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Surmounting Challenges: Procurement of Antiretroviral Medicines in Low- and Middle-Income Countries

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Photograph by Eric Miller

MSF's experience shows that for numerous reasons ARV procurement is often more challenging than that of other types of essential medicines.

Products are expensive and stock management is crucial to avoid disruption of treatment. Treatment protocols are diverse, and procurement systems have to respond quickly to evolving treatment regimens. Also the limited amount of publicly available information, including the lack of quality reference standards, makes assessing the quality of generic ARVs more difficult than that of most other essential medicines - even though quality generic ARVs are being produced.

As the price of antiretrovirals (ARVs) in low and middle-income countries has fallen in recent years, governments, international agencies and non-governmental organizations (NGOs) have been able to start developing treatment programmes for people living with HIV/AIDS (PLWHA). Procurement strategies are a key element in this global scaling-up process. As Médecins sans Frontières (MSF) was one of the first international NGOs providing ARV therapy, the World Health Organization (WHO) requested that MSF document its procurement experiences in 10 countries where it has ARV treatment programmes, so that others could benefit from what has been learnt.

The importance of assisting ARV treatment programmes to procure low-cost, quality ARVs cannot be underestimated. In sub-Saharan Africa, the region hardest-hit by the HIV virus, only one percent of the four million people in need currently receives ARV therapy. While other medicines can cure the opportunistic infections caused by HIV or provide relief from symptoms, these are ultimately only temporary measures. Conversely, ARVs decrease the level of the virus in the body, reduce morbidity, prolong and improve quality or life, and prevent most opportunistic infections.