TUNISIAN EXPERIENCE ON ACCESS ON HIVAIDS TREATMENT

1
TUNISIAN EXPERIENCE ON ACCESS ON HIV/AIDS
TREATMENT

• Regional Meeting on expanded Access on HIV/AIDS
  treatment in Countries in the EMR
• CAIRO 18-20/02/2003
• Ministry of health TUNISIA
• Pr Noureddine Bouzouia
• Dr Ahmed Maamouri

2
Access on HIV/AIDS treatment

• 1985 Free treatment of opportunistic infections
• 1993 Free treatment with monotherapy
  Zidovudine
• 1997 Tritherapy limited for
• - Migrants Tunisians returning back
  home while
• receiving tritherapy in the host
  country ,
• - Post exposure prophylaxis ( health
  personnel)

3
Generalisation of Tritherapy

• 1998-1999 The national technical committee
  worked to
• scale up of coverage by
  tritherapy.
• 2000 Government decision to generalise
  tritherapy.
• April 2001
• - Issue of a circular stating the combined
  treatment
• free of charge for Tunisians
  residents
• - Treatment decision and choice of ARV regimen
• are made by physicians according to
  clinical status
• and biological criteria (CD4/CD8
  countage and viral load)

4
A strategy for HIV/AIDS care management

• Decentralisation of the HIV/AIDS diagnosis and
  patients
• follow up ( including ARV, CD4 countage and
  viral load ) with a referral laboratory
• Case management of patients care is undertaken
  in
• infectious diseases services ( 4 academic
  sites Tunis,
• Monastir, Sousse and Sfax)

5
A strategy for HIV/AIDS care management

• Drugs management is ensured by NASTDP
• Increase in national budget since 2000 up to 1,5
  million USD
• Distribution of drugs organised with the
  collaboration of the pharmacist of the directory
  of primary care health
• Guidelines are available since 1993 reviewed in
  2002 Guide de prise en charge de linfection
  VIH

6
Implementation of the program Accelerating
access to care initiative in Tunisia

• August 2001 UNAIDS agreed to organize a mission
  in Tunisia
• September 2001 elaboration of an action plan
  with agreement UNAIDS
• 2002 negociation with 3 pharmaceutical
  compagnies BMS and MSD.
• Agreement on reducing of prices

7
Drugs available in Tunisia in 2002

• Retrovir (AZT) 100 mg (box of 100), pediatric
  form Sirop 1 ml 10 mg and injecting form
• Didanosine (Videx) 100 mg (box of 60),
  200 mg (box of 60)
• Zalcitabine (Hivid) 0,75 mg (box of 60)
• Stavudine (Zerit) 40 mg (box of 56)
• Lamuvidine (Epivir) 150 mg (box of 60)
• Efavirenz (Stocrin) 200 mg (box of 90)
• Indinavir (Crixivan) 400 mg (box of 180)

8
Drugs registered and not available in Tunisia in
2002

• Liponavir/Ritonavir (Kaletra)
• Abacavir (ziagen)
• Nelfinavir (Viracept)

9
HIV epidemiological situation in Tunisia
1986-2002

• Incidence of HIV/AIDS infection per year 70
  cases
• Total recorded AIDS cases since 1985 to 2002 
  697 Cases Sex Ratio 2,9 (Persons gt 15 years)
• Prenatal transmission less than 5 cases / year
  (46 cases)
• PLWHA 797
• AIDS case care management 150 cases
• Estimated of patients who will need ARV during
  the next 3 years 500

10
New prices of ARV
11
Factors of success

• Political commitment to acced to care
• A national Budget
• A sub committee is in charge of medical and
  biological care of PLWHA
• Aviability of a widenes list of drugs ARV
• Generalisation of the combined ARV since 2000
• Decentralisation of the HIV/AIDS diagnosis and
  follow up
• A solid cooperation with physicians of UHC