Transcript Document

Country Assessment to Determine Factors
Influencing the Cost, Availability and Distribution
of Acyclovir in Eight Sub-Saharan African Countries
Catherine Corbell* Andy Stergachis* Francis Ndowa**
Patrick Ndase* Linda Barnes* Connie Celum*
*University of Washington
**World Health Organization
Third International Conference for Improving Use of Medicines,
November 15, 2011, Antalya, Turkey
Objectives
1. Assess the extent of implementation of WHO STI
treatment guidelines about acyclovir and syndromic
genital urinary disease (GUD) management in
country-specific essential medicines lists and
national STI guidelines.
2. Describe procurement and financing methods used
by the Ministries of Health for the purchase of STI
drugs, including acyclovir.
3. Assess cost and access to acyclovir at selected
public and private pharmacies.
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Rationale
• Anticipation of potential beneficial effects of ACV in
HSV trials for episodic treatment, suppressive therapy
to prevent HIV acquisition/transmission/management.
• WHO interested in ACV for essential drug lists and
recommendations of 2 WHO meetings in 2006.
• Access to STI drugs believed to be generally poor in
SSA affected by costs/financing, erratic procurement
and variable distribution – but not well documented.
Methods
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Countries: Botswana, Kenya, Malawi, Uganda, Tanzania,
South Africa, Zambia, Zimbabwe.
Study period: July 2007-August 2007
Rapid assessment techniques:
• 29 structured in-person interviews with MoH officials and
national STI program managers
• Visits to 28 public and 43 private health facilities to assess
acyclovir cost & availability and conduct structured
interviews with pharmacy workers
• Median price ratio determined by dividing the median
retail cost of acyclovir 200 mg tablet by the median
International Reference Price (IRP).
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Results
GUD Treatment Policy:
• 4 of 8 countries adopted acyclovir as 1st line
syndromic GUD treatment in both EML and STI
guidelines (Botswana, Malawi, Uganda, Zambia).
Acyclovir Procurement Policy:
• Procured centrally for public sector by MoH or
central medical stores (CMS) for all countries
except Zimbabwe.
• Stock-outs reported in 4 of 8 countries (Kenya,
Tanzania, Zambia, Zimbabwe).
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Results
Demand main factor driving availability and accessibility:
Kenya, South Africa and Zimbabwe: STI guidelines recommend ACV as 2nd
line treatment of genital herpes leading to low prescribing.
South Africa and Tanzania: Justification required for ordering of ACV from
CMS, which prolonged lead time and curtailed prescribing.
Uganda: ACV expensive at CMS therefore not ordered by facilities. Inability
to order interpreted as low demand.
Botswana: Demand escalated after ACV was included in syndromic
management.
Lack of sufficient financial resources for purchasing acyclovir:
Zambia: ACV purchased at high prices due to insufficient financial resources
for bulk procurement.
Zimbabwe: Foreign exchange problems hampered procurement.
Botswana: Government unable to meet high demand for ACV; had to turn to
PEPFAR for assistance.
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Cost of Acyclovir
Acquisition Cost of ACV in Public Sector:
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Median IRP ranged from 0.74 to 1.95
– Publically Funded: USD 1.44 to 3.36 for 7-day course
– Donor Funded: USD 1.05 to 1.26 for 7-day course
Cost and Access of ACV in Private Sector:
• Median IRP was 5.85 to 9.76 times the median IRP
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Key Lessons
• Several African countries did not effectively
implement WHO’s 2003 STI treatment guidelines.
• Purchasing through international donor
organizations promoted access to ACV as it was less
expensive than procurement through MoH.
• Retail cost of acyclovir in the private sector was
higher than the median IRP, potentially making it
unaffordable to many.
• Sampling and sample size study limitations.
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Implications
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Changes to STI guidelines that require increased access
to ACV should assess and address systems barriers to
promote timely access to care for GUD.
Strengthening public sector procurement and supply
chains and public-private partnerships should include
strategies for accessible and affordable GUD therapy.
Successful implementation of guidelines requires
guideline dissemination and training; effective drug
procurement and coordinated distribution; and public
education.*
*Lewis D. Sexually Transmitted Diseases. 2010;37:494-6
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Future Research
1. How to ‘Frappez Fort et Frappez Vite’ in treating
GUD effectively and potentially impacting HIV
transmission?
2. New findings on reduction in plasma HIV-1 levels
with high dose valacyclovir reinforce need to assess
and mitigate barriers to access to GUD medicines.
3. Need to assess prevalence and factors associated
with promoting access and affordability of
medicines in anticipation of new evidence and
guidelines.
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Thank You
Wawaru C, Stergachis A, Ndase P, Barnes L, Ndowa F, Celum C.
Sex Transm Dis. 2010 Aug;37(8):488-93.
[email protected]
www.globalmedicines.org
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