Unitaid lance une initiative pour éviter les décès dus au VIH à un stade avancé

Geneva – Unitaid is investing US$ 20 million in measures to avert hundreds of thousands of preventable deaths among people with advanced HIV.

The initiative seeks to forge a more effective global response to diagnosing and treating people whose immune systems are so weakened by HIV that they are at risk of infection by other life-threatening diseases.

The grant, to be implemented by Clinton Health Access Initiative (CHAI), will help make new, WHO-recommended medicines and testing tools affordable and available in lower-income countries.

“This promises to be an enormous benefit not only to individuals, but to the global HIV response,” Unitaid Executive Director Lelio Marmora said. “Addressing advanced HIV could prevent four out of ten HIV-related deaths every year.”

The intention is to create a model for tackling advanced HIV that can be scaled up by national governments and funding partners such as the Global Fund and PEPFAR.

The new investment builds on Unitaid’s 2016-2019 work with CHAI to expand access to the best available antiretrovirals.

The HIV virus weakens the immune system, increasing the risk of dangerous infection by bacteria, viruses and fungi. A person is said to have advanced HIV disease when his or her immune system can no longer fight off these opportunistic infections.

“Millions of lives have been saved by greater access to antiretroviral therapy, but many people with advanced HIV are still at risk of dying,” said Peter Sands, Executive Director of the Global Fund. “By taking on this challenge together, we can move toward our common goal of ending HIV.”

A third of the people who begin HIV treatment get started so late that they already have very weakened immune systems. They are at risk of death even after getting on antiretrovirals, the medicine used to suppress the virus.

Extraordinary progress has been made over the past two decades in expanding access to treatment for HIV and encouraging people to test and begin treatment earlier.  However, deaths from HIV-related diseases have not decreased as much as expected; they stand at about one million annually.

Tuberculosis is the leading cause of death among people living with HIV, claiming 300,000 lives in 2017. About 180,000 people with HIV die every year from cryptococcal meningitis, a fungal infection of the lining of the brain and spinal cord.

Last year, Unitaid secured two landmark agreements to improve treatment for those with advanced HIV disease: An agreement with the Indian drug manufacturer Cipla Ltd. lowered the price of an innovative combination therapy for co-infections including TB, and an agreement with Gilead Science reduced the price of a more tolerable formulation of AmBisome®, a drug for cryptococcal meningitis. Lower prices will allow more people to access treatment for these life-threatening infections.

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Neuf faits en bref sur l’investissement d’Unitaid contre le VIH à un stade avancé

Q&A

  • What is advanced HIV disease?

People with advanced HIV disease have a very weakened immune system, putting them at high risk of deadly opportunistic infections such as tuberculosis (TB), cryptococcal meningitis, pneumocystis pneumonia and other bacterial and parasitic diseases. HIV destroys essential immune system cells (CD4) that protect the body from infections. Hence, the World Health Organization (WHO) defines advanced HIV disease as having a CD4 count below 200 cells/microliter or WHO clinical stage 3 or 4 of the disease. 

  • How big a problem is advanced HIV disease globally?

In lower-income countries, one in three people starting treatment have a very weakened immune system and are at risk of death even after getting on antiretrovirals, the medicines used to suppress the HIV virus. In sub-Saharan Africa, about 10 percent of those patients die within the first three months of enrollment. 

  • Why does advanced HIV prevail despite the increase in access to antiretroviral treatment (ART) in the last decades?

Advanced HIV disease prevails —despite the increase in access to antiretroviral treatment (ART)— due to delays in starting ART, treatment interruptions, and development of resistance to antiretrovirals. 

  • Why is Unitaid targeting advanced HIV disease?

The persistent and high burden of patients with advanced HIV disease leads to deaths from infections that are preventable and treatable; multiplies the costs to health systems; and increases the risk of transmission. Despite the massive scale-up of ART, decline in HIV mortality has plateaued in the last two years at around 1 million annual deaths.

There are now new medicines and screening tools to prevent, diagnose and treat advanced HIV disease, but demand- and supply-side challenges are stopping these products from reaching everyone who needs them.

  • What exactly is Unitaid investing in?

Unitaid is investing US$ 20 million in measures to avert hundreds of thousands of preventable deaths among people living with HIV. Specifically, it intends to widen access to a package of live-saving medicines and diagnostics for opportunistic diseases in patients with advanced HIV disease. The grant, to be implemented by the Clinton Health Access Initiative (CHAI), builds on Unitaid’s work to expand access to the best available antiretrovirals and foster prompter treatment of HIV. 

  • How does Unitaid plan to make a difference?

Unitaid’s catalytic investment intends to make the WHO-recommended package of health products more affordable and accessible, and pave the way for governments and partners to make it widely available in countries. To that end, the grant will address bottlenecks on both the demand and supply-side of the market (e.g., high prices, low demand, regulatory obstacles). The ultimate goal is to avert hundreds of thousands of preventable deaths and improve the global response to HIV.

  • What health products is Unitaid intending to widen access to?

Unitaid will target a package of WHO-recommended drugs and diagnostic tools for the management of advanced HIV disease, particularly TB, cryptococcal meningitis and severe bacterial infections. TB and cryptococcal meningitis account for half of HIV-related deaths. TB, the leading cause of death among people living with HIV, killed some 300,000 people in 2017, 86 percent of them in Africa. Cryptococcal meningitis, a fungal infection of the lining of the brain and spinal cord, takes 180,000 lives of people with HIV every year. 

  • With whom will Unitaid partner?

Lead grantee CHAI will partner with Doctors Without Borders (MSF) and the Elizabeth Glaser Paediatric AIDS Foundation (EGPAF) in key countries, and both Unitaid and CHAI will continue working with civil society, academia, governments, WHO and global health partners towards the elimination of HIV worldwide. 

  • Had Unitaid worked in advanced HIV disease before?

In related work last year, Unitaid struck two landmark agreements to improve treatment for those with advanced HIV disease: A deal with Indian drug manufacturer Cipla Ltd. lowered the price of the only combination pill aimed at preventing TB and other opportunistic infections; and another deal with Gilead Science reduced the price of a more tolerable formulation of a drug to treat cryptococcal meningitis.

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The Medicines Patent Pool and Unitaid publish intellectual property report on long-acting technologies

The Medicines Patent Pool (MPP) and Unitaid have jointly published a study into the patent landscape for long-acting technologies with the potential to have a major impact on preventing or treating HIV, hepatitis C, tuberculosis, and malaria in low- and middle-income countries.

The Intellectual Property Report on Long-Acting Technologies provides an overview of the intellectual property status of long-acting products under development or already on the market as of October, 2018.

The patent situation for long-acting products can be complex, the report finds, involving patent protection on the drugs themselves, on the technologies needed to manufacture them, and, in some cases, on the delivery devices.

In the case of nanoformulations, for example, there is high potential for overlapping patents.  The delivery platforms are often applied to multiple products and are covered, as well, by extensive intellectual property protection. These factors and others summarised in the report may complicate adapting some long-acting products to the needs of low- and middle-income countries.

The report also finds that the geographical breadth of patent protection varies significantly among long-acting products, but that in general,  products appear to have patents pending or granted for generic manufacturing in key countries.

The report, compiled by the MPP and Unitaid, provides a patent landscape of intellectual property protection for long-acting products marketed or under development for prevention and treatment of HIV, hepatitis C, tuberculosis, and malaria.

“There is huge potential for long-acting technologies to make a substantial difference to treatment adherence in low- and middle-income countries, for diseases including HIV, hepatitis C and tuberculosis. But this won’t happen by itself,”  MPP Executive Director Charles Gore said. “Much collaboration is still required to develop them and then ensure affordable access. This report, by mapping the patent landscape for these technologies, will help accelerate this process.”

The report discusses the challenges of developing a healthy market for long-acting products in low- and middle-income countries. It also touches on the range of actors involved, where opportunities for partnerships might be found to speed development and widen access.

“To avoid the pitfalls of the past, when new medicines were introduced first in high-income countries and only much later in lower-income countries, we need to keep ahead of the curve to prepare for a healthy market and prompt access to these game-changing long-acting tools,”  Unitaid Executive Director Lelio Marmora said.

For more information:

Long-acting technologies for infectious diseases in LMICs – The Lancet, October 2018

Unitaid va soutenir de nouveaux outils contre le paludisme à P. vivax et des technologies en santé à longue durée d’action pour combattre les maladies

MARRAKESH, Morocco – Unitaid’s Executive Board agreed to support innovative, long-acting medical technologies to prevent and treat infectious diseases in low- and middle-income countries, and to promote new tools for the diagnosis and treatment of Plasmodium vivax malaria.

In approving the two new areas in which it will target investment, the Board opened the way for Unitaid to invite relevant projects for funding.

In high-income countries, long-acting technologies have brought a shift from daily oral medication to monthly, or even less-frequent dosing for conditions ranging from schizophrenia to osteoporosis. Long-acting contraception has already transformed reproductive health in low-income countries.

Unitaid sees promise in quickly adapting long-acting technologies for major public health challenges in low- and middle-income countries — where introducing the latest health innovations requires operational, regulatory and administrative hurdles to be overcome. Long-acting products could be made available as long-acting injectables, implants, rings, patches, and weekly capsules.

“A rich pipeline is emerging in long-acting technologies, “ Unitaid Executive Director Lelio Marmora said. “Shortening the time to make these innovations a reality in low- and middle- income countries could significantly reduce illness and death from infectious diseases such as HIV, TB and malaria – and many other conditions.”

Long-acting medicines for treatment and prevention hold the promise of revolutionizing the management of major diseases. Daily doses of medicines might no longer be needed, making adherence to treatment or prevention regimens much easier.

Poor adherence to medicines is a major healthcare challenge. It not only leads to continued illness and the spread of diseases but can enhance drug-resistance, including in TB, HIV and malaria. Drug-resistance ranks among the biggest threats to global health.

The Board’s action today also allows for Unitaid to explore projects to fight Plasmodium vivax malaria. More than one-third of the world’s population lives in areas affected by this species of malaria. Those at high risk of Plasmodium vivax malaria include migrants, the rural poor, and children under five years old.

Specifically, Unitaid will explore opportunities such as piloting a new single-dose cure for Plasmodium vivax and supporting development of quality-assured paediatric treatments.

“Radical cure has the potential to avert millions of P. vivax cases and save tens of millions of dollars,” Marmora said. “There is a strong rationale for Unitaid to leverage its unique role and operating model to support the safe use of tafenoquine and other tools.”

Plasmodium vivax accounts for a small proportion of cases of malaria globally and is prevalent in Asian countries, such as India and Pakistan, Latin America and parts of Africa. If not treated effectively, patients may experience increasingly debilitating relapses that can eventually prove fatal.

Plusieurs organisations mondiales actives dans le domaine de la santé vont adopter de nouvelles modalités de collaboration pour agir plus efficacement

Berlin – Eleven heads of the world’s leading health and development organizations today signed a landmark commitment to find new ways of working together to accelerate progress towards achieving the United Nations’ Sustainable Development Goals.

Coordinated by the World Health Organization, the initiative unites the work of 11 organizations, with others set to join in the next phase.

The commitment follows a request from Chancellor Angela Merkel of Germany, President Nana Addo Dankwa Akufo-Addo of Ghana, and Prime Minister Erna Solberg of Norway, with support from United Nations Secretary-General Antonio Guterres, to develop a global action plan to define how global actors can better collaborate to accelerate progress towards the health-related targets of the 2030 Sustainable Development Agenda.

“Healthy people are essential for sustainable development – to ending poverty, promoting peaceful and inclusive societies and protecting the environment. However, despite great strides made against many of the leading causes of death and disease, we must redouble our efforts or we will not reach several of the health-related targets,” the organizations announced today at the World Health Summit in Berlin. “The Global Action Plan represents an historic commitment to new ways of working together to accelerate progress toward meeting the 2030 goals. We are committed to redefine how our organizations work together to deliver more effective and efficient support to countries and to achieve better health and well-being for all people.”

The group has agreed to develop new ways of working together to maximize resources and measure progress in a more transparent and engaging way. The first phase of the plan’s development is organized under three strategic approaches: align, accelerate and account.

Align: The organizations have committed to coordinate programmatic, financing and operational processes to increase collective efficiency and impact on a number of shared priorities such as gender equality and reproductive, maternal, newborn, child and adolescent health.

Accelerate: They have agreed to develop common approaches and coordinate action in areas of work that have the potential to increase the pace of progress in global health. The initial set of seven “accelerators” include community and civil society engagement, research and development, data and sustainable financing.

Account: To improve transparency and accountability to countries and development partners, the health organizations are breaking new ground by setting common milestones for nearly 50 health-related targets across 14 Sustainable Development Goals. These milestones will provide a critical checkpoint and common reference to determine where the world stands in 2023 and whether it is on track to reach the 2030 goals.

The Global Action Plan will also enhance collective action and leverage funds to address gender inequalities that act as barriers to accessing health, and to improve comprehensive quality health care for women and girls, including sexual and reproductive health services.

The organizations that have already signed up to the Global Action Plan for Healthy Lives and Well-being for All are: Gavi the Vaccine Alliance, the Global Fund to Fight AIDS, Tuberculosis and Malaria, the Global Financing Facility, UNAIDS, UNDP, UNFPA, UNICEF, Unitaid, UN Women, the World Bank and WHO. The World Food Programme has committed to join the plan in the coming months.

The final plan will be delivered in September 2019 at the United Nations General Assembly.

For more information, www.who.int/sdg/global-action-plan

Media enquiries

Gavi, the Vaccine Alliance : Frédérique Tissandier; +41 79 300 8253; ftissandier@gavi.org

Global Fund: Ibon Villelabeitia; +41 79 292 5426; ibbon.Villelabeitia@theglobalfund.org

UNAIDS: Sophie Barton-Knott; +41 79 514 6896; bartonknotts@unaids.org

UNDP: Adam Cathro; +19179159725; adam.cathro@undp.org

UNFPA: Omar Gharzeddine; +1 212 297 5028; gharzeddine@unfpa.org

UNICEF: Sabrina Sidhu; +1 917 476 1537; ssidhu@unicef.org

Unitaid: Andrew Hurst, +41795616807; hursta@unitaid.who.int

UN Women: Maria Sanchez Aponte; +16467814507; maria.sanchez@unwomen.org

World Bank Group: Maya Brahmam; +1 202 361 2594; mbrahmam@worldbankgroup.org

WHO: Christian Lindmeier; +4179 500 6552; lindmeierch@who.int

Peru pioneers new treatment for drug-resistant TB — a photo story. (en anglais seulement)

Peru pioneers new treatment for drug-resistant TB – a photo story

How next generation regimens could turn the tide on multidrug-resistant TB Peru is one of the world’s fastest-growing economies. Its capital, Lima, tucked between the Pacific Ocean and surrounding valleys, bustles with trendy restaurants, cafés, museums, shops, and lots of traffic. Close to 10 million people live in Lima today and the population is growing.

The Hummingbird. Unitaid News – September 2018. (en anglais seulement)

The Hummingbird

À l’Assemblée générale des Nations Unies, Unitaid souligne le besoin urgent d’accélérer l’innovation pour mettre fin à la tuberculose

New York – As heads of state and leaders unveiled ambitious plans to fight tuberculosis at the first-ever United Nations High-Level Meeting on the disease, Unitaid has highlighted the special role it is playing to speed introduction of health innovations that are essential to end the disease.

“The road that leads from the laboratory to the final point of delivery of a health product in a clinic or village pharmacy is long and arduous,” said Unitaid Executive Director Lelio Marmora at a panel on TB on Wednesday afternoon. “It is vital to ensure we achieve the ultimate objective of our work of bringing an innovation to scale so it reaches the maximum number of people at the best possible price.”

Marmora said that one of the challenges in introducing innovative health solutions in low-income countries has often been the lack of a market big enough to attract pharmaceutical manufacturers. “This is precisely when well-targeted catalytic investments are called for.”

More than 80 countries are today using a child-friendly fixed-dose combination to treat TB, the result of a Unitaid partnership with the TB Alliance. Close to 700,000 children will get the treatment they need. “We now have a fixed dose combination for children that is used all over the world,” he said.

In an article published earlier today, Marmora and Partners In Health (PIH) co-founder Dr. Paul Farmer pointed out that new medications for multidrug-resistant TB (MDR-TB) are reaching only a tiny fraction of the people who need them, due in part to the exceptionally high cost of treatment. As a result, the number of new TB cases is falling very slowly—by less than 2 percent each year.

Marmora and Farmer said the UNGA’s decision to host the high-level meeting on TB is a sign that the tide could finally be turning. Funded by Unitaid, Partners In Health leads the endTB project, which is piloting the first new TB drugs in more than 40 years, bedaquiline and delamanid. EndTB’s shorter, less-toxic treatment regimens for MDR-TB, which are simpler to administer, have the potential to bring about major public health gains.

Unitaid’s approach makes it possible to introduce very expensive treatments at prices that are affordable in low-income countries. The organization’s experience with diverse partners has shown that medicines and other tools that may have cost large sums to develop can be made available on a very wide scale to those most in need.

Responding to a global TB crisis and the growing menace of drug-resistant forms of the disease, Unitaid expanded its funding for innovative TB projects from US$ 127 million in 2016 to US$ 215 million in 2018. Unitaid’s TB funding is on track to hit US$ 300 million in 2020.

Further investments are in development: new Unitaid projects will fight TB and its drug-resistant strains through innovative diagnostics, wider use of the best new drugs for adults and children, and new technologies to support people in taking their medicines.

In 2017, 10 million people fell ill with TB, according to the World Health Organization, and 1.6 million died from the disease. More than 95 percent of TB deaths occur in low- and middle-income countries. TB is a leading killer of HIV-positive people. In 2016, 40 percent of HIV deaths were caused by TB.