Child starting pediatric DTG 10mg at a health facility in Malawi. Credit: Lighthouse Trust.
Geneva, 4 October 2021 – On World AIDS Day 2020, Unitaid and the Clinton Health Access Initiative (CHAI) announced a groundbreaking deal that would see the very best HIV treatment made available to the youngest children for the first time.
Access for the youngest children
1.8 million children around the world live with HIV, the majority in low- and middle-income countries. Only 53% of these children are diagnosed and on treatment, while 80,000 babies and toddlers die each year from AIDS.
Ensuring access to treatments specifically designed for children is a key priority for Unitaid – and the agreement announced on December 1st 2020 saw the price for pediatric HIV treatment reduced by 75% with a new 10mg scored, dispersible formulation of dolutegravir.
Unitaid Executive Director Dr Philippe Duneton said: “To see this new paediatric formulation of DTG hitting the ground in six initial countries – and knowing that so many more are to come – is a huge moment for all the partners involved, and the communities that will benefit. Making the very best treatments available to the youngest children is at the heart of what Unitaid does and is vital if we are to achieve the global goals for HIV.”
It’s all in the taste
The strawberry-flavoured formulation of the WHO’s recommended first-line treatment for HIV has been designed to overcome many of the barriers that stop young children taking their medication properly.
A lack of appropriate paediatric medicines has meant that tablets are often unpalatable to children, due to a bitter taste or use of adult formulations being crushed or broken for children.
The collaboration between Unitaid, CHAI, originator ViiV Healthcare, and generic manufacturers Viatris and Macleods also led to the generic version of the medication receiving the fastest-ever United States FDA tentative regulatory approval.
“As a result of this unique collaboration alongside ministries of health and impacted communities, thousands of children in need will now receive the best HIV treatment available in the fastest time ever for a pediatric medication,” stated Joy Phumaphi, interim co-CEO of CHAI. “It is so exciting to see patients now accessing this lifesaving medication which has the potential to transform HIV care for children across low- and middle-income countries and save countless lives.”
Reaching those who need it most
DTG arrives in Zimbabwe for distribution. Credit: CHAI.
In May 2021, 100,000 packs of 10mg scored, dispersible DTG started hitting the ground in six African countries that were the target of a catalytic procurement by CHAI and Unitaid – Nigeria, Malawi, Uganda, Kenya, Zimbabwe and Benin.
Despite the difficulties of operating during the COVID-19 pandemic, CHAI – in close collaboration with Ministries of Health and national stakeholders – worked with procurement agent, i+ Solutions, to facilitate the purchase and delivery of the product in each of the six countries.
“The catalytic procurement by Unitaid and the support from CHAI has been a game changer, allowing faster introduction of this child friendly formulation to our young ones. This easy to administer formulation of pDTG is more efficacious, tastes better for the young palates, with more rapid viral load suppression and fewer side effects. The catalytic procurement is already being implemented in 13 high volume sites, and is expected to generate early experience, enabling younger children <20kgs access to the clinically superior benefits of DTG. Lessons learnt during first phase of implementation will inform national scale-up,” said Dr Angela Mushavi, National Prevention of Mother-to-Child Transmission and Pediatric HIV Care and Treatment Coordinator at the Ministry of Health and Child Care, Zimbabwe.
This initial procurement is designed to kickstart the demand in countries and help get the medication to as many of the 1.8 million children living with HIV who could benefit as possible.
Sister Mary Owens is the executive director of Nyumbani, an organization dedicated to providing HIV/AIDS services to children and affected families in Kenya since 1991.
Nyumbani children were among the first to receive the new DTG formulation, through Unitaid and CHAI’s catalytic procurement.
Sister Mary said: “Since the National AIDS Conference in Durban in 2016, I have been lobbying for access to DTG for our children. Since then, 102 of our children have been optimized as a result of our work alongside CHAI and Unitaid and the support of NASCOP to deliver these lifesaving medications. I am unable to express adequately our unbelievable joy that Nyumbani younger children can now access DTG 10mg – and are the first in Kenya and in Africa. We are already seeing the great benefit.”
Mothers of children living with HIV and key community leaders met at a workshop organized by the Community Advisory Board in Senegal. The meeting aimed to raise awareness about the availability and benefits of pediatric DTG and increase demand for the medicine. Credit: AfroCAB.
CHAI’s partnership with communities through the Optimal Community Advisory Board (CAB) is building demand and increasing patient treatment literacy on pediatric DTG 10mg.
Jacque Wambui, AfroCAB and CHAI-Unitaid Optimal CAB said: “It is important for communities and caregivers to be literate on paediatric DTG and how it is administered so as to maximize the benefits of using this formulation”.
Major donors, including PEPFAR and the Global Fund, have rapidly moved to sustainable onward procurement, which will enable national scale-up and widespread access for all eligible children at an unprecedented pace.
The rollout of pDTG 10 mg dispersible, scored tablets is accelerating; more than 30 countries have plans for adoption and rapid rollout.
Map showing countries where adoption is planned.
Dr Angeli Achrekar, Acting U.S. Global AIDS Coordinator at PEPFAR, said: “Enabling sustainable access to paediatric DTG for all children living with HIV is a game changer and will greatly improve the health of children living with HIV worldwide.”
Read more about how paediatric DTG is transforming treatment for young children living with HIV.
Unitaid is a global health agency engaged in finding innovative solutions to prevent, diagnose, and treat diseases more quickly, cheaply, and effectively, in low- and middle-income countries. Its work includes funding initiatives to address major diseases such as HIV/AIDS, malaria, and tuberculosis, as well as HIV co-infections and co-morbidities such as cervical cancer and hepatitis C, and cross-cutting areas, such as fever management. Unitaid is now applying its expertise to address challenges in advancing new therapies and diagnostics for the COVID-19 pandemic, serving as a key member of the Access to COVID-19 Tools (ACT) Accelerator. Unitaid is hosted by the World Health Organization.
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