More on whether/how US foreign 'assistance' is help or hinderance. This
is on the President's AIDS Initiative (PEPFAR).

Mary Anne


-------------------------------------------------------


PEPFAR: US is tackling HIV drug supply in wrong way,
say Christian hospitals

Source: Aidsmap/NAM
By: keith Alcorn
Wednesday, October 20, 2004



An organisation representing front-line mission
hospitals in 22 developing countries says that the US
President’s Emergency Plan for AIDS Relief threatens
to create unsustainable and wasteful two-tier
treatment systems because of the US insistence on
using branded antiretrovirals already approved by the
US Food and Drug Administration.

The Ecumenical Pharmaceutical Network represents
Christian hospitals, drug supply organisations and
development agencies from 22 countries including many
of the countries named as recipients of PEPFAR
support.

In a statement issued last week after the Network’s
annual conference in Tanzania, members highlighted a
number of concerns they have about the way in which
the PEPFAR programme is being imposed on health care
systems.

They say that PEPFAR’s insistence on brand-name drugs
approved by the FDA is creating confusion and extra
work for overstretched health care staff in settings
where generics are also available. This criticism was
first raised at a meeting called by the US, WHO and
southern African governments to review drug approval
standards for fixed dose combinations. Eric Goemaere
of Medecins sans Frontieres told the audience of
international regulatory officials: “If each partner
comes to us only wanting to treat women or children,
or only wanting to use a certain drug combination or
branded products, it will be chaos. If we have
different supplies and different combinations coming
in, it will create confusion both for the clinic and
for patients who have already started with a
particular fixed dose combination.”

Jennifer Patterson of Catholic Relief Services, one of
the agencies funded by PEPFAR to deliver treatment
through mission hospitals, explained why the
programme’s requirement on branded drugs was creating
extra work: "Our programmes fear that they will suffer
the burden of administration of multiple supply lines,
that community workers will face the extra burden of
explaining different regimens to patients within the
same family, and that the use of loose tablets rather
than FDCs will create the danger of pill-sharing
between family members because of the prevailing sense
of community.”

The US government has repeatedly stressed that it will
not use drugs in its PEPFAR programme that US
regulators would not pass for use by US citizens, and
has invited generic manufacturers to submit their
products to the US FDA for approval. If the products
receive approval the US Global AIDS Coordinator
Randall Tobias has said they will be eligible for
purchase with PEPFAR funds.

However there are also concerns about the way in which
drugs will be supplied to the field. Ecumenical
Pharmaceutical Network coordinator Eva Ombaka says
that PEPFAR’s insistence on a vertical drug supply
chain separate from existing systems could undermine
efforts to improve national drug distribution systems

The Ecumenical Pharmaceutical Network has also raised
doubts about what will happen when the current funding
for PEPFAR runs out in 2008. If the same level of
funding is not forthcoming after 2008, says the
Network, levels of treatment achieved may not be
sustainable, especially if branded products remain
more expensive than generics and if the programme has
prevented the development of local drug production.

“The high level of donor control and little or no
country or local ownership further undermines the
sustainability of health care and other services,” the
Network stated last week.

PEPFAR’s policy on procurement and delivery will come
under further scrutiny after a $7 billion tender call
for a drug supply system is announced. According to US
National Public Radio defence contractor Northrop
Grumman will partner with JSI Deliver and Management
Sciences for Health in its bid to bring
antiretrovirals to two million in the 15 PEPFAR
programme countries.


Source: Aidsmap.com:
http://www.aidsmap.com/en/news/3BEB3196-46F8-415F-84F9-B382754C3745.asp

----

A. Odutola
mailto: chpss_abo@...




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