1. What can buyers do to keep the LMIC ARV market competitive?? Jos Perriëns HIV Department WHO

2. The ARV market is concentrating in the hands of a few dominant companies

3. Do we need "5 +"??

4. A difficult case …

5. A not so clear case; [ZDV + 3TC] Too early to say for "TLE" – but therapeutic competition with "TEE" forced price to "TEE" levels, and then further down.

6. "5+" works for "TE" and "TL"

7. "5+" works for EFV, for "TE" and "TEE"

8. So "5+" is important What needs to be done to foster a competitive market for all important formulations?

9. Let's think: In markets with 5+ suppliers: adapt size of orders from past market participation? +5% for lowest bid, -5% for highest bid? For formulations with <5 suppliers: allow recent suppliers a 10% bonus?? Other ideas??