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Responding to the HIV/AIDS crisis in resource-limited settings: the role of pharmacists in improving access to and use of medicines

Responding to the HIV/AIDS crisis in Responding to the HIV/AIDS crisis in resourceresource--limited settings: the role of limited settings: the role of pharmacists in improving access to and pharmacists in improving access to and use of medicinesuse of medicines

The challenge to the profession of pharmacy and to FIP

Jean PARROT, FIP PresidentTuesday 7 September 2004

The challenge to the profession of pharmacy and to FIP

Jean PARROT, FIP PresidentTuesday 7 September 2004

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Alarming figuresAlarmingAlarming figuresfigures

What the HIV/AIDS pandemic is today:

• 38 million people were estimated to be infected with HIV in the world in 2003 (70% of them live in Africa)

• 3 million people died last year

• and 5 million people became infected with HIV

What the HIV/AIDS pandemic is today:

• 38 million people were estimated to be infected with HIV in the world in 2003 (70% of them live in Africa)

• 3 million people died last year

• and 5 million people became infected with HIV

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Inequality in treatment accessInequalityInequality in in treatmenttreatment accessaccess

• 6 million people should receive a treatment

• but only 400,000 patients are getting it

• The HIV/AIDS pandemic highlights the current inequality in health-care access.

• 6 million people should receive a treatment

• but only 400,000 patients are getting it

• The HIV/AIDS pandemic highlights the current inequality in health-care access.

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The needs in limited resource settings

TheThe needs needs in in limitedlimited resource settingsresource settings

ØMany healthcare systems are unable to respond to increasing demands related to the pandemic, due to:Ø

• lack of money and human resources• lack of basic infrastuctures (sanitation, water...)• poor geographical access

ØMany healthcare systems are unable to respond to increasing demands related to the pandemic, due to:Ø

• lack of money and human resources• lack of basic infrastuctures (sanitation, water...)• poor geographical access

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132037.30%19.61%330,000Botswana

1,785,000

6256.70%3.75%1,110,000Kenya

32,000,000

22313.50%6.73%240,000Centrafr. Rep

3,800,000

620.80%0.44%41,000Senegal

10,100,000

50.20%0.09%5,000Denmark

5,360,000

20.40%0.20%120,000France

60,140,000

Infected persons per pharmacist

Infected adults (adult

rate)

Infected adults (total population

rate)

Infected adultsCountryPopulation

Sources : population : ONU 2004; infected persons and %: ONUSIDA 2004; pharmacists : OMS 1999; For Botswana : 2004 (Health ministry)

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The needs in limited resource setting

TheThe needs needs in in limitedlimited resource settingresource setting

Ø Inadequacy of the health system to respond to the increasing demand related to the HIV/AIDS pandemicØLack of human resources ØLack of infrastructureØPoor geographical access

Ø Inadequacy of the health system to respond to the increasing demand related to the HIV/AIDS pandemicØLack of human resources ØLack of infrastructureØPoor geographical access

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All is not darkAll All isis not not darkdark

ØOpportunities:

• stronger international determination:

- to increase human and financial resources;- to improve access to ARV medicines and provision

of care in developing countries

ØOpportunities:

• stronger international determination:

- to increase human and financial resources;- to improve access to ARV medicines and provision

of care in developing countries

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MeansMeansMeans

Some financial response now exists at international level (Global fund, private foundations, NGOs) and at national level

But the outcome depends on the capacity of health professions to mobilise

Some financial response now exists at international level (Global fund, private foundations, NGOs) and at national level

But the outcome depends on the capacity of health professions to mobilise

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I - The challenges for pharmacistsI I -- TheThe challenges for challenges for pharmacistspharmacists

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The challenges for pharmacistsTheThe challenges for challenges for pharmacistspharmacists

ØContinuing education and training on ARV and other HIV related treatments

ØMobilisation to participate in local projects using international HIV/AIDS funds

ØContinuing education and training on ARV and other HIV related treatments

ØMobilisation to participate in local projects using international HIV/AIDS funds

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The challenges for pharmacistsTheThe challenges for challenges for pharmacistspharmacists

1) To ensure efficient logistics of ARV drug supplying2) To give pharmaceutical care and support to patients treated with ARV drugs3) To achieve Quality Assurance throughout

all processes

1) To ensure efficient logistics of ARV drug supplying2) To give pharmaceutical care and support to patients treated with ARV drugs3) To achieve Quality Assurance throughout

all processes

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1) HIV drug supplying1) HIV 1) HIV drugdrug supplyingsupplying

ØThe efficacy of HIV related treatment demands:

• quality of medicine sources (no defective oucounterfeit medicines)

• safe medicine management (transport and conservation)

• uninterrupted medicine supplying

ØThe efficacy of HIV related treatment demands:

• quality of medicine sources (no defective oucounterfeit medicines)

• safe medicine management (transport and conservation)

• uninterrupted medicine supplying

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2) Treatment optimisation2) 2) TreatmentTreatment optimisationoptimisation

ØTo optimise the conduct of the treatment with the patient:

• - explain the treatment, its challenge, how to use the drug, when to take it, how to organise a care plan, ...

• - enhance adhesion to the treatment• - detect failure factors • - give permanent support to the patient

ØTo optimise the conduct of the treatment with the patient:

• - explain the treatment, its challenge, how to use the drug, when to take it, how to organise a care plan, ...

• - enhance adhesion to the treatment• - detect failure factors • - give permanent support to the patient

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3) Quality Assurance, the heartof the process

3) 3) QualityQuality Assurance, Assurance, thethe heartheartof of thethe processprocess

Ø To be trusted by possible partners as a reliable professional, the pharmacist should be able to evaluate his contribution within an HIV/AIDS project:

§ Patient follow-up files§ Analysis and use of patient’s data§ Evaluation of treatment conduct (adherence criteria, …)

Ø To be trusted by possible partners as a reliable professional, the pharmacist should be able to evaluate his contribution within an HIV/AIDS project:

§ Patient follow-up files§ Analysis and use of patient’s data§ Evaluation of treatment conduct (adherence criteria, …)

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II - The challenges for pharmaceutical associations (national

organisations, NGOs, …)

II II -- TheThe challenges challenges for for pharmaceuticalpharmaceutical associations (national associations (national

organisations, NGOs, …)organisations, NGOs, …)

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The challenges are: TheThe challenges are: challenges are:

Ø To show determination to be involved in projects developed in their countries Ø To represent the profession in national working

groups in charge of devising and implementing local projectsØ To develop strategies and support (guidelines...)

for training

Ø To show determination to be involved in projects developed in their countries Ø To represent the profession in national working

groups in charge of devising and implementing local projectsØ To develop strategies and support (guidelines...)

for training

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An example: the ESTHER initiative in France

An An exampleexample: : thethe ESTHER ESTHER initiative in Franceinitiative in France

‘ESTHER’: ‘Ensemble Solidarité Thérapeutique Hospitalière En Réseau’

i. e:‘Together for Solidarity, Hospital Network Care’

www.esther.org

‘ESTHER’: ‘Ensemble Solidarité Thérapeutique Hospitalière En Réseau’

i. e:‘Together for Solidarity, Hospital Network Care’

www.esther.org

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III - The challenges for FIPIII III -- TheThe challenges for FIPchallenges for FIP

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FIP’s initiatives (1)FIP’s initiatives (1)FIP’s initiatives (1)

ØFIP advocates the involvement of pharmacists at global level• In 1997, FIP and WHO signed a joint statement

highlighting the need for pharmacists to contribute to the prevention of HIV transmission: The Vancouver Declaration

• In 2004, a WHPA resolution “Health professionals Issue a Wake up Call on AIDS”

ØFIP advocates the involvement of pharmacists at global level• In 1997, FIP and WHO signed a joint statement

highlighting the need for pharmacists to contribute to the prevention of HIV transmission: The Vancouver Declaration

• In 2004, a WHPA resolution “Health professionals Issue a Wake up Call on AIDS”

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FIP’s initiatives (2)FIP’s initiatives (2)FIP’s initiatives (2)

ØOthers statements or documents on limited resource settings:• Statement of policy on Counterfeit Medicines• Statement on Quality and Safety of medicinal

products• Policy document on Good Practice in the Donation of

Medicines• A report, Good Pharmacy Practice in Developing

Countries: Recommandations for step-wiseimplementation

ØOthers statements or documents on limited resource settings:• Statement of policy on Counterfeit Medicines• Statement on Quality and Safety of medicinal

products• Policy document on Good Practice in the Donation of

Medicines• A report, Good Pharmacy Practice in Developing

Countries: Recommandations for step-wiseimplementation

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FIP’s initiatives (3)FIP’s initiatives (3)FIP’s initiatives (3)

ØFIP has created Regional Pharmaceutical Forums in collaboration with WHO

They gather national Pharmaceutical Associations and the WHO Regional Office for implementing local programs to meet local needs

ØFIP has created Regional Pharmaceutical Forums in collaboration with WHO

They gather national Pharmaceutical Associations and the WHO Regional Office for implementing local programs to meet local needs

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Copenhagen, Denmark - EuroPharm Forum created in 1992

Brazzaville, Congo – African Forum created in 2004

Cairo, Egypt – Eastern Mediteranean Forum

created in 2002

Washington, DCAmericas ForumCreated in 2000

New Delhi, IndiaSEARPharm

ForumCreated in 2001

Manila, PhilippinesWestern Pacific Forum

created in 2001

Joint development of regional pharmaceutical forums by FIP and

WHO

Joint development of regional Joint development of regional pharmaceutical forums by FIP and pharmaceutical forums by FIP and

WHOWHO

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A new FIP achievement in 2004

A new FIP A new FIP achievement achievement in 2004in 2004

ØAn Online Resource Centre on HIV/AIDS for pharmacists:

the International Network for Pharmacists on HIV/AIDS, launched in September 2004

www.fip.org/hivaids

ØAn Online Resource Centre on HIV/AIDS for pharmacists:

the International Network for Pharmacists on HIV/AIDS, launched in September 2004

www.fip.org/hivaids

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A new FIP achievement (2)A new FIP A new FIP achievement (2)achievement (2)

Øwww.fip.org/hivaids is an oneline network:§ reserved for pharmacists§ bilingual (English/French)

Ø It provides pharmacists with:§ information, through links to many relevant international or

national organisations§ training modules for pharmacists§ a place to exchange with each other (mailing list)§ an interactive Events Calendar

Øwww.fip.org/hivaids is an oneline network:§ reserved for pharmacists§ bilingual (English/French)

Ø It provides pharmacists with:§ information, through links to many relevant international or

national organisations§ training modules for pharmacists§ a place to exchange with each other (mailing list)§ an interactive Events Calendar

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http://www.fip.org/hivaidshttp://http://www.fip.orgwww.fip.org//hivaidshivaids

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The Network objectives (1)TheThe Network objectives (1)Network objectives (1)

ØTo promote the role of pharmacists in the fight against HIV/AIDSØTo facilitate collaboration between individual

pharmacists, professional associations and Regional Pharmaceutical ForumsØTo facilitate global collaboration between

pharmacists and other health professionals involved

ØTo promote the role of pharmacists in the fight against HIV/AIDSØTo facilitate collaboration between individual

pharmacists, professional associations and Regional Pharmaceutical ForumsØTo facilitate global collaboration between

pharmacists and other health professionals involved

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The Network objectives (2) TheThe Network objectives (2) Network objectives (2)

ØTo provide an e-mail list for sharing experience between interested organizations and individualsØTo participate in international AIDS conferences

by organizing or supporting presentations relevant to pharmacistsØTo collect and distribute information on

pharmacy-related HIV/AIDS activities and pharmacy-based research on HIV/AIDS

ØTo provide an e-mail list for sharing experience between interested organizations and individualsØTo participate in international AIDS conferences

by organizing or supporting presentations relevant to pharmacistsØTo collect and distribute information on

pharmacy-related HIV/AIDS activities and pharmacy-based research on HIV/AIDS

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CONCLUSIONCONCLUSIONCONCLUSION

ØHIV/AIDS is a challenge for society as a whole

ØPharmacists, among all health professionals, are uniquely embedded in their local communities

ØThey have a duty to take up that challenge and live up to it.

ØHIV/AIDS is a challenge for society as a whole

ØPharmacists, among all health professionals, are uniquely embedded in their local communities

ØThey have a duty to take up that challenge and live up to it.