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The Importance of Market Interventions to Achieve the Goals of Treatment 2.0

Craig McClure, HIV Department, WHO

The Importance of Market Interventions to Achieve the Goals of Treatment 2.0

Craig McClure, HIV Department, WHO

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Treatment 2.0 Priority Work AreasTreatment 2.0 Priority Work Areas

1. Optimize drug regimens

2. Provide access to point of care and other simplified diagnostics.

3. Reduce costs

4. Adapt delivery systems

5. Mobilize communities, protect human rights

TREATMENT2.0

Adapt delivery systems

Mobilize communities

POC and other simplified

monitoring

Optimize drug regimens

Reduce costs

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1. Optimize Drug Regimens1. Optimize Drug Regimens

Work towards harmonizing regimens for children and adults (including pregnant women)

Work towards a "target product profile":– One pill per day fixed dose combination– Minimal toxicities– Potent– High barrier to drug resistance– Minimal drug interactions (e.g. with TB medications)

Improve currently available drugs and drug regimens and stimulate the research pipeline towards development of drugs meeting target product profile

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Evolution of d4T, AZT and TDF use in 1st line therapy (2006-2010)

Evolution of d4T, AZT and TDF use in 1st line therapy (2006-2010)

0

10

20

30

40

50

60

70

80

2006 2007 2008 2009 2010

Year

%

d4T in 1st line

AZT in 1st line

TDF in 1st line

Source: WHO and CHAI, 2011

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Improve API route synthesis

Dose reduction

Substitution of drug components

Reduce pill burden/pill size

Reduce toxicity

Minimize drug-drug interactions

Minimize laboratory monitoring needs

Safe to use in adults, adolescents, children and pregnant women

Co-formulation (FDC or co-blister pack and paediatric formulation)

Improve drug bioavailability

Use of extended release formulations

• Improved adherence & clinical outcomes (maximize time on effective 1st line therapy)

• Improved convenience (patient and programme levels)

•Reduced costs (direct and

indirect)

Use of new strategies (e.g.: induction-maintenance)

ART Optimization Strategies

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2. POC Diagnostics2. POC Diagnostics

CD4 •Some POC on the market

Viral Load•No POC devices on the market yet

Early infant diagnosis•SAMBA 1, NWGHF p24 Antigen rapid test

TB and MDR TB Diagnosis•Xpert MTB/RIF Cepheid GeneXpert multi-platform

Slide courtesy of Maurine M. Murtagh and UNITAID

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What will WHO do?What will WHO do?

Convene expert consultations to drive global consensus

Communicate to partners/stakeholders priorities for optimization of currently available drugs and drug regimens, optimal package of currently available diagnostic technologies and R&D priorities for future products

Communicate through policy statements and rapid advice new developments and standards

Provide clear and detailed normative standards for simplified ART