UNITAID holds a key for revolutionizing access to HIV medicines

Today is World AIDS Day, a time to again take stock of the international community's response to tackling the HIV/AIDS pandemic. We've come a long way since the first World AIDS Day in 1988.
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Today is World AIDS Day, a time to again take stock of the international community's response to tackling the HIV/AIDS pandemic. We've come a long way since the first World AIDS Day in 1988. The discovery of the highly active antiretroviral therapy (HAART) in 1996 and a massive scale-up in HIV/AIDS funding from global health partners*, including UNITAID, has moved HIV/AIDS from a death sentence to a chronic condition for millions of people living with the virus. Sadly, however, we have come full circle in one area that needs drastic international attention. Two and a half decades ago, the first World AIDs Day themes centered on new programmes for young people and children, those most vulnerable to the epidemic. In 2014, we must again call for coordinated action to improve HIV paediatric care.

The truth is that the international community is not doing an adequate job in paediatrics. Despite UNITAID's significant catalytic achievement of creating a market virtually from scratch for child-friendly medicines, enabling the numbers on treatment to increase tenfold since 2005, the 760,000 children on treatment today are only a quarter of those in need. More discouraging, immense challenges in the identification and testing of HIV-exposed infants result in the deaths of about a third of HIV-positive babies before their parents have a clear diagnosis and the chance to put them on any form of treatment. As we work diligently to reduce mother-to-child transmission, many of the youngest AIDS victims are falling through the cracks.

Clearly, efficiently and quickly identifying infected children is vital. Work is already being done, with some organisations investing to bring appropriate effective testing to where the children are, especially for newborns. Progress looks promising, but there is also the vital need to improve treatment options as any delays have long term health implications.

Treating children with appropriate medicines is complicated. The low coverage rates for kids are based on several factors, importantly, a lack of appropriate and adapted formulations suitable for all ages and easily administered in resource-limited settings. Many children must take medicines developed for adults, often foul-tasting and crushed into drinks or broken into tablets, making dosage and adherence difficult. One key WHO-recommended antiretroviral (ARV) combination comes in a liquid syrup with a high alcohol content, unpalatable and difficult to administer to small children and toddlers in sub-Saharan Africa, with more than 90% of the world's paediatric HIV burden. The 2013 WHO recommendation is to provide some specific ARVs to children from three to 10 years of age. The problem is that they are unavailable in combined child-friendly versions. The development and rollout of better, adapted medicines for all children -- from infants to teenagers -- must be a new public health priority if we are to meet the goals of an AIDS-free generation in coming years.

We do have good news, however. In May this year, I announced that UNITAID, the Medicines Patent Pool (MPP), would work together with other institutions** in the Paediatric HIV Treatment Initiative (PHTI) to spur the development of new, appropriate paediatric medicines. As a key step to achieving the objectives of the PHTI, today the UNITAID-founded and funded MPP announced an important licence with US company AbbVie for liponavir and ritonavir - part of the WHO recommended drugs for young children less than three years of age. The licence will allow other organisations to re-formulate and manufacture specifically designed medicines using these drugs for distribution in low and middle income countries. This means we can more effectively treat very young children, 80% of whom, without access to ART, will not survive to celebrate a fifth birthday.

This World AIDS Day, PEPFAR is also announcing a new "global paediatric antiretroviral commitment to action," a powerhouse coalition of PEPFAR, PHTI and the Global Fund to ensure that once the PHTI develops new effective children's formulations, key procurers of AIDS drugs will make them widely available. With this development and the PEPFAR-Children's Investment Fund Foundation commitment to provide 300,000 more children across 10 African countries access to medicines, there is real hope we can end paediatric AIDS.

Just as the AIDS community mobilized in 1988 to push for new solutions, we must join forces to end the HIV/AIDS paediatric crisis. It will take a concerted effort among all of us, industry, communities living with HIV, governments and international organisations, to ensure we have the right medicines, at the right prices and in the right formulations and supply levels. Let's not let another World AIDS Day pass without solid reflection. "Getting to Zero," the global health communities HIV theme through 2015, will never be possible without better diagnostics and treatment for the 3.2 million children living with the HIV in the world today.

*Global health partners funding HIV/AIDS include: Global Fund to Fight AIDS, Tuberculosis and Malaria, the US President's Emergency Fund for AIDS Relief, and UNITAID

**PHTI is composed of UNITAID, the Medicines Patent Pool, the Clinton Health Access Initiative (CHAI), and Diagnostics for Neglected Diseases (DNDi).

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