- First approved for use in the United States a decade ago, HIV treatment dolutegravir (DTG) has reached more than 22 million people in 110 low- and middle-income countries at lower cost than the alternative.
- Global health agency Unitaid invested nearly US$100 million to drive down drug prices, introduce treatments to Africa, build sustainable supplies, develop pediatric formulations, and conduct clinical research to enable safe use by vulnerable groups including pregnant women.
- The groundbreaking drug arrived in low- and middle-income countries just three years after its first approval and is now available for less than US$50 for one year of treatment.
- This product has already generated enormous savings for health systems and is projected to save low- and middle-income countries more than US$7 billion by 2030, as coverage rises to an estimated 31.5 million people.
- The new estimates were released as part of Unitaid’s investment case, which highlights vital health interventions that will drive progress in global health, provided funding targets are met.
Geneva – Global health agency Unitaid today announced new estimates projecting US$7 billion in savings to health systems by 2030, resulting from rapid and widescale implementation of a groundbreaking treatment for HIV, dolutegravir (DTG). The drug, which is used by over 22 million people in 110 low- and middle-income countries today, was approved for use in the first high-income country in 2013.
Typically, introduction of new medicines is a complex and lengthy process, taking up to ten years for the first supplies to reach resource-limited settings, as was the case with previous advances to HIV treatment. With its lower susceptibility to drug resistance and ability to quickly reduce viral load and prevent onward transmission, delays in access to DTG would have had serious implications on the lives and health of countless people in low- and middle-income countries where more than 80% of all those with HIV live.
“This outsized impact of this work makes a clear case: with early support and strong partnerships we can deliver massive returns,” said Dr Philippe Duneton, Executive Director of Unitaid. “As we look to tackle the next great challenges in global health facing men, women, and children in low- and middle-income countries, we know what we need to do. We call on countries to step up and commit to fund equitable access – now.”
Published today showcasing several major achievements, Unitaid’s Investment Case comes as leaders in health convene in Geneva for the World Health Assembly to chart a path towards pandemic recovery, universal health coverage, and 2030 targets.
The success of DTG illustrates how a relatively small, early investment can deliver enormous returns at scale. Achieved through a coordinated multi-partner effort, including a series of parallel interventions backed by Unitaid, the new drug got off the ground and into health systems at affordable prices in record time.
Unitaid’s support for voluntary licensing helped secure an agreement less than one year after DTG received regulatory approval, opening the door to generic manufacture of the drug.
Working in parallel, Unitaid funded clinical trials to expand safe use of the drug among the largest or most at-risk populations of people with HIV who were not included in the original drug trials. It also accelerated the introduction of DTG to enable rapid access, drive demand and develop new markets.
Through these efforts, DTG arrived in low- and middle-income countries just three years after its registration in the United States. And by 2019, clinical trial results enabled access to be expanded to include pregnant women and people undergoing treatment for tuberculosis, the most common opportunistic infection amongst people living with HIV. Critically, DTG proved superior to previous treatments in preventing mother-to-child transmission of HIV, particularly when a woman is diagnosed late in pregnancy.
Today, there are 16 generic manufacturers of DTG-based HIV treatments, including child-adapted formulations. Medicines are available for less than US$50 per person per year, significantly lower than the breakthrough introduction price of US$75 and more affordable than all alternative treatments.
The US$7 billion in savings is the result of nearly US$100 million in early investment from Unitaid to address obstacles standing in the way of widescale uptake coupled with rapid adoption by countries and partners. These obstacles include high prices, insufficient supplies, regulatory hurdles, intellectual property restrictions, supply-chain bottlenecks, low demand, and gaps in evidence, in addition to identifying solutions that are better adapted to use in lower-income settings.
Unitaid’s work over the next five years will advance life-saving solutions to some of the most pressing health challenges facing people in low- and middle-income countries. This includes long-acting preventive treatments for HIV, screen-and-treat solutions for cervical cancer, same-day tuberculosis diagnosis, life-saving tools to protect women from severe bleeding during childbirth, a robust toolbox of malaria-fighting interventions, and sustainable, affordable supplies of medical oxygen, among many others.
As 2030 targets loom large, and countries struggle to regain ground lost to the COVID-19 pandemic, this work is more critical now than ever.
The Investment Case outlines the need for US$1.5 billion in funding to support Unitaid’s next five years of work, in which it will continue to push the boundaries to improve care and reduce the disproportionate burden of disease facing people in low- and middle-income countries.
The rapid and wide-scale adoption of DTG was achieved through strong country leadership and a coordinated partnership effort with contributions from a multitude of partners including: AfroCAB, ANRS, Bill & Melinda Gates Foundation, Central Hospital of Yaoundé, CHAI, EGPAF, Ezintsha/WitsRHI, The Global Fund, HIV i-Base, Institut Bouisson Bertrand, IAME, INSERM, IRD, Infectious Diseases Institute Uganda, Liverpool School of Tropical Medicine, Medicines Patent Pool, Radboud University, SESSTIM, Southern African HIV Clinicians Society, TransVIHMI, Treatment Action Campaign, University of Liverpool, University of New South Wales/Kirby Institute, University of Stellenbosch, USAID/PEPFAR, and WHO.
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, malaria, and tuberculosis, as well as HIV co-infections and co-morbidities including advanced HIV disease, 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, co-leading with Wellcome the Therapeutics Pillar and participating in the Diagnostics Pillar. Unitaid is hosted by the World Health Organization.
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