1. Sources and prices of newer ARVs: Prospects for Pricing and Availability XVI International AIDS Conference Satellite Session -- August 13, 2006 Médecins Sans Frontières (MSF) Fernando.PASCUAL@msf.org

2. How to decrease current prices of newer ARVs?  Generic competition enabled Starting & Scaling Up ART: 99% price reductions of 1 st line treatments through generic competition from 2001 - 05 Simplification of treatment (esp. development and use of FDCs) WHO prequalification

3. Start ARTs: d4T/3TC/NVP Substitute for toxicity: TDF/FTC+EFV Switch after failure: ABC+ddI+LPV/r US$140/y LDCs US$ 1,700/y x5 x2.5 x12 US$689/y Middle- income US$365/y US$ 5,200/y x3 x4 x14 US$ 1,175/y

4. Impact of 2nd line Use on Project Cost: Treatment of 10% of patients uses up 60% of budget >7,000 patients on 1 st line

5. Cost recovery in Nigeria: Impact of user fees on access to Anti-Retroviral Therapy (MSF-H) Sources of financing ART (n=89) 72% of all ARV experienced interviewed people (n= 122) had interrupted ART: - 61% Finance - 14% Out of Gvt. Sotck - 6% Side effects - 19% Other reasons - Questionnaire to determine patients’ reasons for interrupting ART - Income analysis of patients through questionnaire

6. WHO recommendations WHO PQ generics Lowest differential price Lowest generic price NVP643860 3TC56951 AZT4212103 d4T45541 EFV 600mg1277217 ABC1636564 ATV0N/A EC ddI0288N/A LPV/r tablets0N/A ritonavir083N/A SQV 500mg0N/A TDF0207N/A FTC0N/A

7. Generic pipeline TDFTDF/3TC CIPLAUS$ 973*US$ 1,034* HETEROUS$ 360*N/A Other new drugs on the generic pipeline: - LPV/r tablets (heat-stable) - TDF/FTC - TDF/FTC/EFV - ATV * Prices still high and products not yet WHO prequalified

8. Conclusions Drug prices are still a major barrier to access Generic production is needed to ensure available and affordable drugs Generic production is feasible only if patents are not granted, esp. in key producing countries like India WHO and donors should address the need of affordable/quality drugs to be able ensure treatment for life for all people in need.