When the Clinton Health Access Initiative (CHAI) began working on pediatric HIV/AIDS in 2005, kids were being left behind. Only one in 40 children in need were on treatment, compared to one in eight adults. The cost of pediatric medications was prohibitively high and the dosing was difficult in part because young children could only use liquid formulations. Infant testing for HIV was almost non-existent. Despite phenomenal progress in scaling up adult treatment and testing, services for children were lagging.
Lower Prices on Key Treatments
To address the massive disparity between the number of adults and children on treatment, CHAI began by working to bring down the price of pediatric AIDS drugs. By pooling volumes across 40 countries and through our partner UNITAID’s support, pediatric antiretroviral (ARV) regimen prices have come down by more than 80 percent on leading pediatric ARV regimens since the start of the project compared with prevailing prices in developing countries. Since 2006, UNITAID and CHAI have been working together to combine UNITAID’s purchasing power with CHAI’s unique model of marketplace improvement, with a goal of achieving price reductions and accelerating the roll-out of key new products in two niche HIV markets: pediatric HIV treatment and second-line HIV treatment. Prior to the launch of CHAI and UNITAID's work in second-line HIV treatment, the leading second-line ARV regimen in 2006 was priced at approximately $1,500 per patient per year. By 2012, the lowest cost, second-line regimen was available at a price approximately 78 percent lower than the price of the leading, second-line ARV regimen in 2006. Collectively, the two projects have reached more than 500,000 people across 40 countries with treatment, diagnostics, and therapeutic food.
Currently, CHAI is working with UNITAID and UNICEF to help popularize a portable machine – point-of-care-diagnostic tools (POC) – that can be used anywhere to immediately provide a CD4 count, cutting the time between testing and beginning antiviral therapy in half. Starting in 2013, CHAI, UNITAID, and UNICEF will be implementing the initial stages of the program across seven countries including Ethiopia, Kenya, Tanzania, Malawi, Mozambique, Uganda, and Zimbabwe.
Infant Testing and Child-Centered Medicines
Before CHAI got involved, treating children with HIV/AIDS was extremely complex. Beyond higher drug costs, their diagnosis was more difficult, their dosing more nuanced, and their medicines less patient-friendly than those for adults. By the end of 2005, fewer than 200 sites across countries where CHAI worked were equipped to conduct the specialized tests needed to diagnose HIV in children. To overcome this hurdle, CHAI worked with governments around the world to rapidly roll out infant testing. CHAI helped establish testing guidelines for infants and equipped thousands of health facilities with the supplies and know-how needed to collect blood samples from babies. By the end of 2009, 4,600 sites were testing infants for HIV in the 34 CHAI-supported countries.
In 2005, pediatric HIV drugs were only offered in liquid formulations, making them difficult to transport, store and dispense. One month of pediatric medicine once consisted of twelve bottles of syrup. Since then, CHAI helped develop formulations so today kids only have to take one pill twice a day.
Quality of Care and Retention
A landmark 2009 CHAI study found that more than half of children who test positive for HIV are lost to follow-up before they receive proper treatment. One cause of this was the long period of time that elapsed between taking the test and receiving the diagnosis. Kids were getting lost in the system. Parents had them tested, but because they never got the results, they never knew whether their child was HIV-positive or not. By improving data management systems to monitor retention and equipping both testing sites and labs with SMS printers, we have been able to cut this delay in receiving results by 50 percent. Through these and other steps, such as strengthening the referral system between testing sites and treatment clinics, CHAI is helping countries keep kids who test HIV-positive alive and well.