[e-drug] Accelerating access report 29 May meeting

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E-DRUG: Accelerating access report 29 May meeting
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[copied from 
http://www.unaids.org/acc_access/contact_group/index.html
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Summary of the 3rd meeting of the Contact group on 
Accelerating Access to HIV/AIDS-related Care, Geneva, 
29 May 2001

On 29 May 2001, the third meeting of the Contact Group on 
Accelerating Access to HIV/AIDS-related Care was held in 
Geneva.  The Contact group was established by the 
UNAIDS Programme Coordinating Board (PCB) a year ago, 
in June 2000, to share information and to advise the 
UNAIDS Cosponsors and Secretariat on accelerating 
access to HIV care, support and treatment.

The 3rd meeting followed the pattern of the previous meeting 
and comprised four sessions.  In the first session, the 
Contact Group heard country reports from Gabon, Morocco 
and Barbados.  The presentation from Barbados also 
covered regional initiatives in the Caribbean, and was 
followed by presentations on behalf of other sub-regions in 
Africa, given by Mali (for ECOWAS), the Republic of Congo 
(for Central Africa) and South Africa (representing SADC).  
These presentations demonstrated the considerable 
progress made at country level in the twelve months of 
accelerating access and the momentum building up around 
regional and sub-regional approaches.

In session 2, participants were updated on progress at the 
international level, in presentations from WHO, the UNAIDS 
Secretariat, NGOs and the research and development-
based pharmaceutical industry.  The first presentation, from 
WHO, provided information on progress in selected areas 
of access, including pricing information, pre-qualification of 
suppliers for HIV-related drugs and differential pricing, within 
a framework comprising four key elements � the rational 
selection and use of drugs and diagnostics, affordable 
prices, sustainable financing and reliable health systems.  
The updated report, �Sources and prices of selected drugs 
and diagnostics for people living with HIV/AIDS� produced by 
WHO, UNICEF and MSF, is due to be released this week.  

The UNAIDS Secretariat made a presentation on resource 
mobilisation, highlighting the challenge to raise the needed 
level of resources, the principles which should apply when 
considering how to fund care, support and treatment and 
the various approaches adopted by national governments to 
raise funds for greater access to HIV/AIDS-related drugs.  
The proposal for a global fund for AIDS and health was 
discussed in this context.  

The NGO representative addressed a broad range of 
issues, including the need for the close and continuing 
involvement of civil society in access initiatives, the need for 
a complementary process for accelerating access to 
diagnostics, more transparency in the process of country 
missions and price negotiations, a wider geographic spread 
and redoubled efforts to reach all those needing HIV/AIDS-
related care and support.  

The representative of the research and development-based 
pharmaceutical companies spoke of progress in making 
HIV medications more affordable and described some of the 
individual actions of the five companies which signed the 
Joint Statement of Intent in May 2000 in improving the 
affordability and availability of a range of medicines.  The 
commitment of industry to the goal of accelerating access, 
through country-led processes, was reiterated.

In session 3, a technical update on voluntary counselling 
and testing was presented.  This provided data about the 
impact of voluntary counselling and testing interventions on 
prevention, as an entry point to care and as a critical entry 
point for the prevention of mother to child transmission.  A 
number of challenges for voluntary counselling and testing 
programmes were identified, including reaching vulnerable 
groups, increasing the efficiency and reducing the costs of 
testing, ensuring the quality of programmes, addressing 
stigma and discrimination and scaling up voluntary 
counselling and testing programmes. 

The final session provided the opportunity for open 
discussion of the many substantive issues which had 
emerged from the various presentations and interventions 
earlier in the meeting.  The key issues raised for further 
consideration and action were:

The need for a balanced �package� of care, which 
includes redoubled efforts to increase the availability and 
affordability of drugs and medicines, but also encompasses 
such critical elements as scaled-up voluntary counselling 
and testing programmes, medical training which takes 
account of the HIV/AIDS epidemic, increased access to 
diagnostics and better monitoring.  While significant price 
discounts for antiretroviral therapy have been achieved, 
reducing costs to 10% to 20% of world prices in some 
instances, the vast majority of people affected by HIV/AIDS 
remain without access to even basic drugs and medicines.  
Ensuring that essential care � palliative care, prophylaxis 
and treatment for opportunistic infections � is rolled out 
rapidly is as critical a challenge as making ARVs more 
widely available.  

The urgent need for strengthened health systems, to 
ensure that care, treatment and support can be effectively 
delivered and sustained.  Now that the lower price of drugs 
is beginning to bring treatment within the reach of more 
people affected by HIV/AIDS, the urgent need to build up 
health infrastructures and strengthen health systems has 
come into sharper focus on the care agenda.  AIDS can be 
seen as a new driving force � a fresh catalyst � for 
addressing the perennial problem of health systems.

The usefulness of regional and sub-regional 
collaboration, in sharing knowledge and experience and 
developing collective strategies.  Regional and sub-regional 
approaches are beginning to emerge and to prove useful to 
complement the country by country process.  The potential 
for such collaboration to expand the benefits of improved 
access to care, for example through the possibility of bulk 
purchasing, shared technical assistance and joint 
resourcing, is still to be realised � but it is clear that an 
important start is being made.

The need for greater transparency and information 
sharing, about achievements in accelerating access, 
prices and processes.  Interest was registered at the 
meeting in a broader dissemination of the basic elements of 
countries� experience in successfully negotiating for 
reduced prices, in greater reporting on country missions 
involving the UN and in even greater transparency on 
agreed prices.  The report, �Sources and prices of selected 
drugs and diagnostics for people living with HIV/AIDS� will 
contribute to this greater transparency.  UNAIDS recognises 
the need to be still more proactive in publishing information 
� not just putting it on the web-site. 

The importance of integrating care and prevention 
more effectively, and finding new ways to achieve this 
integration.  There are few truly effective models for 
achieving this balance at present.  Voluntary counselling 
and testing was recognised as a critical intervention linking 
both prevention and care, with access to treatment 
encouraging testing, and testing potentially leading to 
access to care.

The obligation to remain vigilant about the risks and 
realities of drug resistance, and to implement effective 
programmes of monitoring and evaluation. If we are going to 
do it, we must do it well.  Fundamental to maintaining the 
gains realised through lower prices is vigilance to the risks 
of drug resistance.  Careful monitoring of antiretroviral 
therapy is essential  to safeguard the value of the current 
generation of drugs for as long as possible.  WHO is 
leading work on this. 

The need for greatly increased resources � the 
encouraging development of the global fund was noted, and 
the opportunity to shape its governance and mandate in the 
process of stakeholder consultations leading up to the 
establishment of the fund was welcomed.  The group had a 
particular interest in ensuring that developing countries have 
a key role in decision-making in the proposed fund and that 
processes are decentralised.

The need to continue to achieve price reductions, 
through all possible means including strengthened 
competition, differential pricing and use of generics.  
Reductions in middle income countries and countries with 
low HIV incidence, where they can be seen to have the 
greatest impact, should be a focus for greater attention.

The need for continuing technical assistance from UN 
agencies, for procurement, quality assurance, certification 
and support to health systems.

The meeting concluded that after one year, the process of 
accelerating access has taken off, and the focus of 
attention for the Contact Group can now shift from 
matters of principle to practical action and 
implementation.  The opportunities to build positively on 
the changes achieved through collective efforts over the 
past year are becoming clearer and should be actively 
pursued.  
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