Presentation Transcript

1. ART Program Managementunder Universal Health Coverage

   SorakijBhakeecheep, MD. National Health Security Office, THAILAND.
2. Outline Overview of Thailand’s HIV/AIDS situation Financial aspect of ART program ARV supply chain management Key success factors Challenges National Health Security Office
3. National AIDS Control Program Royal Thai Government National AIDS Committee Ministry of Public Health (Regulator and Provider) National Health Security Office (NHSO) (Purchaser and System manager) Other Ministries/ governmental org CBO & private sectors (Social security scheme)  SSS CSMBS PWHA networks (Civil servant medical benefit scheme ) Program implementation on: HIV counseling & testing (HCT) HIV/AIDS care and ART Positive prevention HIV/AIDS strategy HIV prevention program implementation Care and treatment related technical guideline Service delivery (by hospitals) National Health Security Office
4. Thailand’s ART Situation Supplies Demands National Health Security Office
5. Thailand’s AIDS Expenditure Thailand’s AIDS expenditure 330 millionUSD in 2011 2.4% of total health expenditure (THE) 0.09% of GDP 73%  Treatment & Care 14%  Prevention 13%Others (social protection, program management, research, etc) National Health Security Office
6. ART Program Budget ART Program Budget under UHC (2007-2013) 58%  ARV cost 27%  LAB cost 99%  Domestic fund (government) 1%  International fund (GF-ATM) ART program budget under UHC ran steadily around 100 mUSD for years. National Health Security Office
7. Unit Cost Analysis Cost of ARV falls to nearly 50% during past five years Cost for 2nd line is  4 times of the 1st line Central procurement and compulsory licensing play significantly role to make ARV prices more affordable Cost Structure in 2013 National Health Security Office
8. Budget Allocation under UHC HIV/AIDS Budget Pay for performance ARV Drugs LAB + HCT Capacity building GO, NGO, CBO GO – Governmental organization NGO – non Governmental organization CBO – Community based organization Hospitals National Health Security Office
9. Establishing National ARV Drugs List Academic issue Financial issue National ART Guideline Taskforce National Committee on Essential Drugs List National ARV Drugs List Approve for: Clinical criteria Clinical efficacy Approve for: Cost effectiveness Long term affordability -Planning -Budgeting National Health Security Office Management issue
10. First line: NRTI Zidovudine (AZT) Stavudine (d4T) Lamivudine (3TC) Didanosine (ddI) Tenofovir (TDF) NNRTI Nelvirapine (NVP) Efavirenz (EFV) Third line: PI Darunavir (DRV) National ARV Drugs List Second line: PI Lopinavir (LPV) Ritonavir (RTV) Atazanavir (ATV) Original Remark: Drugs indicated in blue color can be produced domestically by GPO Drugs indicated in red color are original drugs All ARV drugs are managed by GPO, including procurement, quality control, stock management and logistic. Abbrev: ARV Anti-retroviral UCS Universal Health Coverage Scheme SSS Social Security Scheme GPO Government Pharmaceutical Organization National Health Security Office
11. Drugs Supply Framework Individual data input ID Demography Clinical LAB Prescription etc Hospitals Realtime data transfer Drugs supply to hospitals Daily data transfer Safety stock ARV consumption ARV On-hand Amount delivered Data verification Data calculation NHSO – National Health Security Office GPO – Government Pharmaceutical Organization National Health Security Office
12. Key Success Factors Clear policy commitment from government Strong existing health system infrastructure Implementation of Universal health coverage Effective price regulation mechanism to ensure ART program sustainability Centralized program management Central procurement vs. central negotiation Domestic manufacturing of generic ARV Good collaboration among key stakeholders Effective HIV/AIDS information system National Health Security Office
13. Challenge #1 To prevent more deaths through early diagnosis and early treatment Finding: > 78% of PWHA has CD4 level < 350 at first diagnosis and registration More than half of PWHA has CD4 level < 100 at first time of ART initiation National Health Security Office
14. Challenges # 2 To maintain quality/effectiveness despite of increasing workload Finding: Registered PWHA is increasing overtime (+10% each year) Death & lost follow-up are still high, especially in non-ART group (pre-ART stage) Increase workload could lead to poor services and poor adherence, thus aggravate drug resistance and mortality National Health Security Office
15. Challenges # 3 To control ART program budget and ARV cost to ensure affordable financing and supply system Finding: 11% PWHA receiving ART are taking 2nd line protocol, and still increasing A number of PWHA need higher than 2nd line protocol Cost of 2ndline is 4 times higher than 1stline, but 3rdline is much higher CL VL MPP National Health Security Office
16. Thank you for your attention National Health Security Office