Cheaper antiretrovirals improve HIV treatment
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.”
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.
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.”
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.