Press Release: About the Pediatric and Rural Programs
What will the pediatric program accomplish?
The pediatric program of the Clinton Foundation HIV/AIDS Initiative (CHAI) will put 10,000 children on AIDS treatment in at least 10 countries in 2005, doubling the number of children on treatment today in developing countries outside of Brazil and Thailand.
Why focus on children?
According to the World Health Organization (WHO), children account for one-sixth of annual HIV/AIDS deaths (500,000 in 2004) but represent far less than five percent of current antiretroviral treatment (ART) coverage. As few as 15,000-25,000 children are on treatment today, with nearly one-half of those in two countries, Brazil and Thailand.
The lack of coverage to date reflects special difficulties associated with pediatric HIV/AIDS care. The diagnosis of HIV in children under 18 months of age has been expensive and complex. Health professionals have believed that only pediatricians can treat children, but few pediatricians in developing countries have ART experience. The formulation of medicines varies from that of adults, as children require syrups or small tablets instead of larger pills or capsules, and their dosage varies further based on weight and size. Finally, the cost of pediatric formulations has been prohibitive—four to five times that of most affordable adult formulations—in part because suppliers have not received large orders.
Isn’t 10,000 children a small number compared to the need?
Yes. It is a tragedy that so few children currently receive treatment. 10,000 additional children is a beginning, but hundreds of thousands still need ART. By assuring drug orders for this initial group, the Initiative is bringing the drug prices down, which is a first step. By setting up pediatric programs in at least 10 countries, CHAI we will create models that can be used elsewhere. Working with UNICEF and other partners, CHAI will expand the program extensively in 2006.
At what price will the program get the drugs? Will these prices be available to everyone?
The Initiative has made an agreement with Cipla to purchase the bulk of the pediatric formulations needed for this year. Due to the volumes guaranteed, the prices will be more than 50 percent lower than what is available in the market today. Cipla has requested that the negotiated prices not be disclosed.
Based on recommendations from the WHO, UNICEF and CHAI’s care consortium of medical professionals, the program will begin treatment with a first line regimen of 3TC, AZT and nevirapine for most children. The Initiative will also order additional drugs including efaverinz, abacavir, lopinavir, ddI and d4T for alternative first-line regimens and second-line treatment as well as cotrimoxazole for prophylactic treatment of other infections. The Initiative will work with other governments and NGOs to make these prices available to them. By aggregating the orders of others with the Initiative’s own orders, the program can ensure that the manufacturer will have large batches and therefore lower costs to support the lower prices.
When will the pediatric program start?
It has already started. In late March the Initiative placed orders for 2,800 children in five initial countries (China, Dominican Republic, Lesotho, Rwanda and Tanzania). CHAI is providing technical assistance in these countries now and will expand to additional countries in the next few months. In May, children will begin to receive treatment as a result of this program.
Who is funding the program?
The Clinton Foundation has raised funds from private donors, led by the Children’s Investment Fund Foundation. Lone Pine Capital has additionally made a substantial contribution. The Initiative will raise more funds as needed. During the first year of the program, CHAI will donate the drugs and provide technical assistance. After this, the program will integrate this pediatric care component into the national plans of each partner country.
What is the role of the Clinton Foundation?
The HIV/AIDS Initiative is acting as a catalyst to accelerate the pace of pediatric treatment. Because the Initiative is assisting a number of governments with their AIDS care and treatment programs, and has a presence in more than a dozen countries, it can help implement programs on the ground. Because the Initiative has partnerships with pharmaceutical and testing companies, it can negotiate the price reductions. Because the Initiative is collaborating with UNICEF, WHO and various groups of expert doctors, it can supply technical assistance to get the programs going. Finally, because the Initiative has partnerships with private donors, it can provide start-up funds to initiate the programs quickly.
RURAL PROGRAM
What will the rural program accomplish?
The rural program of the Clinton Foundation HIV/AIDS Initiative (CHAI) will accelerate the penetration of treatment into rural settings, where most people in Africa and Asia live, and the Initiative’s first step in this program is to bring Partners in Health to Rwanda. The program will expand in 2005 to Tanzania and Mozambique in order to develop models of rural care that can be shared and replicated throughout the developing world.
Why target people living in rural areas?
Much of the recent increase in global ART coverage has relied on expansion of HIV/AIDS services in cities and towns. This initial focus is successfully leveraging existing infrastructure and resources to bring people into treatment programs as quickly as possible. However, in most developing countries the vast majority of people with HIV live in rural areas, where they have limited access to healthcare services and rely on incomes of less than $1 per day. Because of the scarcity of health professionals and facilities in rural areas, scale-up of ART has been limited. Moreover, the actual delivery of care must rely on different models of treatment, ones that require fewer resources, rely on indigenous capacity, and integrate HIV/AIDS services into comprehensive health programs that respond to a range of diseases and reach whole communities.
For example, the national AIDS care and treatment plans that were developed by the governments of Rwanda, Mozambique and Tanzania, with assistance from the Clinton Foundation, collectively call for providing ART to more than 700,000 people by the end of 2008. The first few years of these plans focus on delivering care in cities and towns. Meeting the 2008 goals requires the creation of models of care that can work in the rural areas of these countries.
Who is responsible for actually implementing the program?
In every country in which the Clinton Foundation HIV/AIDS Initiative works, the implementation of comprehensive HIV/AIDS programs depends on governments—including Ministries of Health and national HIV/AIDS commissions. The rural program will provide assistance to and work through them. It will also work with local and international NGOs such as Partners in Health and the Elizabeth Glaser Pediatric AIDS Foundation. For this and all its programs, the Initiative partners with various international organizations and donors including the Global Fund, the World Bank, WHO, UNICEF, UNAIDS and a number of donor governments including those of Norway, Sweden, England, France, Ireland, Canada and the United States. The Initiative believes that collaboration among many organizations under the leadership of local governments is the only way to address the HIV/AIDS crisis.
How is the rural program being financed?
The Clinton Foundation has raised private funds to support the rural program. In Rwanda, the Ruettgers Family Foundation has been the principal donor.
How much total money is being committed to both the pediatric and rural programs?
The Clinton Foundation HIV/AIDS Initiative will raise and donate about $10 million to these programs in the next year. This will, in turn, leverage far greater amounts from partner governments, donors and international organizations to carry out these programs effectively well into the future. The Initiative’s funds will serve as a catalyst to get the programs moving.
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