Affordable healthcare Product Selection for TB, Malaria and HIV/AIDS Key issues for procurement IDA HIV/AIDS Group, Nienke Gruppelaar

- 2 - Selection criteria Strategic decision on the extent of treatments WHO treatment guidelines Global Fund guidelines/other funding guidelines Legal possibilities Availability of Cold Storage facilities Generic versus Originator sources Costs & Cost effectiveness Ease of use Safety & Efficacy Quality

- 3 - HIV/AIDS Generic availability first line treatment is high Second line treatment & pediatric formulations are a challenge PMTCT, Pediatrics Pregnant Woman, TB Co-infection Medicines for Opportunistic Infections and Palliative Care are an essential part of a HIV/AIDS Program –Not all are available from generic sources –Some require high-end facilities –Cooperation with TB program HIV diagnostics

- 4 - Lessons learned Make sure specifications are clearly defined from the start –According to guidelines for treatment (pediatrics, FDCs) –Registration & patent situation –In-country specs –Products, dosages, language labels Increase the amount of generics > lower cost and delivery time

- 5 - TB Define regimens (NTP) and formulations according to: –Epidemiological situation (risk of MDR) –Health Care Workers’ capacity for DOT (daily vs. intermittent) –Training capacity for switches (e.g. to FDCs) –Simplified distribution with few items –Less risk of drug resistance with FDCs –Consider patient kits with complete courses –Consider second line drugs only when basic first- line DOTS is well in place

- 6 - Malaria TREATMENTS P. Falciparum vs. P. Vivax 1 st line drugs 2 nd line drugs Severe malaria Cost Pregnancy –Treatment –Prevention NETS/IRS ITN vs LLIN Issues with procurement of non WHOPES approved LLIN – production now scaled up by order processing (usually unnecessarily) lengthy

- 7 - Sample ITNLLIN - Type 1LLIN - Type 2 Weight per bale (125 nets): 60 kg Weight per bale (100 nets): 42 kgs Weight per bale (40 nets): 29 kgs Volume per bale (125 nets): cbm Volume per bale (100 nets): cbm Volume per bale (40 nets): cbm Nets per 40' container: 37,000 pieces Nets per 40' container: 36,900 pieces Nets per 40' container: 16,800 pieces Logistics: Weights, Volumes & Costs The Shipment and Distribution of nets are a major logistical challenge. Depending, for example, on the type of LLIN, international shipping and handling costs (ITSH), inland transportation, testing and inspection costs could run between 45% and 65% of net cost. N.B. Different types have different weights and volumes Data based on Rectangular net size 150 x 190 x 180cm

- 8 - Rapid Diagnostic Test Considerations for choosing an RDT include: Plasmodium species to be detected (P. falciparum only, or panspecific) Shelf -life and temperature stability in intended conditions of storage and use Ease of use, including format of the test (e.g. cassette, dipstick, card) Requirement for post-treatment testing of patients Cost (including transport, training, and quality control) Sensitivity Good quality assurance processes after purchase are likely to be of greater importance.