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Making universal access a reality Scaling up towards universal access: country reality

Making universal access a reality Scaling up towards universal access: country reality. Mariângela Sim ão Director National STD/AIDS Program Ministry of Health - Brazil. HIV/AIDS – Brazil. Number of cases (2005): 371.827 Prevalence (2004): 0,61% (pop. 15 a 49 yrs)

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Making universal access a reality Scaling up towards universal access: country reality

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  1. Making universal access a reality Scaling up towards universal access: country reality Mariângela Simão Director National STD/AIDS Program Ministry of Health - Brazil

  2. HIV/AIDS – Brazil • Number of cases (2005): 371.827 • Prevalence (2004): 0,61% (pop. 15 a 49 yrs) • Aids Deaths (1980-2004): 171.923 • Mortality rate (2004): 6,1/100.000 • Aids Incidence (2004): 17,2/100.000 • Number of cities with at least one case(2004): 4.354 (79%) • New cases / year: around 20.000

  3. Number of patients receiving ARV therapy. Brazil, 1997 – 2005 Projected 180000 160000 140000 120000 100000 80000 60000 170.000 40000 20000 0 jul/97 jul/98 jul/99 jul/00 jul/01 jul/02 jul/03 jul/04 jul/05 jan/97 jan/98 jan/99 jan/00 jan/01 jan/02 jan/03 jan/04 jan/05 out/97 out/98 out/99 out/00 out/01 abr/97 abr/98 abr/99 abr/00 abr/01 out/02 out/03 out/04 out/05 abr/02 abr/03 abr/04 abr/05 * Dados preliminares

  4. The crisis around the corner • Brazil’s experience - transition from 1st to 2nd line can double the budgetary needs in 2 years • Current trends in LA countries • the number of patients on 2nd line will increase by 50-60% in 2007 • an estimated 40% increase in associated budget due to the high proportion of the expense that 2nd line medication represent (60-80% of the budget in the region).

  5. Antiretroviral drugs distributed according to therapeutic category. Brazil, 2005 ITRN and ITRNt IP • ZIDOVUDINE (1993)* • ESTAVUDINE (1997)* • DIDANOSINE (1998)* • LAMIVUDINE (1999)* • ABACAVIR (2001) • DIDANOSINE EC (2005) • TENOFOVIR (2003) • RITONAVIR (1996)* • SAQUINAVIR (1996)* • INDINAVIR (1997)* • NELFINAVIR (1998) • AMPRENAVIR (2001) • LOPINAVIR/r (2002) • ATAZANAVIR (2004) ITRNN FUSION INHIBITOR • NEVIRAPINE (2001)* • EFAVIRENZ (1999) • ENFUVIRTIDE (2005) *Brazilian local production

  6. Situation in Brazil • “apparent sustainability” of universal access • legally protected – increasing pressure on budget • long term treatment program – around 40% of all patients using 2nd line ARV (although with a low level of primary resistance - 8,3% - 2003) • 2nd line ARV may become 1st line • 3rd line ARV – extremely high prices (ex. T-20)

  7. Evolution of the distribution of ARV costs - national e multinational production ARV Production 1999 2000 2001 2002 2003 2004 2005* National 16,7 44,6 42,2 47,4 36.7 23,0 25,7 Multinational 52,6 64,3 83,3 55,4 57,8 77,0 74,3 2006 – NAtIONAL 18,4%, MULTINATIONAL 81,6% ( estimated) * SourceE: Coordenação-Geral de Ações de Suporte às Ações de Assistência Farmacêutica - CGSAF/DAF/SCTIE

  8. Average cost of ARV therapy per patient/year (US$). Brazil, 2005 7000 6240 6000 5486 Introduction of expensive new ARVs 5000 4603 4000 • Substantial falls in prices of second-line patented drugs have ceased • Number of people using them has increased dramatically 3464 3000 Thousands (US$) 2500 2210 2000 1500 1359 1336 1000 0 1997 1998 1999 2000 2001 2002 2003 2004 2005* Year

  9. ARV produced in Brazil - 2005

  10. Lopinavir/ritonavir (LPV/r) Price reduction and number of patients, 2002-2006

  11. Main Challenges – Sustainability To foster ARV “rational use” • adoption of new ARV drugs based on solid scientific evidence – cost/effectiveness, cost/benefit

  12. New drugs on the pipeline... Adaptado de Hoffman, 2003

  13. Main Challenges – Sustainability Negotiate ARV price reduction • directly with producers • Regional initiatives – Latin America + PAHO • International Initiatives – Clinton Foundation, UN agencies (PAHO, UNICEF, IDPF/UNITAID)

  14. Main challenges – sustainability To foster national production • technical capacity in place: • new formulations of 1st line ARV • R&D – API and new molecules A need for the near future – Brazil will have to consider making use of the TRIPS flexibilities

  15. Obrigada mariangela.simao@aids.gov.br

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