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L08 - Universal access to AIDS treatment: targets and challenges
- countries where almost half of the population are diseased
- antiretroviral drugs: medications for the treatment of infection by retroviruses, primarily
HIV (when 3 or 4 are taken in combination: highly active antiretroviral therapy/HAART)
- first line therapy - develop side effects and the body develops resistance to the drugs, no
longer effective Æ second line therapy - much more expensive, less side effects, combination
of less drugs (easier to take) but for warmer climates and have longer shelf life
- even people who have access to antiretroviral have high prevalence
- Sub-Saharan Africa increased recipient of antiretroviral therapy
- estimated that access to antiviral treatment is below 10% in every region except the
- Sub-S Africa, ~4.3 million ppl need AIDS home-based care but only 12% receive (SE Asia
- 2%)
- several South American countries have universal coverage for antiretroviral therapy
(Argentina, Brazil, Chile, Cuba, Mexico, Uruguay), 2/3 (Barbados, Colombia, Costa Rica,
- to monitor and contain disease
- few HIV medicines are produced in paediatric formulations (have short shelf life, difficult
to measure correct doses, taste, very expensive)
- social and financial challenges in treating children Æ children's treatment may be a low
priority within family & research
- 'rank' to determine who receives treatment (often the eldest male)
- AIDS challenges health systems (deadly chronic disease in need of life-long regular follow-
- CD4+ cell count threshold for beginning treatment (usually > 350, but >200)
Establishing guidelines for treatment rationing (possibly)
- particular demographics targeted for treatment (mothers, children, etc) to reduce spread
- skilled workers (e.g. teachers, police, judges, civil servants) contributing to economic
productivity or social stability more privileged
- poorest people are the least able to fund their own treatment privately
- high-risk populations
- patients start cure but do not take medication for a long period of time (low retention rate,
20% dropped after 12 months, at 48 months, less than ¾)
- many staffs needed for various stages of treatment programme
- Malawi - one doctor per 50 000 people (high ratios)
Æ in Botswana, 17% of health-care workers died due to AIDS between 1999-2005
- attempts to train nurses to care for patients
Antiretrovirals and Intellectual Property Rights
- Price Barrier
- ARV therapy proven to extend/improve lives for HIV/AIDS peoples in wealthy countries
by <70%
- average cost = $10 000-15 000 per patient per year
- falling prices for first line antiretrovirals from $10k Æ $300 after patent expired, relation to
trade organizations
- generic antiretroviral: copied, less expenses .'. low prices and introduced competition
- World Trade Organization Agreement on Trade Related Aspects of Intellectual Property
Rights (comprehensive international agreement on intellectual property rights such as
patents, copyrights, and trade marks) - set forth minimum standards for intellectual property
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