Cheaper an­tiretro­vi­rals im­prove HIV treat­ment

Kyiv Post - - Business Focus/opinion - BY JOSH KOVENSKY KOVENSKY@KYIVPOST.COM

Olek­sandr Yurchenko wasn’t al­ways in­ter­ested in HIV/AIDS.

Rather, the hos­pi­tal di­rec­tor started off as an ob­ste­tri­cian-gy­ne­col­o­gist, he told the Kyiv Post from the Kyiv pro­phy­lac­tic and anti-AIDS hos­pi­tal in Svy­atoshyn.

“I wanted to do re­search,” he said. “But since so much has al­ready been done in gy­ne­col­ogy, HIV/AIDS seemed like a new topic, and so I came to the AIDS cen­ter.”

Ukraine has the sec­ond-high­est HIV in­fec­tion rate in East­ern Europe, with var­i­ous es­ti­mates plac­ing the amount in­fected at around 220,000 as of 2015. Around 8,000 Ukraini­ans die each year be­cause of the ill­ness, mak­ing it one of the coun­try’s big­gest killers.

Kyiv’s AIDS cen­ter is Ukraine’s only hos­pi­tal that treats HIV/AIDS along­side a host of other ill­nesses — other in­fec­tious dis­eases, sur­gi­cal prob­lems, and ag­ing. But Yurchenko says that thanks to cheaper medicines pro­cured by in­ter­na­tional agen­cies, the av­er­age age of HIV pa­tients in Ukraine has rock­eted up to 37 years old from the 20s.

“Un­til the mid­dle of 2017, in Ukraine as a whole and in Kyiv in par­tic­u­lar there was a deficit of an­tiretro­vi­ral drugs,” he said. “There just wasn’t enough to pre­scribe as needed.”

“For decades we told pa­tients that, dear, you feel fine? Then ev­ery­thing is fine. Good im­mu­nity. So you don’t need to take ther­apy be­cause ev­ery­thing is fine,” he re­called. “But at the same time we were telling them this be­cause there wasn’t enough medicine.”

Trans­par­ent pur­chas­ing

In­ter­na­tional or­ga­ni­za­tions have taken over much of med­i­cal pro­cure­ment in Ukraine since the 2014 EuroMaidan Revo­lu­tion that re­moved Pres­i­dent Vik­tor Yanukovych from power on Feb. 22, 2014. A few donors pro­cure HIV/ AIDS med­i­ca­tion for Ukraine, aim­ing to do it at a cheaper price and to re­duce cor­rup­tion in the process.

The main drugs that were lack­ing in Ukraine were an­tiretro­vi­ral ther­apy — a so-called “cock­tail” of medicines that slow the spread of HIV with­out erad­i­cat­ing the dis­ease from the body. If taken cor­rectly, the treat­ment can pro­long the life ex­pectancy of those in­fected with HIV by decades.

The Global Fund to Fight AIDS has been procur­ing an­tiretro­vi­rals for Ukraine since 2003, and has spent $547 mil­lion in the coun­try since then, ac­cord­ing to an au­dit re­port.

Yurchenko said that a U.S.spon­sored pro­gram called PEPFAR — part­ner­ing to achieve epi­demic con­trol in Ukraine — had made by far the big­gest im­pact.

“The prices went down be­cause PEPFAR came to Ukraine,” he said. “Be­cause of this, we now have a huge quan­tity of an­tiretro­vi­ral drugs, and they came to Ukraine last year. They are de­liv­ered to Ukraine as a good and avoid the Min­istry of Health en­tirely.”

UNICEF has par­tic­i­pated in procur­ing drugs on orders from the Min­istry of Health, but on a smaller scale.

And not just HIV/AIDS has been af­fected.

Crown Agents, a quasi-govern­men­tal Bri­tish agency, signed a con­tract with the Min­istry of Health in 2015 to pro­cure Hep­ati­tis B and C drugs on the Ukrainian gov­ern­ment’s be­half.

That ef­fort led to 40 per­cent bud­get sav­ings be­tween 2015 and 2016, ac­cord­ing to an in­de­pen­dent es­ti­mate, with ex­tra cash avail­able for the gov­ern­ment to pro­cure ad­di­tional drugs.

Lin­ger­ing is­sues

Other prob­lems re­main among the drug com­pa­nies that sup­ply an­tiretro­vi­ral medicines to Ukraine.

One of the big­gest sup­pli­ers, a U.S. com­pany called Ab­b­vie, is ac­cused of us­ing its global patent on an an­tiretro­vi­ral called Lopinavir to jack up prices.

“In the sense of money spent from the bud­get on procur­ing it, Lopinavir is prob­a­bly the most ex­pen­sive drug in Ukraine,” said Mykyta Trofi­menko, an at­tor­ney at Net­work, a pa­tients’ or­ga­ni­za­tion su­ing Ab­b­Vie over its Ukrainian patent.

Trofi­menko said that Ab­b­Vie charges $61.60 for a month of treat­ment.

“The is­sue with the high price is that Ab­b­vie has a mo­nop­oly on it, its done via two patents, one fin­ishes in 2024 and the other in 2026,” he said. “Generic com­peti­tors could bring the price down.”

An Ab­b­Vie spokes­woman said the com­pany would not com­ment on on­go­ing lit­i­ga­tion.

A com­peti­tor of Ab­b­Vie — Gilead Sci­ences — came un­der sim­i­lar al­le­ga­tions re­gard­ing anti-Hep­ati­tis med­i­ca­tion that it pro­duces.

Ob­sta­cles also ex­ist in the chang­ing re­la­tion­ships be­tween pa­tients and their doc­tors.

Years of de­cep­tion, caused by deficits in drugs, have proven difficult to over­come for many pa­tients. Yurchenko said that peo­ple who have been told for years not to take an­tiretro­vi­rals are of­ten sus­pi­cious to hear the same doc­tors sud­denly singing a dif­fer­ent tune.

“The hard­est thing now is to change the per­cep­tion of pa­tients who have been told for decades that they shouldn’t take the drugs,” he said. “They say, ‘I was al­ready told I didn’t have to take the ther­apy,’ but now we can ac­tu­ally help them.”

(Oleg Pe­tra­siuk)

A wo­man un­der­goes an HIV ex­press test in a mo­bile lab in Kyiv in May 2017. HIV kills around 8,000 Ukraini­ans each year, but a re­cent uptick in the amount of medicines avail­able has helped doc­tors treat the ill­ness.

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