the endless concerted efforts for universal access: accessibility, quality, equity, sustainability
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The Endless Concerted Efforts for Universal Access: Accessibility, Quality, Equity, Sustainability. Taweesap Siraprapasiri MD, MPH Office of the Global Fund Grants Administration Department of Disease Control Ministry of Public Health The Royal Thai Government. - PowerPoint PPT PresentationTRANSCRIPT
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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1985 1990 1995 2000 2005 2010
Cu
rren
t HIV
Infe
ctio
ns
in m
illio
ns
Baseline No Intervention
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
0
10,000
20,000
30,000
40,000
50,000
60,000 ART roll out
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
30008000
19551
58233
88261
0
10000
20000
30000
40000
50000
60000
70000
80000
90000
100000
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)
$0
$50
$100
$150
$200
$250
$300
$350
$400
$450
$500
20
00
20
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20
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20
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25
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