Utilization patterns and projected demand of antiretroviral drugs in low- and middle-income countries.

Françoise Renaud-Théry,Marco Vitoria,Carlos Avila-Figueroa,Yves Souteyrand,Vincent Habiyambere,John Stover,Sigrid Thierry

doi:10.1155/2011/749041

Abstract

Background. The rapid scale-up of antiretroviral therapy in resource-limited settings has greatly increased demand for antiretroviral medicines and raised the importance of good forward planning, especially in the context of the new 2010 WHO treatment guidelines. Methods. Forecasting of the number of people receiving antiretroviral therapy from 2010 to 2012 was produced using three approaches: linear projection, country-set targets, and a restricted scenario. Two additional scenarios were then used to project the demand for various antiretroviral medicines under a fast and slower phase-out of stavudine. Results. We projected that between 7.1 million and 8.4 million people would be receiving ART by the end of 2012. Of these, 6.6% will be on second-line therapy. High variation in forecast includes reductions in the demand for d4T and d4T increases in the demand for tenofovir, emtricitabine followed by efavirenz, ritonavir, zidovudine and lopinavir; lamivudine, atazanavir, and nevirapine. Conclusion. Despite the global economic crisis and in response to the revised treatment guidelines, our model forecasts an increasing and shifting demand for antiretrovirals in resource-limited settings not only to provide treatment to new patients, but also to those switching to less toxic regimens.

Highlights

In the past five years, low- and middle-income countries have aggressively scaled up HIV treatment
Thirty-nine national AIDS programmes responded to the survey, representing a total of 3.4 million people receiving antiretroviral therapy, or about 85% of the estimated 4.0 million people receiving antiretroviral therapy in resource-limited countries as of December 2008
An exploratory data analysis confirmed that the pattern of use of first- and second-line regimens was similar among the 37 countries that scaled up treatment programmes after the publication of WHO’s public health approach to antiretroviral therapy in 2002 [13]

Summary

Introduction

In the past five years, low- and middle-income countries have aggressively scaled up HIV treatment. By the end of 2009, more than 5.2 million people were receiving antiretroviral therapy [1] This represented an increase of more than 1.2 million people from the end of 2008 and a 13-fold expansion over the previous six years. This rapid scale-up has greatly increased the demand on antiretroviral medicines and raised the importance of good forward planning. The rapid scale-up of antiretroviral therapy in resource-limited settings has greatly increased demand for antiretroviral medicines and raised the importance of good forward planning, especially in the context of the new 2010 WHO treatment guidelines. Despite the global economic crisis and in response to the revised treatment guidelines, our model forecasts an increasing and shifting demand for antiretrovirals in resource-limited settings to provide treatment to new patients, and to those switching to less toxic regimens

Methods

Results

Conclusion