The Global Access Programme makes HIV viral load tests and the early detection of HIV infections in infants possible in countries that are most affected by the disease. Roche’s collaboration with the Clinton Health Care Initiative has led to a dramatic increase in the number of patients tested.
If you ask people what they understand by the word “access”, they often give two answers: it means “giving away medicines for free”, or is just another word for the price of drugs. Wolfgang Friede Keller (Head of Strategy and Business Development Emerging Markets) and Jakob Butina (Life Cycle Leader Virology) at Roche Diagnostics explain why neither of these answers is strictly correct. They supervise the Global Access Programme (GAP), which was set up in 2014 together with the Clinton Health Access Initiative (CHAI) and other partner organisations. The GAP improves access to HIV viral load tests and early infant diagnosis in 82 eligible countries and thus makes an important contribution to the 90-90-90 treatment target announced by UNAIDS at the International AIDS Conference in July 2014: By 2020, 90% of all people living with HIV will know their HIV status, 90% of all those with diagnosed HIV infection will receive sustained antiretroviral therapy and 90% of all patients receiving antiretroviral therapy will have viral suppression.
The right price for a sustainable programme
One of the biggest hurdles to date had been the price of HIV tests. As Jakob explains, the breakthrough came with bold pricing policies: “Working closely with CHAI, we reduced the price substantially so that HIV tests could become more accessible in poor countries with the highest disease burden. The programme is sustainable today and enables us to look into further solutions for the emerging markets.” Wolfgang adds: “This massive scale-up wouldn’t have been possible without the South African government, the largest purchaser of viral load tests in the world. We collaborated with the National Health Laboratory Service to expand their viral load programme to millions of patients across sub-Saharan Africa and beyond. In 2016, more than 8 million patients were tested with a Roche platform, twice the 2015 figure. We thus contribute to the global goal that 90% of all people receiving antiretroviral therapy achieve viral suppression.”
High-tech in emerging and developing countries
Roche also invests in the countries affected. Last year, for example, state-of-the-art, highly automated cobas systems were launched in countries such as South Africa, Kenya and Uganda to enhance HIV diagnostics. Jakob is delighted: “Emerging markets now have access to the latest technology. A single laboratory in Johannesburg is carrying out over a million viral load tests per year – a real achievement.”
As Wolfgang emphasises, however, it is not enough to just install the equipment and get it up-and-running: “Very often, we have to set up the infrastructure and train doctors and healthcare staff first. You need many dedicated people on the ground who work tirelessly to make this a reality.”
The close collaboration with NGOs such as CHAI is key for the programme’s success (see the interview in the side bar). The idea is now to extend this model to other health issues. Thus, together with CHAI, Roche launched the Quick Start Programme to use the shared expertise in HIV in the battle against hepatitis C. Much remains to be done, by 2020 and beyond.
Interview with Alan Staple (Clinton Healthcare Access Initiative):
‘Our collaboration changed the world’s attitude towards viral load testing’
The Clinton Health Access Initiative (CHAI) was founded in 2002 and aims to improve access to medicines and diagnostics for diseases like HIV/AIDS, malaria and tuberculosis. Alan Staple is Head of CHAI’s Global Markets Team and has worked together with Roche for many years.
Roche: How did the collaboration with Roche in HIV come about?
Alan: Roche had always been a leader in HIV testing in the West. We approached Roche initially because they had the technology – Early Infant Diagnosis and Viral Load Tests – but it was not being used in poorer countries then. We wanted to provide the same quality of care in countries where the income, the technical knowledge and the infrastructure were not similar. CHAI helped Roche to understand and tackle the various barriers to access and we worked together to make this a practical and sustainable initiative.
Roche: Where do you see the pivotal role of Diagnostics in HIV treatment?
Alan: Prior to the launch of the Global Access Programme, only around a quarter of patients in lower income countries had access to viral load testing. Our collaboration changed the world’s attitude towards viral load testing in the developing world. Previously, the WHO was not recommending this for every patient, now they do. The US government was not prioritising funding in President's Emergency Plan for AIDS Relief (PEPFAR), now they have made a commitment that there should be one viral load test for everyone on treatment. The 90-90-90 goal includes viral load testing – so it evolved from something that wasn’t even mentioned five years ago to a key measure of programmatic success.
Roche: What motivates you?
Alan: We have huge public health problems, and big life science companies have the resources and technology to solve them. What really motivates me is to meet the individuals at Roche who really care about these problems, who convince their management and their teams to support projects that might not be the most profitable. Access is not just a matter of pricing, but of so many different factors, from training and infrastructure to relationships in the countries. People at Roche appreciated this complexity.