The Endless Concerted Efforts for Universal Access:Accessibility, Quality, Equity, Sustainability

Taweesap Siraprapasiri MD, MPHOffice of the Global Fund Grants Administration

Department of Disease ControlMinistry of Public Health

The Royal Thai Government

Universal Access to HIV Prevention and Care

There is no doubt on the benefits of prevention and care efforts at a national scale

This can save million of lives if we are able to implement in a timely manner

Enormous current benefits of prevention Enormous current benefits of prevention efforts in Thailandefforts in Thailand

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Red line represents what might have been if behaviors had not changed

Infectionsprevented

Number of annual death in Baseline VS National access to ART for PLWHA program (NAPHA) Scenario, Thailand

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Universal Access for ART

What we have learned from the 3by5 Strategy on antiretroviral treatment (ART)? Globally, ART access has increased from

400,000 on 12/2003 to 1,300,000 on 12/2005 Thailand is able to include ART to universal health

care coverage on Oct 1 2005

Can we achieve the goal of universal access to treatment by 2010?

Yes, we can

BUT

We need concerted efforts with a sustained manner

Universal Access for ART

Key issues for scaling up ART program

ARV and lab reagent (CD4) affordability and accessibility

Human and infrastructure capacities

Multi-sector and level collaboration

Resource mobilization and sustainable financing

Programmatic Challenges

At what level of ART coverage (accessibility) is feasible for limited resource countries Phasing to Universal Access

What approach and strategy should be used to achieve appropriate quality ensure equity long term sustainability

Scaling up ART to Universal Access;Thailand experience

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Before 2001 2002 2003 2004 2005

Local generic drug production on 4/2002

GF major contribution

NAPHA launched

Universal Access

Provincial hospitals are able to provide ART

All District hospitals are able to provide ART

ARV affordability

Triple combination of ARVs before 2001 was 220 USD /month in Thailand

April 2002, Government Pharmaceutical Organization launched D4T+3TC+NVP in a fixed dose combination at 30 USD/month

During 2004-2005, GF has supported about 30% ARVs providing to patients in Thailand using the standard 3-regimen of first line therapy ( Average cost is 40 USD/month) D4T+3TC+NVP (FDC local production) 30 USD/month (80%) D4T(local), 3TC (local), EFV (original) 64.5 USD/month (15%) D4T, 3TC, Boosted PI (original) 87.5 USD/month (5%)

Challenging issues for ARV affordability

Can Thailand afford second line treatment? ABC+ddI+Boosted PI 561.5 USD/month

Currently, Thailand can not use the Global Fund budget to purchase GPO’s generic products due to the policy restriction of WHO- GMP prequalification

The price of first line ARVs from original companies are 3 to 10 time even they have been marketed more than 15 years

There is no practical mechanism for lower middle income countries to get the Global Access Price

Does Thailand compromise the quality of care?

GF contributing in laboratory monitoring networks

Before 2002 25USD / CD4 test 18 units of flow cytometry

located in 14 provinces are used for 3,000 patients

Currently in 2006 6 USD/ CD4test 90 units (64 units from the GF) in

70 provinces are used for more than 100,000 cases

“Within 2 years, 160 holistic centers are ran by PLWHA in concordance with 160 hospitals, which follow around 20,000 PHA on ART.

300 centers with 39000 PLWHA are expected to reach in 2008.

GF budget supports and strengthens PLWHA networks so that their members have necessary knowledge, skills and resources to participate as equal partners

Multi-sector and level collaboration

GF support faith based organizations to provide community and home based care

4 religions including Buddhism, Muslim, Protestant, and Catholic have jointly created an interfaith network for providing care

4500 PLWHAs are expected to benefit from the work of this interfaith network in 3 years

Resource mobilization and sustainability

Government budget on ARVs has increased from USD 6.2 M in 2002 to USD 70 M in and integrated into Universal Health Coverage (cover 48 millions) in 2006

Social Security Scheme (cover 8 million workers in private sector) has covered ARV in the health benefit package since 2004

GF has provided additional resources about 40% of budget for ARV care in 2004 and phasing to 15% in 2006

After 2010, most costs are 2nd line drugs

Total Cost of Public ART (NAPHA)

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Millions

Cost of Public ART_1 line_asy Cost of Public ART_1 line_sym

Cost of Public ART_2 line_asy Cost of Public ART_2 line_sym

Source: MOPH WB joint study 2004

Can we achieve the goal of universal access to treatment by 2010

Universal Access to HIV Prevention and Care

Ensure equity

At appropriate quality

And be sustained

Acknowledgements

Health personnel from different levels and sectors

Thai NGOs coalition on AIDS PLWHA network Academic persons and institutions International organization Political support from Ministers, Permanent

Secretary, Director Generals. Funding agencies