Access Programs
A cornerstone of CHAI’s work since 2002 has been its Access Programs. These programs were developed in response to overwhelming number of individuals in the developing world in immediate need of treatment, which they were not receiving.
In order to make health care and treatment more accessible, President Clinton and CHAI’s Access Programs have worked to lower the price of essential drugs and diagnostics, facilitate rapid access to new products, and improve the health and efficiency of the marketplace for these commodities. CHAI does this by transforming the marketplace for commodities from a low-volume, high-margin market to a high-volume, and low-margin market through simultaneous and intensive engagement on both the supply and demand sides of the market. CHAI’s initial work in Access Programs was focused on HIV/AIDS but, today, has expanded in to new areas such as malaria drugs and nutrition commodities.
HIV/AIDS
Beginning in 2002, CHAI’s Access Programs have worked with generic pharmaceutical companies to negotiate affordable prices for HIV/AIDS medicine. Since 2003, CHAI has completed pricing agreements for 40 formulations of antiretrovirals (ARVs) with eight companies. Currently, more than 70 countries have access to reduced pricing for these medicines. In 2006, CHAI entered into a partnership with the international funding organization UNITAID to combine the purchasing power of UNITAID with CHAI’s model of price negotiations in order to increase the availability of pediatric and second-line commodities.
Since then, CHAI and UNITAID have achieved cumulative price reductions of 30 percent for second-line ARVs and 60 percent for pediatric ARVs. In addition, CHAI and UNITAID made new pediatric fixed-dose combinations (FDCs), priced at just $60 per child per year, available to more than two dozen countries in 2007.
Access to CHAI pricing agreements have become widespread, with purchasers readily able to access prices under the original ceilings set by CHAI. As of the beginning of 2008, 2 million people living with HIV, globally, are benefiting from ARVs purchased under CHAI agreements.
Beyond HIV/AIDS Treatment
Laboratory Testing
Access to laboratory testing is essential for the provision of effective HIV/AIDS care and treatment. Indeed, diagnostics are critical in diagnosing infection, informing clinicians when to initiate treatment, and detecting treatment failure. Yet investment in laboratory systems has historically lagged behind that of other areas of healthcare delivery.
How CHAI Helps
Since 2003, CHAI has used its market-based approach to reduce the price of the most expensive diagnostics for HIV/AIDS treatment and to introduce available testing technologies in the developing world. President Clinton and CHAI have now negotiated price reductions with 10 manufacturers for 15 HIV/AIDS test platforms, including HIV rapid tests for initial diagnosis, CD4 tests for staging and monitoring of the disease, and viral load tests for identifying treatment failure.
In addition, CHAI has helped to introduce and scale up DNA PCR testing, which is used for the diagnosis of infants under the age of 18 months; the test was virtually unavailable in developing countries as recently as 2006. CHAI, in partnership with UNITAID, achieved a price reduction of approximately 30 percent for this test in Africa and developed convenient "bundled" packages containing all the commodities required for testing. Since 2006, more than 30 countries have ordered this test, and together with CHAI’s in-country support, the number of sites conducting the test has increased dramatically.
Once laboratories are established, complex systems are required to monitor and maintain quality, to ensure an uninterrupted supply of reagents, to train and develop skilled laboratory technicians, and to repair instrument networks. Therefore, CHAI also provides technical assistance to countries to develop and strengthen the systems that support diagnostic testing in-country. This includes the creation of strategic and operational plans for laboratories; improvement of procurement and supply chain systems; the design of instrument networks and sample transportation programs; and the development of training and mentoring programs for laboratory workers and managers.
Nutrition
Administering ready-to-use-therapeutic food (RUTF) can make it possible to effectively treat children with severe acute malnutrition, a condition that goes hand in hand with HIV/AIDS. CHAI has worked to increase the supplier base for RUTF, increasing competition and lowering cost in order to make RUTF available to those that are most affected by hunger. Learn more about RUTF.
Malaria
Building on CHAI’s successful approach to changing the marketplace for HIV/AIDS medicines, we expanded our efforts in 2007 to increase access to effective malaria treatment. Since then, our work in malaria has grown rapidly. We are now supporting 14 countries in Africa and Southeast Asia and we are working closely with key manufacturers.
CHAI’s malaria work is focused in three areas:
- Improving treatment access by dramatically increasing the availability of more effective antimalarial medicines
- Supporting countries to assess and plan for the total elimination of malaria
- Strengthening diagnosis of malaria by ensuring that diagnostic tools are effectively used
PROFILE
Lisebo came back to life after receiving antiretroviral treatment at the clinic at age seven. But there are still 2.3 million children in the world who live with HIV, most of whom do not receive treatment.
