1. Supporting patients living with cancer worldwide www.themaxfoundation.org Access to Diagnostics: First CML Molecular Test Conducted in Ethiopia October 6, 2011 Addis Ababa Pat Garcia-Gonzalez, The MAX Foundation

2. Background  Ethiopia is quite a large country with a population of 85 million people  It has one cancer center and two hematologists in the entire country – Black Lion Hospital in Addis Ababa  Novartis has provided Glivec through GIPAP to CML patients since 2004  Currently 300 CML patients are actively on Glivec therapy

3. African Organization for Research and Training in Cancer (AORTIC) 2009

4. Only 2 countries in Sub-Saharan Africa can diagnose CML or monitor treatment, and testing is limited for most countries in Central America and Central Asia Lack of Diagnostics, a widespread problem

5. Mission of the CML Diagnostics Initiative To improve clinical outcomes for CML by strengthening capacity for diagnostics in low and middle income countries

6. Ethiopian Health and Nutrition Research Institute (EHNRI)

7. Mr Osman In the right place at the right time

8. October 6, 2011 Dr Amha (hematologist) and Mr Fayissa ( lab’s research assistant) making sure they have everything

9. Blood sample is ready

10. Very carefully following instructions Dr Amha read the instructions step by step

12. Under the watchful eye of Dr Amha and Dr Abdulaziz

13. Barcode scanning! Will it work?

14. Dr Amha himself carefully inserts the cartridge

15. Solid green means it is in properly!

16. 1:29:29 Time left until the result is ready

17. And now everyone waits!

18. It worked! In a matter of two hours, the BCR-ABL level of our patient was known Email from Dr Amha Gebremedhin, Oct. 9, 2011 “Dear all, on the 6 th of October, 2011, we successfully carried out the BCR/ABL assay with the GeneXpert (Cepheid) equipment of 4 CML patients who have been on Imatinib for 4-7 years. The results varied from 0.0017 to 6.1%. We are extremely glad to know the molecular status of our patients. No more blind treatment of CML patients in our country”

19. Oct 8 2011 Celebration of Life Patients listen attentively to Dr Amha’s explanation of the importance of CML monitorin g

20. No more blind treatment of CML Towards sustainable access to monitoring  Cepheid collaboration:  Donation of a Cepheid instrument and tests to Uzbekistan  Donation of 1,000 tests  Preferential pricing for instruments and tests  Validation study in three emerging countries  Mapping of PCR labs for HIV in Africa  Pilot program, Uganda  Training of hematologists  ERSAP program and  Virtual Education Program  Annual ASH meeting for physicians from Emerging Countries  Upcoming First Africa CML Colloquium for physicians and patients  Patient education  Upcoming Latin American Virtual education session for patients  Upcoming First Africa Region Advocates meeting

21. Cepheid price for 68 high burden countries through MAX program GeneXpert 4- module with desktop GeneXpert 4- module with laptop BCR-ABL Monitor Assay (10 cartridge kit) Price (Ex Works)US$ 17,000US$ 17,500 US$ 500 (US$ 50 each) >60% reduction over Cepheid EU/US

22. Lessons Learned  The power of involving all stakeholders  The power of a story  The power of partnerships  The power of tenacity

23. Thank You