The South African government has negotiated savings of about US$250 million in its latest antiretroviral (ARV) tender, which is the first to include a three-in-one tablet. This triple fixed-dose combination ARV will now allow the country to move to new, simpler HIV treatment and prevention of mother-to-child HIV transmission (PMTCT) guidelines in April 2013.
South Africa’s newly announced tender, worth about US$672 million, is the first to include a fixed-dose combination (FDC) ARV that, by combining multiple pills into one, helps reduce patient pill burdens and improve adherence. Under the new tender, an FDC containing tenofovir, efavirenz and emtricitabine will be available to patients starting in April.
Although doctors will be responsible for deciding which patients can switch to the new FDC, Francesca Conradie, president of the HIV Clinicians Society, estimates that at least 80 percent of the country’s ARV patients will be eligible to make the switch.
The FDC will now help the country roll-out new, simpler PMTCT guidelines. From April, all HIV-positive expecting mums not already on treatment will be started on the FDC during pregnancy and kept on the drug combination until they stop breastfeeding, regardless of CD4 count - a measure of the immune system’s strength.
Previously, only expecting mums with CD4 counts of 350 and below started treatment. Those with higher CD4 counts received shorter, dual ARV therapy to prevent vertical (mother-to-child) transmission of the virus.
Prices come down
With an HIV prevalence of about 18 percent, South Africa runs the world’s largest HIV treatment programme. Its 1.7 million ARV patients comprise 21 percent of the global market for the drugs, but the country has only recently been able to begin to bring the costs of these drugs down.
With 2.5 million people expected to be on ARVs in the country by 2015, policymakers had expected the tender to cost about 25 percent more than the final price. According to Minister of Health Aaron Motsoaledi, South Africa is now paying the lowest price for that specific FDC of any country in the world.
“There’s major benefits in terms of compliance, logistics and, we’re told by experts, that there are fewer side effects,” Motsoaledi told IRIN/PlusNews. “The FDC is more effective than dual therapy for pregnant women… and because we’ll be saving two billion rand in the next two years, we can afford to treat more patients with the same budget.”
|In this era of financial austerity every rand must be seen as an investment ... Every rand spent on HIV must be used effectively|
FDCs will now be provided by three companies - Aspen, Mylan and Cipla Medpro - reflecting a trend within the tender towards multiple suppliers, according to Motsoaledi. In 2011, the country experience shortages of the ARV tenofovir after suppliers failed to meet demand; this latest tender expands the number of suppliers to prevent a repeat of this problem.
Conradie welcomed the second consecutive tender to slash ARV prices, noting that the newly negotiated prices, which cut the costs of some ARVs like tenofovir by almost 50 percent, were lower than she could have dreamed.
“In this era of financial austerity, every rand must be seen as an investment… Every rand spent on HIV must be used effectively,” said Catherine Sozi, the UNAIDS country director for South Africa, who added that the move to FDCs is about more than money.
“One pill a day is better than an amalgamation of pills,” she added. “Now the delivery mode (of treatment) is rationalized, the regimen is simplified and all of this is geared towards the country’s primary healthcare re-engineering policy.”