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Indian Journal of Medical Sciences, Vol. 61, No. 7, July, 2007, pp. 377-378 Editorial Antiretroviral treatment in resource-poor settings: A challenging task for broad-based multi-sectorial responses Dionisio Daniele Director, Infectious Disease Division, Pistoia Hospital, Piazza Giovanni XXIII 1, 51100 Pistoia Code Number: ms07062 In their article ′Antiretroviral treatment in resource-poor settings: A view from India′,[1] published in this issue of IJMS, the Authors appropriately look for the formulation of treatment-monitoring guidelines suitable for resource-poor settings of developing countries. This editorial comment, while taking their commendable effort into account, wishes to highlight the overall challenges faced by developing country′s health systems when scaling up equitable access to antiretroviral (ARV) treatments. [2] National policies have first to consider enhancing infrastructure building, as well as human resource capacity in the area of caregivers and social and health workers aiming to spread correct information and awareness on effectiveness and rationale of appropriate ARV treatments for adult and underage end users. Policies should urge that ARV treatment programs entwine with extant interventions on prevention (including mother-to-child transmission), as well as with human immunodeficiency virus (HIV) treatment initiatives focused on mothers and household members. Policies, again, should consider centralizing functions and pooling resources to help overcome drug supply barriers. Unfortunately, unaffordable drug prices still remain as the major obstacle to ARV treatment access. Even worse, challenges are complicated by regulatory obstacles bound up with enforcement of trade-related aspects of intellectual property (TRIPS) inside World Trade Organization. [3],[4] Insightfully, this is a worrisome situation based on second-generation medicines and any new drugs are crucial to HIV treatment programs once first-line antiretrovirals (ARVs) fail. This stifling backdrop mostly damages children. The market for pediatric ARVs in the US and Europe is very small compared with the developing world. [5] So, there are no incentives for brand name corporations to develop new ARV formulations for children because they aren′t a lucrative market. On the other hand, generic manufacturers are discouraged because pediatric formulations are still perceived as a niche product in income-constrained countries where achievement of accurate demand forecasting mistakenly remains difficult. [5] Difficulties are compounded by the fact that treating children implies much higher costs than adults. [5] On the flip side, TRIPS rules do encompass flexibilities [also including compulsory licenses (CLs) and voluntary licenses (VLs)] to help poor populations equitably access low-priced ARV treatments. Actually, while CLs are frequently feared by governments in the developing world, VLs could act, if appropriately harmonized through combination of incentives, as equitably balanced tools for trade agreements securing all counterparts-sustained advantages. [5],[6] Under such a perspective, WHO′s brokering role in VL-bound agreements between wealthy and developing country industries, as well as its technical guidance in setting international standards, should not be waived while looking for equitable access to optimized ARV treatments for income-poor populations. Enforcement of the favorable perspectives mentioned here is conditioned hugely by long-term trade and drug policy directions of China and India due to frontier-crossing implications of their TRIPS management, along with their mushrooming penetration of the wealthy and under-served markets the world over. [5],[6] Again, enforcement will depend on the feasibility of measures to effectively offset current US drug trading policy. Eventually, to extensively be put into effect, these perspectives also depend on the policy directions of at least Brazil, South Africa and Thailand. References
Copyright 2007 - Indian Journal of Medical Sciences |
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