[Ip-health] [HEALTHGAP] Groups to Global Fund, PEPFAR: Support switch from toxic treatment

Giten Khwairakpam giten.khwairakpam at treatasia.org
Tue Aug 21 01:53:43 PDT 2012

Dear Jamie and Mathew thanks for the response.

I am not sure if anyone has done a mapping on who is prescribing d4T now as preferred first line. And we need an organization with a reach to the countries. That’s why I am suggesting ITPC and this should not be a very difficult exercise. ITPC can reach Eastern Europe, Africa, Latin America and of course through this List serve members can contribute on where else it is being prescribed- Probably we can set up a survey monkey too.

We can also see some organizations in Asia like APN+, who has a direct stake in this to figure out the d4T use and can collect such info from their country networks.

Majority of the countries will be receiving funds from the Global fund to run their national ARV program- some of them with 100% dependency on GF-so advocating to the GF makes sense. And these countries will be the ones who will not be in a position to switch to TDF because of cost.

There would be budget implications for this switch for sure. So we have to agree (as the process progresses) what do we ask. With majority of the countries already budgeted for cost of ARVs- when should we ask GF makes changes- at grant renewals or new applications? TRP weightage/ comments on what kind of drug being purchased from GF funds?

MSF Access Campaign has done extensive studies on TDF cost effectiveness and if I remember correctly in the Lesotho study there was a difference of 87 USD compared from d4T to TDF. But in the long run, TDF was much more cost effective due to the side effect related care and inpatient management cost.

I guess the point is not about the cost entirely (though it is important as it has lots of programmatic and coverage implications) but the ethicality of continuously prescribing a drug which has been told be phased out and no longer used in any developed setting.

Many of you who were at IAC might have seen Delhi network of Positive People (DNP+) work around stopping d4T use in India. The side effects are not only resulting in clinical manifestations to the user but also to the family, child, throwing families economic sustenance out of gear, increased stigma after 30 years of the epidemic, social barring  lots more!!

More thoughts welcome!


From: jamespackardlove at gmail.com [mailto:jamespackardlove at gmail.com] On Behalf Of Jamie Love
Sent: Monday, August 20, 2012 11:05 PM
To: Public list for Health GAP notices and discussions
Cc: Giten Khwairakpam; ITPC; Hgap list
Subject: Re: [HEALTHGAP] Groups to Global Fund, PEPFAR: Support switch from toxic treatment

What is the budget impact of the switch to the newer regimes, and how impact if any does this have on enrollments?
On Mon, Aug 20, 2012 at 8:36 AM, Matthew Kavanagh <matthew at healthgap.org<mailto:matthew at healthgap.org>> wrote:
Thanks Giten... agreed, let us know what we can do to help with a wider push... Has anyone done a good recent analysis of which countries are still initiating on d4t?
On Mon, Aug 20, 2012 at 5:55 AM, Giten Khwairakpam <giten.khwairakpam at treatasia.org<mailto:giten.khwairakpam at treatasia.org>> wrote:
Hi Mathew, thanks starting this topic and also sharing the letter. I hope this topic also gets equal attention from the members like some of the recent ones.

The continuous use of d4T is true developing countries in Asia also. Like the Malawi study, there have also been several studies in Asia where the irreversible side effects of d4T have been documented. Like Malawi, many countries want to phase out d4T but just cannot afford to do it. Like Malawi, many countries here needs global fund support to buy the national program ARVs and without the support of mechanisms like global fund, it is not possible to provide the ARVs at the current rate, scale up or  switch people to safer and newer regimens.

If the goal of providing antiretroviral drugs is also improving the quality of life, how can one be having an improved quality of life exposed to peripheral neuropathy or lipodystrophy for continuous years that too while newer more effective meds are available.

The cost effectiveness of TDF has also been documented but probably the long term cost gains gets sidelines as price of procurement/money needed to pay up for the meds immediately gets more importance.

Thank you for sharing this. This effort needs to take a larger scale, many other countries needs similar move and support. Probably Global fund needs to consider its options for checking kind of medicines being bought from its funds, so also PEPFAR?

Some countries recently are beginning to make some positive changes here (like India and Indonesia) but lots of our friends in other countries continues to suffer the side effects of stavudine knowingly just because there is no other way out.

Let’s do this in a wider scale. Many other friends in many countries needs this support the only question is who can take the lead?  ITPC?


From: internationaltreatmentpreparedness at yahoogroups.com<mailto:internationaltreatmentpreparedness at yahoogroups.com> [mailto:internationaltreatmentpreparedness at yahoogroups.com<mailto:internationaltreatmentpreparedness at yahoogroups.com>] On Behalf Of Matthew Kavanagh
Sent: Thursday, August 16, 2012 12:30 AM
To: Hgap list; ITPC; global-aids-policy-partnership at googlegroups.com<mailto:global-aids-policy-partnership at googlegroups.com>
Subject: ITPC SciSpeaks: Groups to Global Fund, PEPFAR: Support switch from toxic treatment

Groups to Global Fund, PEPFAR: Support switch from toxic treatment
Science Speaks
By Antigone Barton<http://sciencespeaksblog.org/author/antigone-barton/> ⋅ August 15, 2012

Read more: http://sciencespeaksblog.org/2012/08/15/groups-to-global-fund-pepfar-support-switch-from-toxic-substandard-drug/#ixzz23dMhW51H


... That’s the situation in Malawi, where the government changed its guidelines to a safer regimen, and where a recent study<http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3406059/?tool=pubmed> showed that stavudine carries its own built in obstacle to treatment adherence. Along with earlier studies, it demonstrated, in effect, that the cost of not switching is higher, in the long term costs of treatment drop out,  as well as costs associated with monitoring and addressing side effects.

But while children and pregnant or breastfeeding women, as well as tuberculosis patients have access to less toxic treatments, stavudine continues to be the first treatment supplied to most Malawi patients under the terms of the country’s grant from the Global Fund to Fight AIDS, Tuberculosis and Malaria.

In a letter to Global Fund General Manager Gabriel Jaramillo and United States President’s Emergency Plan For AIDS Relief Global AIDS Coordinator Eric Goosby<http://www.healthgap.org/documents/CSO_Malawi.pdf>, the Centre for Devlopment of People (CEDEP), Health GAP (Global Access Project), and the Malawi Network of People Living with HIV/AIDS (MANET+) are asking the Global Fund to find a way to switch to first line treatment in Malawi that is acceptable to patients and World Health Organization standards. They are asking the President’s Emergency Plan For AIDS Relief, which supplies technical assistance but currently does not play a role in supplying treatment in Malawi to support the switch, and to focus on paying for treatment coverage expansion and health worker salaries. “Importantly, the Government of Malawi is committed to phasing out stavudine firstline regimens, as reflected in updated national guidelines — but has been unable to do so because of funding limitations” the letter says.
Read more: http://sciencespeaksblog.org/2012/08/15/groups-to-global-fund-pepfar-support-switch-from-toxic-substandard-drug/#ixzz23dMZu12Z
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Matthew  Kavanagh
Health GAP (Global Access Project)
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matthew at healthgap.org

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James Love.  Knowledge Ecology International
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