Nairobi - The international medical humanitarian organisation Médecins Sans Frontières (MSF) and the World Health Organization (WHO) jointly released a report today documenting the experience of MSF AIDS treatment projects in procuring antiretroviral (ARV) drugs in 10 countries. The report provides evidence from actual ARV purchasing experience showing that countries which registered generics and fostered competition between generic and originator producers had more affordable prices for ARVs.

The new publication was released in Nairobi on the first day of the International Conference on AIDS and STIs in Africa (ICASA), where people living with HIV, AIDS clinicians and researchers, and members of international and community-based organisations are discussing strategies to scale up AIDS treatment in Africa. The report is designed to help governments and other purchasers of AIDS drugs procure low-cost quality ARVS effectively and efficiently and support efforts to scale-up access to treatment.

The importance of assisting ARV treatment programmes to procure low-cost, quality ARVs cannot be underestimated. In sub-Saharan Africa, only one percent of the 4 million people in urgent clinical need currently receive ARV therapy. In the MSF/WHO report, the Malawi country case study recounts MSF’s experience in procuring drugs for its programme in Chiradzulu district, where 1,400 people are currently under ARV treatment. Malawi is a least-developed country with an HIV prevalence of nearly 16%.

The prices of ARVs in Malawi are among the lowest in the world, at US$ 288 per person per year. This is because there is intense competition from several generic companies and the government has registered key generic ARVs. Since drugs are relatively affordable in Malawi, with support from the Global Fund to Fight AIDS, Tuberculosis and Malaria, the government has been able to develop a national plan that includes ARV treatment. "We no longer have to stand empty handed watching our patients die needlessly.

We are providing ARVs that are transforming peoples lives," said Didakus Odhiambo, head of mission in MSF’s Chiradzulu project. "We know that it is the emerging government program that will ultimately reach large numbers of people with AIDS, and we are now helping by creating a simplified, decentralised model of treatment at the primary care level."

In Kenya, where more than two million people are living with HIV, generic ARVs are used in the non-profit sector including MSF projects. There are approximately 800 people receiving treatment in MSF projects in Homa Bay, Busia and Nairobi and MSF is paying US$292 per patient per year. However, to date these lower cost medicines are only available through limited non-profit distribution and are not available through the national procurement centre.

The report clearly shows that the Kenyan government could expand access by including ARVs in the existing national drug distribution system, as Cameroon has done. "In the 10 countries profiled in the report, it has been possible to supply low cost quality ARVs to MSF projects, but in many cases lack of a government procurement strategy has meant that MSF had set up supply channels in-country," said Sophie-Marie Scouflaire, lead author of the MSF/WHO report. WHO has set the objective of reaching three million people with ARV therapy by 2005.

This ambitious goal will only be possible with clear government commitment to implement national HIV/AIDS treatment programmes that are supported by strong national procurement and distribution strategies. Although critical, procurement is only one element of expanding access to treatment.

For example, the deficit in international funding threatens to cripple the efforts of endemic countries to increase access to treatment. Simplification of treatment and monitoring strategies also need to be put in place to ensure treatment reaches people at the community level. The full report, "Surmounting challenges: procurement of antiretroviral medicines in low- and middle-income countries", can be found at the Access to Essential Medicines website.