In July of 2013, an important step was taken for the 35 million people living with HIV when the World Health Organization recommended viral load testing as the gold standard to monitor patients receiving antiretroviral therapy (ART). The test itself measures the amount of the HIV virus that is present in a person’s blood. Lower amounts of virus means improved health outcomes for a patient as well as less of a chance to transmit HIV to others. When on ART, viral load testing provides a clear picture of whether a patient is responding successfully to HIV treatment.
In addition, UNAIDS recently announced a set of unprecedented HIV testing and treatment targets for the global health community to reach by the year 2020. Called the 90:90:90 targets, the goals of the initiative are to ensure that 90 percent of HIV-infected patients know their HIV status; that 90 percent of positively diagnosed patients are on life-saving ART treatment; and that 90 percent of patients on treatment are responding successfully to their drugs.
These two initiatives alone have set incredible change in motion: these policy changes required to provide the life-extending care and treatment that patients deserve – regardless of age, gender, race, or socioeconomic background.
While viral load testing has been routinely provided in developed settings for some time, access to this test has been severely limited in resource-limited countries. This lack of access is, in large part, due to the challenges that health care systems that many developing countries face, as well as the high cost of the test itself. Despite these barriers, countries moved rapidly to adopt the 2013 WHO guidelines and worked to understand the country-specific benefits, risks, and gaps of scaling access to viral load. Many developed implementation plans that demonstrated their commitment to overcome infrastructure and program complexities, while highlighting to the global community the urgent need to address the affordability issue.
Working under the leadership of UNAIDS, partners came together to create an innovative structure to negotiate a global access price for viral load testing. As the government of South Africa had established the largest and most advanced viral load program in Sub-Saharan Africa, it was also the largest purchaser of viral load tests globally. A review of several country-wide assessments identified pricing as a key barrier to access, leading to a negotiation that would ultimately leverage the viral load volumes associated with the 2.5 million people on treatment in South Africa to benefit the millions of others in need across the globe. In partnership with the Global Fund and PEPFAR, the negotiations were completed in September 2014. Roche Diagnostics announced a reduction in the cost of a viral load test to $9.40. This represents a 40 percent decrease in the overall cost and a potential savings of over $150 million over the next 3 years.
With support from UK Department for International Development (DFID), CHAI helped to structure the new viral load agreement, which is just one example of how effective partnerships can deliver meaningful impact. The approach taken by partners to negotiate pricing in response to a clear gap prioritized by countries demonstrates the essential nature of bringing countries to the table to help find solutions.
It is in this context that governments, partners, and technical professionals are gathered this week in South Africa for the Associated Society of Laboratory Medicine Conference. Laboratory and clinical professionals will come together to present important research on viral load testing and discuss with governments the implications for patients living with HIV. With the recognition that the challenges of scaling up access to viral load testing are too great for any single country, organization, or donor to advance alone, countries and partners have formed a consultative and collaborative process to advance tackling this critical access gap. Today, on World AIDS Day, we recognize that ultimately, even with limited resources, all people living with HIV can receive the same quality of care as those in developed countries. The new access price proves that we are one step closer to this reality.