HIV/AIDS Track Session

Key Points Application of international reference price list during a national tender is a valuable tool for achieving optimal pricing in South Africa for ARVs and anti-TB medicines Various countries have different information systems with varying level of robustness which affect patient and program monitoring. In many countries mostly non-pharmaceutical personnel perform ARV medicine dispensing roles; through task- shifting Poor practices and knowledge among health care providers – Low compliance to ART guidelines – Patient education vs Patient counseling

Key Points Appointment systems combined with tracking and linkages to home-based care programs promote adherence to keeping appointments for ART/TB care Integration of services was found to be feasible and promoted patient outcomes – With chronic diseases (CVD) Performance-based reimbursement was associated with good adherence outcomes

Policy Recommendations Countries should consider if international price benchmarking is applicable to achieve competitive prices for selected essential medicines, such as ARVs and anti-TB medicines For sustainability, low and middle-income countries should integrate ART/TB care into the existing health care systems and services – Other Chronic disease ART and TB programs should implement interventions and technologies to improve patient and data management at all levels (as necessary) as it will allow for patient and program monitoring

Policy Recommendations Adapt standardized indicators, develop and implement standardized tools for monitoring adherence and retention into the health care system – Countries should develop comprehensive and robust M & E systems for tracking patient and program performance Countries should activate and enforce legislation banning the availability and selling of anti-TB drugs and other antibiotics over the counter (and in – informal outlets). Chemoprophylaxis for TB should be shorter and supervised Promote patient and public information on HIV/AIDS itself, particularly about successful treatment outcomes and impacting patient behavior – Health and treatment literacy

Key Research Gaps What factors make the strategy of international price benchmarking successful and what factors comprise its effectiveness? There is need to better define medicines shortages, stock outs and treatment interruptions and to quantify and determine causes using standardized tools and approaches

Key Research Gaps What is the drop out rate between HIV testing and initiation of treatment and what interventions can be done to improve Pre- ART patient retention in the system? What interventions work at system; facility and individual level in improving patient adherence to treatment and how can these be scaled up? What is the best strategy for scaling up technology – based interventions and how do we evaluate the benefit of these interventions vs. the cost? – Integration and sustainability and ROI.