A new database is being developed in Eastern Europe and Central Asia (EECA) containing information on antiretrovirals (ARVs) in use in 15 countries: Armenia, Azerbaijan, Belarus, Estonia, Georgia, Kazakhstan, Kyrgyzstan, Latvia, Lithuania, Moldova, Poland, the Russian Federation, Tajikistan, Ukraine and Uzbekistan.
The database is a pilot project of a regional program (“Partnership for Equitable Access to HIV Care Continuum in the EECA Region”) financed by the Global Fund and jointly implemented by the East Europe and Central Asian Union of People Living with HIV (ECUO) and the Eurasian Harm Reduction Network (EHRN) – see GFO article for information on the regional program. The ECUO is managing the database.
Although it is still a work in progress, the database is available online.
For each medicine currently in use in the 15 countries, and for each formulation of that medicine, the database provides information on the brand name, the generic name, the manufacturer, the price per unit, the number of units in a package and the price per package. The database also provides information on the source of funding (i.e. either the Global Fund or the national government).
At this stage, a user can filter the data using five parameters: the country, the manufacturer, the source of funding, the generic name and the formulation. However, the database is still under development and some information is not yet complete – for example, data on whether a medicine has been registered in the country, whether it has been included in the national list of the essential drugs, and whether it has been pre-qualified by the World Health Organization is missing in most instances.
When the database is complete, it will also show what orders have been made for each medicine, when each order was placed, and when delivery was effected.
The purpose of developing this database is to provide information to support advocacy by civil society organizations (CSOs) in the EECA on the right to health of persons living with HIV, including the right to treatment. This advocacy is one of the objectives of the regional program.
For example, the database shows whether second and third line ARVs are available in each country, which is a measure of the quality of antiretroviral therapy (ART) being provided. In addition, information about unit price of the medicines enables users of the database to estimate how much it would cost to increase number of persons living with HIV who are receiving ART. Finally, the database could help to identify more attractive purchasing options in neighbouring countries.
The database will also provide useful information for countries transitioning from Global Fund support. Most countries in the EECA have either transitioned or are on their way to transitioning. One of the elements of transition readiness is the ability of the country to maintain uninterrupted treatment when it becomes completely responsible for procuring the ARVs. As long as the Fund is doing the purchasing, the drugs do not have to be registered in the countries; but once a country transitions from the Fund support and does its own purchasing, the drugs will need to be registered in that country – either that or the country needs to pass a law exempting ARVs from the need for registration if they are prequalified by the WHO.
The requirements for registration and prequalification vary by country and the processes involved are often complicated, and might be time-consuming and expensive. For example, if a medicine is prequalified by the WHO, it does not automatically mean that it is exempted from registration. The laws vary country by country. However, if the medicine is prequalified, there is a better chance that accelerated registration can happen.
CSOs will not be the only ones using the database. It will be used by government officials responsible for procuring ARVs; and by donors that provide either financial or technical support to the national HIV programs.
The information currently in the database was collected by people from key population organizations in the period from September to November 2016. The information covers purchases made in 2015-2016. This exercise was part of a communities’ capacity building initiative in the regional program. Additional data collection is planned for later this year and in 2018. There are also plans to update the information on an ongoing basis starting in 2018.
“When we gathered information for the database,” said David Ananiashvili, Director of the NGO Georgia Plus Group, a member organization of the ECUO, “we were not just collecting ‘dry figures.’ We were thoroughly analyzing the purchase orders.”
Ananiashvili explained that the communities want to be sure that the money allocated for ARVs is spent only for the latest medications and that the procurement process is transparent. “Being able to compare the prices across the region allows us to identify purchase orders that are problematic,” he said. “We also look for signs of corruption. For example, if we see that a country is dealing with only one particular company, we start a deeper investigation and react accordingly.”