The representatives of the Ministry of Health of Lithuania, the National Medicinal Products Control Service and the Patent Services of Lithuania, as well as representatives of patient organizations from Vilnius, Kaunas, Klaipeda and Ukmerge, attended the event.
“ECUO PLWH, representing the patient community of Eastern Europe and Central Asia, advocates for the rights of PLWH, both in the low-income countries where the Global Fund operates and in the EU countries. Since 2015 we have been implementing a regional PARTNERSHIP program with the GF support, focused on the priority of improving access to the continuum of services for PLWH in the entire EECA region. All services are important in the continuum, but we all perfectly understand that without the treatment, without the availability and accessibility of modern medications, the HIV/AIDS epidemic cannot be stopped.
For Lithuania, the availability of medications, as we found out in the context of ART monitoring, is very relevant. Prices for drugs purchased by Lithuania are 5-6-7 times or even more higher than in other countries of Eastern Europe and Central Asia. Meanwhile, none of the existing methods to reduce prices are used in Lithuania nowadays. Unfortunately, the Ministry of Health of Lithuania cannot even say whether they engage in negotiations.
Of course, in order to understand the possibilities to reduce the price of ARV drugs, to ensure their availability in the country, it is necessary to understand the whole cycle of the medication entry into the pharmaceutical market. To improve the availability of innovative drugs, it is very important to maintain a dialogue between the state, experts and patient community representatives. The discussion that took place during the round table in Vilnius and the results of the analysis conducted and presented by Andrey Rudanov provide an effective advocacy tool for the PLWH community in Lithuania”, says Gennadiy Golobokov, Adviser to the President of ECUO PLWH.
In a discussion with government officials, Giedrius Likatavičius, consultant to the Demetra Association, presented data on the HIV/AIDS treatment cascade for 2016 in Lithuania and the achievement of the 90-90-90 goals. Cascades of Latvia and Estonia were also presented to discuss the country progress. In his report, Giedrius noted that the national treatment protocol of Lithuania does not comply with the European recommendations and does not endorse a consolidated “Test & Treat” strategy which is supported by a community of doctors, patients and reputable international organizations.
Svetlana Kulshis, Director of the Demetra Association: “To date, Lithuania and Latvia are the only countries in the European Union where treatment does not start immediately, it is initiated only the patient’s immune system suppression reaches 350 CD4 cells. Thus, new protocols must be approved immediately, which will allow to receive treatment right after diagnosis. As of June 1, 2017, there were registered 2842 HIV-positive people in Lithuania, of which 2262 are men and 580 are women. With profound regret we have to state that every 5-th person with HIV in Lithuania is at the stage of AIDS, and every 8 people have already died of AIDS or concomitant diseases. At the same time, there is access to innovative drugs in Lithuania. We, unfortunately, observe a large gap between those diagnosed with HIV and those who receive treatment. As of December 30, 2013, only 754 out of officially registered 2842 PLWH in Lithuania receive treatment. In November 2016, a working group was established by the order of the Minister of Health of Lithuania to prepare new protocols for treatment in accordance with European recommendations”.
It should be noted that as of December 2017, the issue of updating the national treatment protocol has been opened, discussions and discussions are underway.
Andrey Rudanov, expert of the Drakshas, Mekionis, Smirnov and Partners Law Firm, the head of the natural sciences department, presented a report “The epidemiological situation in the country and the availability of modern ARV drugs”. He focused on the basics of legal regulation, the procedures for including new ARV drugs in existing HIV treatment protocols in Lithuania, described the public procurement process of ART and procedures regulating the state registration of generics, modern ARVs pricing in Lithuania. He used the example of Lithuania to demonstrate the path of the medications entry into Lithuanian market, while pointing out that the country is in the stringent framework of the European legislation.
It’s worth mentioning that the purchase prices of ART can be compared in the online database of ARV drugs created by ECUO experts. For example, in Lithuania, a European country, most regimens include Kaletra (lopinavir, ritonavir). Nowadays, the procurement price of the drug is 6 times higher than similar price in Ukraine.
Ruslan Bukin, consultant to the Demetra Association, told about adherence to treatment from the patient’s point of view and the role of the community, noted that in Lithuania there exist problems of arbitrary replacing treatment regimens without medical indications, causing a number of side effects and serious complications in patients which pose additional challenges. PLWH from all over the country still report about stigma and discrimination in health facilities.
The round table in Lithuania was held by the Demetra Association within the framework of the regional program “Partnership for Equal Access to the Continuum of HIV Care for All Who Need It in the EECA Region”, implemented by the East Europe and Central Asia Association of People Living with HIV (ECUO PLWH) with the support of the Global Fund.
It should be noted that earlier similar events took place in Moldova and Kyrgyzstan, and in December another discussion is planned in Kazakhstan.