[afro-nets] PEPFAR's HIV drug supply wrong, say Christian hospitals

[A. Odutola <chpss_abo2@yahoo.com>]

PEPFAR'S HIV drug supply wrong, say Christian hospitals
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PEPFAR: US is tackling HIV drug supply in wrong way, say Chris-
tian hospitals

Source: Aidmap/NAM
By: Keith Alcorn
Wednesday, October 20, 2004

An organisation representing front-line mission hospitals in 22
developing countries says that the US President's Emergency Plan
for AIDS Relief threatens to create unsustainable and wasteful
two-tier treatment systems because of the US insistence on using
branded antiretrovirals already approved by the US Food and Drug
Administration.

The Ecumenical Pharmaceutical Network represents Christian hos-
pitals, drug supply organisations and development agencies from
22 countries including many of the countries named as recipients
of PEPFAR support.

In a statement issued last week after the Network's annual con-
ference in Tanzania, members highlighted a number of concerns
they have about the way in which the PEPFAR programme is being
imposed on health care systems.

They say that PEPFAR's insistence on brand-name drugs approved
by the FDA is creating confusion and extra work for over-
stretched health care staff in settings where generics are also
available. This criticism was first raised at a meeting called
by the US, WHO and southern African governments to review drug
approval standards for fixed dose combinations. Eric Goemaere of
Medecins sans Frontieres told the audience of international
regulatory officials: "If each partner comes to us only wanting
to treat women or children, or only wanting to use a certain
drug combination or branded products, it will be chaos. If we
have different supplies and different combinations coming in, it
will create confusion both for the clinic and for patients who
have already started with a particular fixed dose combination."

Jennifer Patterson of Catholic Relief Services, one of the agen-
cies funded by PEPFAR to deliver treatment through mission hos-
pitals, explained why the programme's requirement on branded
drugs was creating extra work: "Our programmes fear that they
will suffer the burden of administration of multiple supply
lines, that community workers will face the extra burden of ex-
plaining different regimens to patients within the same family,
and that the use of loose tablets rather than FDCs will create
the danger of pill-sharing between family members because of the
prevailing sense of community."

The US government has repeatedly stressed that it will not use
drugs in its PEPFAR programme that US regulators would not pass
for use by US citizens, and has invited generic manufacturers to
submit their products to the US FDA for approval. If the prod-
ucts receive approval the US Global AIDS Coordinator Randall To-
bias has said they will be eligible for purchase with PEPFAR
funds.

However there are also concerns about the way in which drugs
will be supplied to the field. Ecumenical Pharmaceutical Network
coordinator Eva Ombaka says that PEPFAR's insistence on a verti-
cal drug supply chain separate from existing systems could un-
dermine efforts to improve national drug distribution systems

The Ecumenical Pharmaceutical Network has also raised doubts
about what will happen when the current funding for PEPFAR runs
out in 2008. If the same level of funding is not forthcoming af-
ter 2008, says the Network, levels of treatment achieved may not
be sustainable, especially if branded products remain more ex-
pensive than generics and if the programme has prevented the de-
velopment of local drug production.

"The high level of donor control and little or no country or lo-
cal ownership further undermines the sustainability of health
care and other services," the Network stated last week.

PEPFAR's policy on procurement and delivery will come under fur-
ther scrutiny after a $7 billion tender call for a drug supply
system is announced. According to US National Public Radio de-
fence contractor Northrop Grumman will partner with JSI Deliver
and Management Sciences for Health in its bid to bring antiret-
rovirals to two million in the 15 PEPFAR programme countries.

Source: Aidsmap.com:
http://www.aidsmap.com/en/news/3BEB3196-46F8-415F-84F9-B382754C3745.asp


--
A. Odutola
mailto:chpss_abo@yahoo.com