Advanced HIV disease care under threat
Despite substantial progress in antiretroviral therapy (ART) scale up, an estimated 30% of people living with HIV (PLHIV) continue to present with advanced HIV disease, contributing to ongoing HIV-related morbidity and mortality.
WHO recommends that all adults entering or re-entering care receive a CD4 test to identify AHD. But the removal of two WHO prequalified point-of-care CD4 machines for CD4 counting
Obscene profits and funding gaps
The CD4 crisis is not the only threat in the global response to HIV. Prices of other commodities are also threatening broad access and effective response. One major example is the medical test maker Cepheid, which is owned by US corporation Danaher, who vastly overcharges LMICs for the GeneXpert tests used for HIV early infant diagnosis and HIV treatment monitoring in specific populations (e.g. pregnant women, children and adolescents) for whom rapid turnaround times to get results is important. A study by Médecins Sans Frontières (MSF) shows that Cepheid and Danaher could be charging $5 for each of these medical tests and still make a profit, but instead, the company charge LMICs $14.90 per HIV test for more than a decade now, even in the world’s poorest countries.
The exorbitant profits from pharma companies on lifesaving medical tools are situated in a broader context of generalized funding gaps that are largely responsible for the low uptake of basic AHD package in most LMICs. Countries must make impossible choices between equally important components of the response, leading to AHD care being not prioritized, deprioritised or not implemented at a large scale. Commitment and investments from donors and countries are definitely needed to accelerate the implementation of an extended AHD package that should include TB, cryptococcal meningitis, histoplasmosis, severe bacterial infections and other opportunistic infections such as Kaposi sarcoma.
The shrinking space for innovations in the sustainability era
New tools are coming to the market, such as the rapid test for histoplasmosis, bringing hope for easy screening of this disease. But to what extent will they be implemented considering the funding gaps and the CD4 crisis? Other innovations are waiting to be made broadly available and affordable in LMICs, such as long-acting HIV prevention drugs (CAB-LA & lenacapacir).
Since January 2022, MSF has been in negotiations with ViiV Healthcare to procure the critical HIV prevention drug long-acting cabotegravir (CAB-LA), for use in MSF’s HIV programmes in Mozambique, Malawi, Zimbabwe and Eswatini. Over the past two years, ViiV has repeatedly introduced new hurdles for MSF to jump through in order to access and purchase CAB-LA. Finally, CAB-LA is on its way to MSF HIV programmes from mid-2024, but global supply remains inequitably distributed and concentrated in high-income countries, fair and transparent pricing for middle-income countries still unannounced, and slow progress towards generic manufacturing.
With lenacapavir, a subcutaneous injection delivered every six months, likely soon to be approved for the prevention of HIV, MSF does not want to see any repetition of the access barriers that thwarted access to CAB-LA in LMICs, and will continue to advocate for Gilead to voluntarily license lenacapavir to ensure that people in LMICs can access this long-acting HIV prevention drug without unnecessary delays. This follows on from a recent MSF letter to Gilead and a public letter MSF signed on to (here).
But ambitions for acceleration, innovation and implementation of new tools, already suffering from lack of funding, might further be cut off in the sustainability conversations. How much will governments and actors in charge of sustaining the gains be open to new interventions?
Knowing the shrinking of civic space in many countries, to what extent will CSOs and communities still be able to try to reach criminalised populations to give them access to care? How will those CSOs function without international support, when it is already clear that donors should focus more on how to ensure safety for CSOs when they are operating against the laws?
Lastly, we will not succeed in ending HIV as a global public health threat by 2030 if there is no effort to cover blind spots and complex environments where disruptions of HIV care happen daily. International donors and actors, together with governments and CSOs, need to work closely together to develop the mindset and the strategies that will minimize the disruption in case of emergency.
Fonte original msf.org
