In low- and middle-income countries, women often learn of their HIV status during routine screenings at prenatal checkups, which may not occur until the second or third trimester. In other cases, women who do know their status may face other barriers that have limited their access to antiretrovirals. It is therefore critical to have an HIV treatment that can be used in pregnancy to rapidly reduce a woman’s viral load before giving birth to prevent HIV from being transmitted to the baby. Dolutegravir is safe for pregnant or breastfeeding mothers and works faster than alternative treatments, meaning women can get the best care and ensure their babies are born free of HIV.

When dolutegravir was first approved, we acted fast to help coordinate the global health response and ensure people in low- and middle-income countries would have access to the drug quickly and affordably. We worked with generic manufacturers, our market-shaping implementers, and the Unitaid-funded Medicines Patent Pool to secure a voluntary license to enable generic production and fixed-dose combinations to enable treatment with a single daily pill. We led catalytic procurement to accelerate introduction of the medicine and increase demand while supporting pricing agreements of a historically low introductory price of US$75 per person per year. Working in parallel, we funded clinical trials to fill evidence gaps – such as those surrounding the use of the drug during pregnancy or for young children or people with tuberculosis coinfection. We also backed the development of properly dosed, fruit-flavored drug formulations for children.

Today, dolutegravir, as the WHO-recommended first-line treatment, is taken daily by more than 24 million people living with HIV in low- and middle-income countries. With massive uptake, the price of the drug has continued to fall, and the combination treatment now costs less than US$40 a year.