Sources of Limited Access to Treatment

1
Sources of Limited Access to Treatment
High Cost of Treatment
Lack of Demand
Lack of Pilot Projects
Lack of Policy
Lack of Evidence
2
Treatment Regimen Costs
Standard Reference Country Cost (USA)

High Income Country Average Cost
Low Income Country Average Cost
Green Light Committee Cost
60000
50000
40000
Per Patient Drug Cost (USD)
30000
20000
10000
0
HR
HRES
HRESZK
Resistance Pattern
Gupta, et al., Science 2001.
3
Linking Independent Concepts
ACCESS
RATIONAL USE
GLC
POLICY
4
Green Light Committee (GLC)

• Releases preferentially-priced, quality-assured
  drugs
• Decision process
• application review
• Instructions for Applying to the Green Light
  Committee for Access to Second-line Anti-TB Drugs
• Guidelines for Establishing DOTS-Plus Pilot
  Projects for the Management of MDR-TB
• site visit
• Continual monitoring of projects
• Technical assistance

Gupta, et al. Trop Med Intl Health, 2001
5
Changing Global Health Policy

• New guidelines for MDR-TB treatment
• Expanding DOTS framework to include MDR-TB
• HIV, public-private mix
• Improving allocation of financial resources
• Increasing new funds for TB control
• Scaling up primary health care/capacity building
• Bridging equity gap
• No longer whether or not to treat patients, but
  how to best treat patients

6
Similarities between HIV and MDR-TB

• Multidrug regimen given for extended periods with
  adverse events
• Disproportionately affects disadvantaged
• Access to drugs
• Drug resistance
• Laboratory requirements
• Lack of standard international policy
• Most experience in resource-wealthy settings