Patients and relatives wait at the entrance of Thyolo district hospital to be seen at the HIV/AIDS clinic supported by MSF. January 2007. Photo by Eva Lam
Thyolo is a rural district in Malawi in southern Africa, which is among the ten countries most affected by HIV/AIDS worldwide. Of the district’s 600,000 inhabitants, one out of five adults is living with HIV, many are impoverished and authorities face a dire shortage of health workers.
Currently, the Ministry of Health, together with MSF, not only offers access to antiretroviral (ARV) treatment to almost everyone who needs it, they do so at a reasonable and affordable cost.
Marielle Bemelmans, MSF head of mission in Malawi, explains how this is possible and why the high prices of newer HIV/AIDS drugs put this great achievement in peril.
In Thyolo district, universal access to ARV treatment has become a reality, with at least eight out of ten people who need this receiving it – currently over 14,000 in total. How was this achieved?
HIV care has been integrated into the public health system, standardised and simplified. Also, services are being provided in smaller health centres by nurses and health workers. In a country with such an acute shortage of doctors, using these medical workers to treat HIV-infected patients has allowed us to increase the number of people who start antiretroviral treatment four-fold.
What are the benefits of this approach?
Providing health care in local clinics means that people can access treatment closer to their homes and so spend less money and time on transport. More people in the district now know about the services available and they see family members, friends, and colleagues get better [once they start receiving treatment] which motivates them to come to the clinics, get tested and start treatment.
Also, we have been able to start people on treatment much earlier before their health has deteriorated. The time between the first test and the moment when patients take their first pill has been reduced from more than three months to three weeks on average.
This all sounds fine, but is this approach affordable for a developing country like Malawi?
At the moment, it costs 233 euro to treat one patient for one year. The per capita financial burden for the AIDS treatment programme is 2.60 euro per inhabitant per year - a significant cost, but it is do-able.
What could prevent this hard-won universal access to treatment in Thyolo in future?
The main threat is the high prices of newer AIDS drugs. Today, more than 95 per cent of patients in Thyolo take relatively cheap first-line antiretroviral generic drugs. Even if patients take these drugs regularly, they will inevitably need to change to newer second line or even third line drugs after a couple of years but most of these newer drugs are patented and are not yet available as cheaper generics.
As more people will need to switch to newer drugs over the coming years, the costs of this programme will increase astronomically because of spiraling drug costs.
We need to take all the necessary measures right now to ensure competition between different companies producing generic drugs. This is the best way to get the newer drugs much, much cheaper.
These animations explain why people in developing countries can’t get the HIV medicines they need to survive and how setting up a ’patent pool’ - which would allow generic-drug manufacturers to produce low-cost versions of HIV drugs - could change that.