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Affordable healthcare Product Selection for TB, Malaria and HIV/AIDS Key issues for procurement IDA Affordable healthcare Product Selection for TB, Malaria and HIV/AIDS Key issues for procurement IDA HIV/AIDS Group, Nienke Gruppelaar

Selection criteria • Strategic decision on the extent of treatments • WHO treatment guidelines Selection criteria • Strategic decision on the extent of treatments • WHO treatment guidelines • Global Fund guidelines/other funding guidelines • Legal possibilities • Availability of Cold Storage facilities • Generic versus Originator sources • Costs & Cost effectiveness • Ease of use • Safety & Efficacy • Quality -2 -

HIV/AIDS • Generic availability first line treatment is high • Second line treatment & HIV/AIDS • Generic availability first line treatment is high • Second line treatment & pediatric formulations are a challenge • PMTCT, Pediatrics • Pregnant Woman, TB Co-infection • Medicines for Opportunistic Infections and Palliative Care an essential part of a HIV/AIDS Program – Not all are available from generic sources – Some require high-end facilities – Cooperation with TB program • HIV diagnostics -3 -

Lessons learned • Make sure specifications are clearly defined from the start – – Lessons learned • Make sure specifications are clearly defined from the start – – According to guidelines for treatment (pediatrics, FDCs) Registration & patent situation In-country specs Products, dosages, language labels • Increase the amount of generics > lower cost and delivery time -4 -

TB • Define regimens (NTP) and formulations according to: – Epidemiological situation (risk of TB • Define regimens (NTP) and formulations according to: – Epidemiological situation (risk of MDR) – Health Care Workers’ capacity for DOT (daily vs. intermittent) – Training capacity for switches (e. g. to FDCs) – Simplified distribution with few items – Less risk of drug resistance with FDCs – Consider patient kits with complete courses – Consider second line drugs only when basic first-line DOTS is well in place -5 -

Malaria TREATMENTS • • • P. Falciparum vs. P. Vivax 1 st line drugs Malaria TREATMENTS • • • P. Falciparum vs. P. Vivax 1 st line drugs 2 nd line drugs Severe malaria Cost Pregnancy – Treatment – Prevention NETS/IRS • ITN vs LLIN • Issues with procurement of non WHOPES approved LLIN – production now scaled up by order processing (usually unnecessarily) lengthy -6 -

Logistics: Weights, Volumes & Costs The Shipment and Distribution of nets are a major Logistics: Weights, Volumes & Costs The Shipment and Distribution of nets are a major logistical challenge. Depending, for example, on the type of LLIN, international shipping and handling costs (ITSH), inland transportation, testing and inspection costs could run between 45% and 65% of net cost. N. B. Different types have different weights and volumes Sample ITN LLIN - Type 1 LLIN - Type 2 Weight per bale (125 nets): 60 kg Weight per bale (100 nets): 42 kgs Weight per bale (40 nets): 29 kgs Volume per bale (125 nets): 0. 260 cbm Volume per bale (100 nets): 0. 1894 cbm Volume per bale (40 nets): 0. 127 cbm Nets per 40' container: 37, 000 pieces Nets per 40' container: 36, 900 pieces Nets per 40' container: 16, 800 pieces -7 - Data based on Rectangular net size 150 x 190 x 180 cm

Rapid Diagnostic Test • Considerations for choosing an RDT include: • Plasmodium species to Rapid Diagnostic Test • Considerations for choosing an RDT include: • Plasmodium species to be detected (P. falciparum only, or panspecific) • Shelf -life and temperature stability in intended conditions of storage and use • Ease of use, including format of the test (e. g. cassette, dipstick, card) • Requirement for post-treatment testing of patients • Cost (including transport, training, and quality control) • Sensitivity Good quality assurance processes after purchase are likely to be of greater importance. -8 -