult.

A new pricing partnership has been struck between the UN, African nation governments such as South Africa and Kenya, the pharmaceutical industry, and the US President’s Emergency Plan for Aids Relief (PEPFAR) to drastically reduce the price of a crucial HIV/Aids treatment drug.

The cost for treatment has now been set at around $75 per person per year in over 90 low to middle-income countries. The treatment cost was previously upwards of a $1,000.

The drug in question contains dolutegravir (DTG), which has been billed by the Joint United Nations Programme on HIV/Aids (UNAIDS) as the “first affordable, generic, single-pill HIV treatment regimen” that will be available to public purchasers.

The once a day, one pill treatment is also the preferred treatment option by the US Department of Health and Human Services as well as the World Health Organisation.

The drug, which is actually a combination of tenofovir disoproxil fumarate, lamivudine, and dolutegravir (TLD), was developed by two pharmacies: Mylan and Aurobindo Pharmaceuticals.

They have licensing agreements from ViiV Healthcare, the original developer of DTG.

Dr Larkin Callaghan, Director of Strategic Communications and Partnerships at the Aids Research Institute at the University of California – San Francisco, told The Independentthat DTG is a “best in class integrase inhibitor”.

Dame Sally Davies, the Chief Medical Officer for the UK, said DTG is known to fight a growing problem with HIV/Aids treatments in sub-Saharan Africa – resistance to the disease.

Speaking during a news conference on Thursday, Ms Davies said the drug also produced significantly fewer side effects for patients, which encouraged continued use of the drug and thus prolonged life.

Dr Mike Reid, a Clinical Fellow at the University of California-San Francisco Hospital said DTG is not a new drug.

In fact, he uses DTG in his California practise. However, this is the first time the drug will be made affordable to over 90 lower and middle-income countries.

“DTG is so much more potent than any other drugs used in sub-Saharan Africa,” Mr Reid said.

He also said that the drug is good for patients who have never been anti-retroviral drug treatments (ARVs) as well, making it accessible to a larger pool of infected people.

While the number of Aids-related deaths have fallen by 42 per cent in eastern and southern Africa since 2010, South African Minister of Health Aaron Motsoaledi pointed out that his country still has about seven million people living with either HIV or Aids.

In 2016, there were 19.4m people in eastern and southern Africa living with HIV, with women and girls making up nearly 60 per cent of that population.

These parts of Africa also account for approximately 43 per cent of new HIV infections, or nearly 800,000 new cases in last year.

Over a quarter of those were in South Africa.

Mr Motsoaledi said the majority of people infected in South Africa are receiving help from government sources, with only about a quarter million able to afford private care.

With the new pricing agreement, combined with the effectiveness of DTG however, he said that the burden on the state is dramatically reduced.

Over the next six years, the government will save approximately $900m according to Mr Motsoaledi.

“We can now treat more people with the same amount of money,” he said, adding that without the new pricing agreement his government would need an additional $900m to treat an increasing number of infected people by 2022.

Lelio Marmora is the Executive Director of Unitaid, a UN global health initiative that works to invest in better prevention and treatments of pandemics like HIV/Aids.

He said that one of the biggest problems African leaders who come to his organisation have is “increasing the fiscal space and investments available for health.”

Pilot programmes or small public initiatives have been run in the past, but to have a lasting impact on an entire population, programmes will need to reach a wide swathe of people being serviced by the governments.

Also, companies like Viiv, Mylan, and Aurobindo cannot reduce prices of drugs, even generic versions of them, if the number of patients cannot be accurately forecast and market conditions in these countries cannot be accurately predicted, Mr Marmora explained.