The Importance of Market Interventions to Achieve the Goals of Treatment 2.0 Craig McClure, HIV Department, WHO
Estimated percentage coverage with antiretroviral therapy in low- and middle-income countries by region, based on WHO 2010...
Treatment 2.0 Priority Work Areas <ul><li>1. Optimize  drug regimens </li></ul><ul><li>2. Provide access to  point of care...
1. Optimize Drug Regimens <ul><li>Work towards harmonizing regimens for children and adults (including pregnant women) </l...
Evolution of  d4T, AZT and TDF use in 1 st  line therapy (2006-2010) Source: WHO and CHAI, 2011
Improve API route synthesis Dose reduction Substitution of drug components <ul><li>Reduce pill burden/pill size </li></ul>...
2. POC Diagnostics <ul><li>CD4  </li></ul><ul><li>Some POC on the market </li></ul><ul><li>Viral Load </li></ul><ul><li>No...
What will WHO do? <ul><li>Convene expert consultations to drive global consensus </li></ul><ul><li>Communicate to partners...
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The Importance of Market Interventions to Achieve the Goals of Treatment 2.0

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Presentation with the occasion of the Technical Briefing at World Halth Assembly, Geneva, 18 May 2011

Published in: Health & Medicine, Business
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  • The guiding principles of Treatment 2.0 are focused on radical simplification of ART with accelerated scale-up and full integration with prevention. This detailed strategy is still under elaboration but is basically an &amp;quot;action framework&amp;quot; that is defining key activities and responsibilities jointly between key partners considering 5 major areas of actions: 1) optimize treatment regimens, promoting the use of effective and less toxic FDC regimens; 2) use of point of care and other simplified lab technologies, which will permit a more effective diagnosis, ART initiation and treatment monitoring; 3) reducing tretament costs and promoting more efficient use of the financial and human resources (doing more with less); 4) improve delivery systems, by promoting a more effective decentralization of treatment and use of task shifting approach; and last but not least, the involvement of community in treatment delivery and support.
  • The Importance of Market Interventions to Achieve the Goals of Treatment 2.0

    1. 1. The Importance of Market Interventions to Achieve the Goals of Treatment 2.0 Craig McClure, HIV Department, WHO
    2. 2. Estimated percentage coverage with antiretroviral therapy in low- and middle-income countries by region, based on WHO 2010 and 2006 guidelines, 2008 and 2009
    3. 3. Treatment 2.0 Priority Work Areas <ul><li>1. Optimize drug regimens </li></ul><ul><li>2. Provide access to point of care and other simplified diagnostics . </li></ul><ul><li>3. Reduce costs </li></ul><ul><li>4. Adapt delivery systems </li></ul><ul><li>5. Mobilize communities , protect human rights </li></ul>TREATMENT 2.0 Adapt delivery systems Mobilize communities POC and other simplified monitoring Optimize drug regimens Reduce costs
    4. 4. 1. Optimize Drug Regimens <ul><li>Work towards harmonizing regimens for children and adults (including pregnant women) </li></ul><ul><li>Work towards a &quot;target product profile&quot;: </li></ul><ul><ul><li>One pill per day fixed dose combination </li></ul></ul><ul><ul><li>Minimal toxicities </li></ul></ul><ul><ul><li>Potent </li></ul></ul><ul><ul><li>High barrier to drug resistance </li></ul></ul><ul><ul><li>Minimal drug interactions (e.g. with TB medications) </li></ul></ul><ul><li>Improve currently available drugs and drug regimens and stimulate the research pipeline towards development of drugs meeting target product profile </li></ul>
    5. 5. Evolution of d4T, AZT and TDF use in 1 st line therapy (2006-2010) Source: WHO and CHAI, 2011
    6. 6. Improve API route synthesis Dose reduction Substitution of drug components <ul><li>Reduce pill burden/pill size </li></ul><ul><li>Reduce toxicity </li></ul><ul><li>Minimize drug-drug interactions </li></ul><ul><li>Minimize laboratory monitoring needs </li></ul><ul><li>Safe to use in adults, adolescents, children and pregnant women </li></ul>Co-formulation (FDC or co-blister pack and paediatric formulation) Improve drug bioavailability Use of extended release formulations <ul><li>Improved adherence & clinical outcomes (maximize time on effective 1 st line therapy) </li></ul><ul><li>Improved convenience (patient and programme levels) </li></ul><ul><li>Reduced costs (direct and </li></ul><ul><li>indirect) </li></ul>Use of new strategies (e.g.: induction-maintenance) ART Optimization Strategies
    7. 7. 2. POC Diagnostics <ul><li>CD4 </li></ul><ul><li>Some POC on the market </li></ul><ul><li>Viral Load </li></ul><ul><li>No POC devices on the market yet </li></ul><ul><li>Early infant diagnosis </li></ul><ul><li>SAMBA 1, NWGHF p24 Antigen rapid test </li></ul><ul><li>TB and MDR TB Diagnosis </li></ul><ul><li>Xpert MTB/RIF Cepheid GeneXpert multi-platform </li></ul>Slide courtesy of Maurine M. Murtagh and UNITAID
    8. 8. What will WHO do? <ul><li>Convene expert consultations to drive global consensus </li></ul><ul><li>Communicate to partners/stakeholders priorities for optimization of currently available drugs and drug regimens, optimal package of currently available diagnostic technologies and R&D priorities for future products </li></ul><ul><li>Communicate through policy statements and rapid advice new developments and standards </li></ul><ul><li>Provide clear and detailed normative standards for simplified ART </li></ul>

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