AIDS 2014: Médecins Sans Frontières releases viral load and antiretroviral drug pricing reports

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AIDS2014postScience Speaks is live-blogging from AIDS 2014 in Melbourne, Australia through the coming week, with updates on research, policy and insights from the 20th International AIDS Conference.

MELBOURNE, AUSTRALIA –  Médecins Sans Frontières released a study of viral load monitoring in five countries along with the organization’s annual report on antiretroviral drug pricing. The intensive study of viral load consisted of interviews of key country informants about barriers to viral load testing. It identified price as the 307No. 1  barrier and considerable variability in pricing ranging from $10 per test to $55. The cost of transporting specimens to facilities where viral loads would be evaluated and overall funding shortages for the AIDS response were also cited.

In Swaziland, MSF implemented viral load in its programs successfully by freezing specimens at the clinics and transporting them twice a week to a central facility to be evaluated. The organization’s project influenced country guidelines. Swaziland will move to implement viral load in lieu of CD4 monitoring after the first of the year.  Notably, the price differential between viral load and CD4 monitoring had decreased and an MSF cost-effectiveness analysis found that viral load monitoring priced at $35 per patient per year compared to $25 per patient per year for CD4 monitoring.

“Viral load monitoring detects adherence problems early which, when paired with counseling and support, can help people stay on more affordable first-line treatment for longer”, said Dr. Jennifer Cohn, medical direlctor of MSF’s Access Campaign. “Viral load monitoring also more accurately and rapidly identifies those people who need to be switched to second or third-line treatment if their existing regimen is failing.”

The new MSF report Getting to Undetectable describes viral load testing in India, Kenya, Malawi, South Africa and Zimbabwe and reveals that while these countries aspire to implement routine viral monitoring, almost none have been able to do so on a large scale.

MSF’s annual drug pricing report Untangling the Web of Antiretroviral Price Reductions concludes that while costs have fallen, second-line regimens are still more than double the cost of first-line treatment.  Middle-income countries face an even worse situation with some countries paying more than 12 times more for second-line than the lowest known price.

MSF is calling for a number of actions to ameliorate the challenges of providing viral load monitoring and second-line regimens from greater transparency of viral load pricing, volume purchasing and country-initiated compulsory licensing to produce their own second-line drugs.

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