THPDB102: The Ugandan perspective
We have been advocating ART rollout for 10 years and, for many of us, it has steep learning curve. Successful scale-up requires an ARV treatment and care policy which is approved by the country’s Ministry of Health, a framework for implementation, treatment guidelines, mechanisms to deliver services and monitoring and evaluation.

THPDB103: Use of antiretroviral therapy in resource-limited countries in 2007: up-take of 2nd-line and paediatric treatment stagnant
In July 2007, the AIDS Medicines and Diagnostics Service (AMDS) of WHO repeated its 2006 survey on the use of antiretroviral (ARV) therapy in developing countries. Thirty countries, representing 63% of patients on treatment in developing responded. WHO recommended regimens were implemented for 90% of first-line and 60% of second line regimens. Of the thirteen countries reporting switching rates, this ranged from 1% to 13%. Tenofovir use was reported in 1.5% of first- and 14.2% of second-line adult regimens, compared to no reported use in 2006, and the uptake of paediatric treatment, while increasing in absolute volume, was stagnant relative to adults (7% and 8% in 2007 and 2006, respectively).

THPDB104: Forecasting antiretroviral product demand: successful application of a simulation-based modeling approach
Accurate predictions of demand for antiretroviral drugs are necessary to ensure that both funding and supplies remain in balance with the demand. However, the procurement landscape is not stable. In early ART scale up efforts, we “took the low hanging fruit” and 80% of people on ARVs were in the big capital cities. HIV care and ART delivery into the community are more complex Price remains a key issue but the Global Fund and the Clinton Foundation for HIV/AIDS Initiative (CHAI) can help. By 2011, it is predicted that d4T use will increase by 15% in line with scale-up, with much larger increases in the sue of EFV (114%) , ATZ (170%) and TDF (300%).

THPDB105: Effect of fixed-dosed combination therapies on HAART initiation among ARV naïve population in a managed care setting
It is not known whether newer ARVs treatments, such as fixed-dosed combinations (FDC) have increased the likelihood of ART initiation. Time-dependent Cox regression models were used to examine the independent effect of the FDC era on ART uptake among 2,069 ARV naïve patients receiving care in the US. The advent of FDCs did not affect ART initiation which was only associated with the presence of AIDS defining illness and a CD4 count of 200-350 cells.

THPDB106: Increasing access to treatment by redistributing medication and decreasing waste
Inefficient procurement and distribution systems in developing countries resulted in wasted medication that expired before use. AID FOR AIDS redistributed 17,980 bottles of 8 different ARV medications. National AIDS Programs in Latin America and the Caribbean were notified of available medication and encouraged to request anything that they needed. Medication was shipped to the recipient country and program directors completed a short demographic surveillance questionnaire to ensure proper use of treatment.

THPDB107: Ensuring continuous uninterrupted treatment through a regional solidarity fund
The Indian Ocean Commission (IOC) islands are Comoros, France Reunion, Madagascar, Mauritius and Seychelles. HIV low prevalence is low (0.5-2%) but ARV stock-outs are common. An emergency order of ARV can take weeks to reach these countries. A regional solidarity fund for ARV was set up to ensure a continuous, uninterrupted supply of antiretroviral drugs. Buffer stock is kept in Mauritius and can be quickly been shipped. From January 2008, the African Development Bank is providing funding for the solidarity fund and for training of regional pharmacists and dispensers for better stock management.

THPDB108: Rational use of ARV medicines
Although Indian national guidelines are adhered to in the public system, the availability of ARV in the market and promotion by pharmaceutical companies, leaves scope for prescriptions in the private sector that do not conform with standard treatment. There are 70,000 private practitioners in Delhi alone. The non-compliance with national guidelines private sector doctors and poor adherence among patients, coupled with easily available ARV formulations in chemist shops are a recipe for drug resistance.