ACCESS TO HIVAIDS TREATMENT IN RESOURCEPOOR SETTINGS

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ACCESS TO HIV/AIDS TREATMENT IN RESOURCE-POOR
SETTINGS

• THE CASE OF ANSS/BURUNDI
• By Jeanne Gapiya Niyonzima
• ANSS Legal Representative

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HIV/AIDS in Burundi

• Total population estimated at 6.5 millions
• Prevalence 18.6 urban, 7.5 rural, first cases in
  83, 11 in 89, 20 in 2000 (urban)
• 390.000 persons living with HIV/AIDS (2001)
• More than 70 of hospital beds occupied by AIDS
  patients

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ANSS history and background

• Founded in 1993 by PLWHA
• Mission to promote full enjoyment of human
  rights by PLWHA, to give the epidemic a human
  face and voice, to prevent new infections through
  VCT
• 1995 VCT starts in an office rented with the
  support of Aides Federation Nationale, a French
  NGO (FF 26000)

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ANSS (contd)

• Increase in the demand for VCT as a result of our
  sensitization campaigns 35 people in Dec. 95,
  489 Jan.-Nov. 96, 747 Jan.-Mar 99
• Development of peer psychosocial support for
  those who get positive results
• 1996 started treatment through drugs donations
  with volunteer and part time physicians from
  public hospitals started a nutrition program for
  25 poor families

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ANSS (contd)

• 1996 started an informal support network of
  PLWHA using ARVs
• 1998 ANSS negotiates with one private pharmacy
  to make ARVs available and one private clinic to
  make CD4 count equipment available. Before that,
  people had to travel to Uganda or Kenya for over
  BIF 500,000 . The cost came down to BIF 10,000
• ANSS reaches agreement with Glaxo SK on reducing
  prices for AZT and 3TC (about 350/mo

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Strategies for political commitment

• ANSS lobbied government on the basis of prior
  achievements (reduced prices of ARVs, available
  CD4 count) and led it
• to waive customs duties on ARVs and drugs for
  opportunistic infections (40)
• to set up a national therapeutic fund with an
  annual gov. contribution of USD 150.000 (now
  built into the national annual budget)

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Political commitment (contd)

• The leadership and commitment of ANSS members
  contributed to government involvement in the
  response in general and in care and treatment in
  particular
• Continued PLWHA advocacy led gov. to accept them
  as stakeholders and to include them in decision
  making bodies National AIDS Commission, Theme
  Group (GIPA in action)

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Professionalizing care and treatment Centre
TURIHO

• 1999 with the support of Ensemble Contre le
  SIDA, a French NGO, ANSS opened Centre TURIHO,
  a center for VCT, care and support. In Kirundi,
  the local language, the word Turiho is a
  statement in itself. It means we PLWHA are
  alive. We are here!

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TURIHO

• Turiho is now the second VCT center in the
  country after the national blood transfusion
  center (747 people tested in 99, 2176 in 2000,
  2949 in 2001). Counseling is done by PLWHA
• A total of 7 doctors see patients at the center.
  Two of them are employed and paid by the
  association, the other five are volunteers

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TURIHO (CONTD)

• Center Turiho provides psychosocial support
  through counseling, food aid with the support of
  WFP (25 households in 96, 156 in 2002 ) and
  training in nutrition(2 workshops per month)
• Turiho has now become a reference center for
  HIV/AIDS in general and for antiretroviral
  therapy in particular

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TURIHO (CONTD)

• 8980 visits have been registered by the reception
  desk in 2001. Of these 6266 were medical visits.
  6687 prescriptions (essential medicines) have
  been served by the pharmacy of the Center. 700
  patients were under cotrimoxazole prophylaxis
• The Center has a three-bed ward where patients
  can stay a few hours (e.g. injections for
  cryptococcal meningitis)
• A little lab performs simple investigations

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TURIHO (CONTD)

• In 2000, ANSS obtained funding to purchase CD4
  count and VL dosage equipment and placed them in
  public hospitals. It also started training
  programs for physicians on the management of ARVs
  
• In 2001, the gov. signed an agreement with 5
  pharmaceutical companies on the reduction of ARV
  prices with the support of UNAIDS

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Partnerships for care

• In collaboration with MSF and the government,
  ANSS negotiated with the generic manufacturer
  CIPLA for the provision of generic ARVs. As a
  result, the price of a monthly triple therapy
  combination which ranged from 112 and 215 was
  reduced to 30- 60.

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TURIHO

• Out of the estimated 1000 patients using ARVs
  throughout the country, 400 get them through the
  Center
• 5 persons from the poorest and 10 ANSS staff
  members receive ARVs from ECS

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Conclusion

• This experience demonstrates the feasibility of
  access to treatment in general and to ARVs in
  particular in poor countries. For ANSS to achieve
  this, it took vision, guts, determination and
  leadership from PLWHA. This is indeed one
  example that they are not part of the HIV/AIDS
  problem but part of the solution.

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Conclusion

• Undoubtedly, a number of challenges remain
  making treatment available and accessible to all
  those in need building the capacity of health
  professionals to deal with treatment issues
  decentralizing care services, managing
  resistance.
• As encouraging as it can be, we need to recognize
  that this is small. It needs to be scaled up.
  Further drugs price reductions are needed,
  increased resources for care are needed (GFATM,
  governments, private sector, donors, etc)

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Conclusion

• If a little association of PLWHA in a small, very
  poor country torn apart by 9 years of conflict
  can make some progress in access to HIV/AIDS
  treatment, then there is every reason to say that
  everyone else should do a hundred times better.
  All it takes is commitment, organization and, off
  course, resources.
• THANKS FOR LISTENING!