February 2002 Insights Health Issue #2

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Model of success
Universal access to treatment in Brazil

In the mid-1990s, the Brazilian Ministry of Health (MoH) adopted a policy of universal free access to antiretroviral (ARV) drugs for people with HIV. 113,000 patients now receive ARVs through the public health system. The scheme has improved patients' quality of life, produced a six-fold reduction in hospitalisation rates and is cost-effective - saving the government around US$ 1 billion over five years. How has it achieved this success? Could this be repeated in other countries?

The MoH initiated the strategy by establishing:

• an advisory committee to develop treatment guidelines for 14 ARV drugs
• logistic drug control systems through 400 dispensary units
• 138 laboratories to monitor patients' progress (CD4 count and viral load)
• a network of more than 1300 public HIV/AIDS care facilities.

The guidelines recommend ARV treatment for all AIDS patients and other HIV-infected people with a CD4 count below 200 (see box). The health impact is impressive. Average CD4 counts increase from 244 to 372 after 18 months of treatment. Since 1996, the rate of HIV-related infections has fallen by up to 80 percent and 358,000 AIDS-related hospital admissions were avoided from 1997 to 2001.

But what about the costs? The annual cost of ARVs is US$ 235 million - 1.6 percent of the total MoH budget. Treatment for each patient is now 50 percent cheaper than in 1997, because:

• 63 percent of ARVs used are generic versions produced by six Brazilian pharmaceutical companies. The prices of locally-produced drugs have fallen by 82 percent over five years.
• One local producer, established by the MoH, produces almost half of all ARVs used in Brazil.
• The MoH negotiated with foreign pharmaceutical companies to reduce the cost of certain imported drugs by 60 percent. They avoided the use of compulsory licensing by agreeing tiered or differentiated pricing schemes.

This experience suggests that objections to HIV treatment in developing countries are no longer valid. A well-designed and supported international effort to reduce drug prices and improve health infrastructure could overcome many obstacles even in poorer countries. This should incorporate some of the successful elements of the Brazilian scheme, including:

• concerted governmental response
• strong and effective civil society participation
• multisectoral mobilisation
• balanced prevention and treatment approaches
• advocacy of human rights, reflected in Brazil's policy of universal access to treatment.

Marco Antônio de Ávila Vitória
National STD/AIDS Program
Ministry of Health
W3 Norte
SEPN 511 Bloco C
2º Andar
70.750-543
Asa Norte
Brasília/DF
Brazil

T: 55 (61) 448 8066 F: 55 (61) 448 8057

mvitoria@aids.gov.br

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