title: Optimizing antiretroviral product selection: a sample approach to improving patient outcomes, saving money, and scaling-up health services in developing countries.
abstract: Over the last decade, increased funding to support HIV treatment programs has enabled millions of new patients in developing countries to access the medications they need. Today, although demand for antiretrovirals continues to grow, the financial crisis has severely constrained funding leaving countries with difficult choices on program prioritization. Product optimization is one solution countries can pursue to continue to improve patient care while also uncovering savings that can be used for further scale up or other health system needs. Program managers can make procurement decisions that actually reduce program costs by considering additional factors beyond World Health Organization guidelines when making procurement decisions. These include in-country product availability, convenience, price, and logistics such as supply chain implications and laboratory testing requirements. Three immediate product selection opportunities in the HIV space include using boosted atazanavir in place of lopinovir for second-line therapy, lamivudine instead of emtricitabine in both first-line and second-line therapy, and tenofovir + lamivudine over abacavir + didanosine in second-line therapy. If these 3 opportunities were broadly implemented in sub-Saharan Africa and India today, approximately $300 million of savings would be realized over the next 5 years, enabling hundreds of thousands of additional patients to be treated. Although the discussion herein is specific to antriretrovirals, the principles of product selection are generalizable to diseases with multiple treatment options and fungible commodity procurement. Identifying and implementing approaches to overcome health system inefficiencies will help sustain and may expand quality care in resource-limited settings.
authors.affiliation: Access Programs, Clinton Health Access Initiative, 383 Dorchester Avenue, Boston, MA 02127, USA.
authors.forename: Carolyn D
authors.initials: CD
authors.lastname: Amole
authors.forename: Catherine
authors.initials: C
authors.lastname: Brisebois
authors.forename: Shaffiq
authors.initials: S
authors.lastname: Essajee
authors.forename: Erin
authors.initials: E
authors.lastname: Koehler
authors.forename: Andrew D
authors.initials: AD
authors.lastname: Levin
authors.forename: Meredith C
authors.initials: MC
authors.lastname: Moore
authors.forename: David H
authors.initials: DH
authors.lastname: Brown Ripin
authors.forename: Joanna J
authors.initials: JJ
authors.lastname: Sickler
authors.forename: Inder R
authors.initials: IR
authors.lastname: Singh
mesh_terms: D044966:Anti-Retroviral Agents / Q000191:economics*; D000069446:Atazanavir Sulfate; D003906:Developing Countries / Q000191:economics*; D016049:Didanosine / Q000191:economics / Q000627:therapeutic use; D015224:Dideoxynucleosides / Q000191:economics / Q000627:therapeutic use; D004359:Drug Therapy, Combination; D015658:HIV Infections / Q000188:drug therapy* / Q000191:economics; D006285:Health Planning / Q000191:economics*; D006296:Health Services / Q000191:economics*; D006801:Humans; D019259:Lamivudine / Q000191:economics / Q000627:therapeutic use; D061466:Lopinavir; D009842:Oligopeptides / Q000191:economics / Q000627:therapeutic use; D011725:Pyridines / Q000191:economics / Q000627:therapeutic use; D011744:Pyrimidinones / Q000191:economics / Q000627:therapeutic use; D016896:Treatment Outcome; D000099227:Abacavir
chemical_list: D044966:Anti-Retroviral Agents; D000069446:Atazanavir Sulfate; D016049:Didanosine; D015224:Dideoxynucleosides; D019259:Lamivudine; D061466:Lopinavir; D009842:Oligopeptides; D011725:Pyridines; D011744:Pyrimidinones; D000099227:Abacavir