RESUMEN
ABSTRACT OBJECTIVE To estimate the public-private composition of HIV care in Brazil and the organizational profile of the extensive network of public healthcare facilities. METHODS Data from the Qualiaids-BR Cohort were used, which gathers data from national systems of clinical and laboratory information on people aged 15 years or older with the first dispensation of antiretroviral therapy between 2015-2018, and information from SUS healthcare facilities for clinical-laboratory follow-up of HIV, produced by the Qualiaids survey. The follow-up system was defined by the number of viral load tests requested by any SUS healthcare facility: follow-up in the private system - no record; follow-up at SUS - two or more records; undefined follow-up - one record. SUS healthcare facilities were characterized as outpatient clinics, primary care and prison system, according to the respondents' self-classification in the Qualiaids survey (72.9%); for non-respondents (27.1%) the classification was based on the terms present in the names of the healthcare facilities. RESULTS During the period, 238,599 people aged 15 years or older started antiretroviral therapy in Brazil, of which 69% were followed-up at SUS, 21.7% in the private system and 9.3% had an undefined system. Among those followed-up at SUS, 93.4% received care in outpatient clinics, 5% in primary care facilities and 1% in the prison system. CONCLUSION In Brazil, antiretroviral treatment is provided exclusively by SUS, which is also responsible for clinical and laboratory follow-up for most people in outpatient clinics. The study was only possible because SUS maintains records and public information about HIV care. There is no data available for the private system.
RESUMO OBJETIVO Estimar a composição público-privada da assistência em HIV no Brasil e o perfil organizacional da extensa rede de serviços públicos. MÉTODOS Foram utilizados dados da Coorte Qualiaids-BR, que reúne dados dos sistemas nacionais de informações clínicas e laboratoriais de pessoas com 15 anos ou mais com primeira dispensação de terapia antirretroviral, entre 2015-2018, e informações dos serviços do SUS de acompanhamento clínico-laboratorial do HIV, produzidas pelo inquérito Qualiaids. O sistema de acompanhamento foi definido pelo número de exames de carga viral solicitados por algum serviço do SUS: acompanhamento no sistema privado - nenhum registro; acompanhamento no SUS - dois ou mais registros; acompanhamento indefinido - um registro. Os serviços do SUS foram caracterizados como ambulatórios, atenção básica e sistema prisional, segundo autoclassificação dos respondentes ao inquérito Qualiaids (72,9%); para os não respondentes (27,1%) a classificação baseou-se nos termos presentes nos nomes dos serviços. RESULTADOS No período, 238.599 pessoas com 15 anos ou mais iniciaram a terapia antirretroviral no Brasil, das quais, 69% receberam acompanhamento no SUS, 21,7% no sistema privado e 9,3% tiveram o sistema indefinido. Entre os acompanhados no SUS, 93,4% foram atendidos em serviços do tipo ambulatório, 5% em serviços de atenção básica e 1% no sistema prisional. CONCLUSÃO No Brasil o tratamento antirretroviral é fornecido exclusivamente pelo SUS, que também é responsável pelo acompanhamento clínico-laboratorial da terapia da maior parte das pessoas em serviços ambulatoriais. O estudo só foi possível porque o SUS mantêm registros e informações públicas acerca do acompanhamento em HIV. Não há nenhum dado disponível para o sistema privado.
Asunto(s)
Humanos , Masculino , Femenino , Adulto , Persona de Mediana Edad , Anciano , Anciano de 80 o más Años , Adulto Joven , Sistema Único de Salud , Calidad, Acceso y Evaluación de la Atención de Salud , Fármacos Anti-VIH/provisión & distribución , Salud Complementaria , Instituciones de Atención AmbulatoriaAsunto(s)
Infecciones por VIH/epidemiología , Accesibilidad a los Servicios de Salud/ética , Disparidades en Atención de Salud/ética , Grupos de Población/psicología , Poblaciones Vulnerables/psicología , Fármacos Anti-VIH/provisión & distribución , Fármacos Anti-VIH/uso terapéutico , Terapia Antirretroviral Altamente Activa , Brasil/epidemiología , COVID-19/epidemiología , Infecciones por VIH/tratamiento farmacológico , Infecciones por VIH/psicología , Infecciones por VIH/transmisión , Accesibilidad a los Servicios de Salud/organización & administración , Servicios de Salud del Indígena/organización & administración , Humanos , Estigma SocialAsunto(s)
Infecciones por VIH/epidemiología , Accesibilidad a los Servicios de Salud/ética , Disparidades en Atención de Salud/ética , Grupos de Población/psicología , Poblaciones Vulnerables/psicología , Fármacos Anti-VIH/provisión & distribución , Fármacos Anti-VIH/uso terapéutico , Terapia Antirretroviral Altamente Activa , COVID-19/epidemiología , Infecciones por VIH/tratamiento farmacológico , Infecciones por VIH/psicología , Infecciones por VIH/transmisión , Accesibilidad a los Servicios de Salud/economía , Accesibilidad a los Servicios de Salud/organización & administración , Servicios de Salud del Indígena/organización & administración , Disparidades en Atención de Salud/economía , Humanos , Perú/epidemiología , Estigma SocialRESUMEN
OBJECTIVE: To evaluate the impact of the 12 January 2010 earthquake on HIV cases from Haiti's national HIV surveillance system and assess the characteristics of people living with HIV 1-year before and after the earthquake. DESIGN: An interrupted time-series design and cross-sectional analysis. METHODS: We used autoregressive integrated moving average structures to model abrupt changes to the monthly, incident HIV case counts from HIV care clinics as reported to the Haitian Active Longitudinal Tracking of HIV System (French acronym SALVH) by clinical networks (nâ=â3) and earthquake instrumental intensity zones (nâ=â4). Preearthquake and postearthquake differences in patient-level characteristics including clinical values were examined using the χ test, t tests, Wilcoxon rank-sum test. RESULTS: In the month immediately following the earthquake, all three clinical networks experienced statistically significant declines in cases reported: iSanté (-31.4%), Groupe Haïtien d'Etude du Sarcome de Kaposi et des Infections Opportunistes (-29.9%) and Zamni Lasante (-32.2%). Zone 8 (the most severe) was the only area with a statistically significant decline (-45.5%). Of the three clinical networks, only iSanté returned to preearthquake reporting levels by the end of our study period. Patient-level characteristics did not change dramatically after the earthquake. CONCLUSION: Despite case reporting declines, especially in clinics near the earthquake epicenter, SALVH remained intact with less impact than expected. This national system is a critical component of Haiti's strategic health information system initiative and plays a central role to HIV monitoring and evaluation efforts.
Asunto(s)
Fármacos Anti-VIH/uso terapéutico , Terremotos , Infecciones por VIH/tratamiento farmacológico , Seropositividad para VIH , Vigilancia de la Población/métodos , Adolescente , Adulto , Anciano , Fármacos Anti-VIH/provisión & distribución , Niño , Preescolar , Estudios Transversales , Desastres , Infecciones por VIH/epidemiología , Haití/epidemiología , Humanos , Lactante , Análisis de Series de Tiempo Interrumpido , Persona de Mediana Edad , Adulto JovenAsunto(s)
Fármacos Anti-VIH , Infecciones por VIH/tratamiento farmacológico , Fármacos Anti-VIH/administración & dosificación , Fármacos Anti-VIH/economía , Fármacos Anti-VIH/provisión & distribución , Infecciones por VIH/epidemiología , Humanos , Asistencia Médica/organización & administración , Asistencia Médica/estadística & datos numéricos , México , Educación del Paciente como Asunto , Vigilancia de la Población , Evaluación de Programas y Proyectos de Salud , Seguridad Social/organización & administración , Seguridad Social/estadística & datos numéricosRESUMEN
OBJECTIVE: to evaluate the availability of Brazilian National Health System (SUS) outpatient services for people living with HIV in Mato Grosso state, Brazil. METHODS: this is an evaluative study with descriptive cross-sectional design carried out in 2016; data were collected via the HIV Services Quality Assessment System in all 15 outpatient services; data were analyzed by frequency of answers. RESULTS: five of the 15 services had a sufficient number of physicians; antirretroviral drugs were out of stock for more than seven days in half of the services; other medications for sexually transmitted infections, opportunistic infections, Hepatitis B and C, and metabolic disorders were available in less than 1/3 of the services within the recommended timeframe. CONCLUSION: resources were found to be deficient in services for people living with HIV in Mato Grosso, mainly regarding the availability of professionals and drugs.
Asunto(s)
Atención Ambulatoria/organización & administración , Infecciones por VIH/terapia , Recursos en Salud/provisión & distribución , Programas Nacionales de Salud/organización & administración , Fármacos Anti-VIH/provisión & distribución , Brasil , Estudios Transversales , Infecciones por VIH/complicaciones , Accesibilidad a los Servicios de Salud , Humanos , Factores de TiempoRESUMEN
This article examines the activities of national and international actors in Pharmaceutical Services (PS) in Mozambique from 2007 to 2012, focusing on the public provision of HIV/Aids, malaria and tuberculosis medicines. It describes how PS functions in the country, what actors are involved in this area and the relations among them, pursuing salient issues in the modus operandi of partners in cooperation. The methodology combines literature review, document survey and analysis and interviews. The theoretical and analytical framework was given by the policy analysis approach, focusing on the role of the State and its interrelations with other actors in foreign aid in PS, and also by the networks approach. It was concluded that the interactions among the actors involved is complex and characterised by operational fragmentation and overlapping of activities between entities, centralised medicine procurement in the hands of few agents, bypassing of national structures and disregard for the strengthening needed to bolster national health system autonomy. Despite some advances in the provision and availability of medicines for these diseases, external dependence is strong, which undermines the sustainability of PS in Mozambique.
Este artigo analisa a ação de atores nacionais e internacionais na Assistência Farmacêutica (AF) em Moçambique, no período de 2007 a 2012, com foco na provisão pública de medicamentos para HIV/Aids, malária e tuberculose. Descreve-se o funcionamento da AF no país; os atores que atuam nesse âmbito e as relações entre eles; discutem-se questões relevantes sobre o modus operandi dos parceiros de cooperação. A metodologia combinou: revisão bibliográfica, levantamento e análise documental e entrevistas. O marco teórico e analítico utilizou a análise de políticas públicas com foco no papel do Estado e suas inter-relações como os demais atores na ajuda externa na área farmacêutica e a abordagem de redes. Conclui-se que a interação entre os atores envolvidos é complexa, caraterizada pela fragmentação operacional e sobreposição de atividades entre diversos entes; centralização da aquisição de medicamentos na mão de poucos agentes; by pass das estruturas nacionais e desconsideração do necessário fortalecimento do sistema nacional de saúde para a construção de sua autonomia. A despeito de alguns avanços na provisão e disponibilidade de medicamentos para essas doenças, existe forte dependência externa nesse âmbito, o que obstaculiza a sustentabilidade da AF em Moçambique.
Asunto(s)
Cooperación Internacional , Servicios Farmacéuticos/organización & administración , Fármacos Anti-VIH/administración & dosificación , Fármacos Anti-VIH/provisión & distribución , Antimaláricos/administración & dosificación , Antimaláricos/provisión & distribución , Antituberculosos/administración & dosificación , Antituberculosos/provisión & distribución , Infecciones por VIH/tratamiento farmacológico , Política de Salud , Humanos , Malaria/tratamiento farmacológico , Mozambique , Tuberculosis/tratamiento farmacológicoRESUMEN
Resumo Este artigo analisa a ação de atores nacionais e internacionais na Assistência Farmacêutica (AF) em Moçambique, no período de 2007 a 2012, com foco na provisão pública de medicamentos para HIV/Aids, malária e tuberculose. Descreve-se o funcionamento da AF no país; os atores que atuam nesse âmbito e as relações entre eles; discutem-se questões relevantes sobre o modus operandi dos parceiros de cooperação. A metodologia combinou: revisão bibliográfica, levantamento e análise documental e entrevistas. O marco teórico e analítico utilizou a análise de políticas públicas com foco no papel do Estado e suas inter-relações como os demais atores na ajuda externa na área farmacêutica e a abordagem de redes. Conclui-se que a interação entre os atores envolvidos é complexa, caraterizada pela fragmentação operacional e sobreposição de atividades entre diversos entes; centralização da aquisição de medicamentos na mão de poucos agentes; by pass das estruturas nacionais e desconsideração do necessário fortalecimento do sistema nacional de saúde para a construção de sua autonomia. A despeito de alguns avanços na provisão e disponibilidade de medicamentos para essas doenças, existe forte dependência externa nesse âmbito, o que obstaculiza a sustentabilidade da AF em Moçambique.
Abstract This article examines the activities of national and international actors in Pharmaceutical Services (PS) in Mozambique from 2007 to 2012, focusing on the public provision of HIV/Aids, malaria and tuberculosis medicines. It describes how PS functions in the country, what actors are involved in this area and the relations among them, pursuing salient issues in the modus operandi of partners in cooperation. The methodology combines literature review, document survey and analysis and interviews. The theoretical and analytical framework was given by the policy analysis approach, focusing on the role of the State and its interrelations with other actors in foreign aid in PS, and also by the networks approach. It was concluded that the interactions among the actors involved is complex and characterised by operational fragmentation and overlapping of activities between entities, centralised medicine procurement in the hands of few agents, bypassing of national structures and disregard for the strengthening needed to bolster national health system autonomy. Despite some advances in the provision and availability of medicines for these diseases, external dependence is strong, which undermines the sustainability of PS in Mozambique.
Asunto(s)
Humanos , Servicios Farmacéuticos/organización & administración , Cooperación Internacional , Tuberculosis/tratamiento farmacológico , Infecciones por VIH/tratamiento farmacológico , Fármacos Anti-VIH/administración & dosificación , Fármacos Anti-VIH/provisión & distribución , Política de Salud , Malaria/tratamiento farmacológico , Mozambique , Antimaláricos/administración & dosificación , Antimaláricos/provisión & distribución , Antituberculosos/administración & dosificación , Antituberculosos/provisión & distribuciónRESUMEN
OBJECTIVE: We estimated the average annual cost per patient of ART per facility (unit cost) in Nigeria, described the variation in costs across facilities, and identified factors associated with this variation. METHODS: We used facility-level data of 80 facilities in Nigeria, collected between December 2014 and May 2015. We estimated unit costs at each facility as the ratio of total costs (the sum of costs of staff, recurrent inputs and services, capital, training, laboratory tests, and antiretroviral and TB treatment drugs) divided by the annual number of patients. We applied linear regressions to estimate factors associated with ART cost per patient. RESULTS: The unit ART cost in Nigeria was $157 USD nationally and the facility-level mean was $231 USD. The study found a wide variability in unit costs across facilities. Variations in costs were explained by number of patients, level of care, task shifting (shifting tasks from doctors to less specialized staff, mainly nurses, to provide ART) and provider´s competence. The study illuminated the potentially important role that management practices can play in improving the efficiency of ART services. CONCLUSIONS: Our study identifies characteristics of services associated with the most efficient implementation of ART services in Nigeria. These results will help design efficient program scale-up to deliver comprehensive HIV services in Nigeria by distinguishing features linked to lower unit costs.
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Síndrome de Inmunodeficiencia Adquirida/tratamiento farmacológico , Síndrome de Inmunodeficiencia Adquirida/economía , Fármacos Anti-VIH/economía , Fármacos Anti-VIH/provisión & distribución , Atención a la Salud/economía , Costos de la Atención en Salud/estadística & datos numéricos , Fármacos Anti-VIH/uso terapéutico , Humanos , NigeriaRESUMEN
The provision of ARVs is central to HIV/AIDS programs, because of its impact on the course of the disease and on quality of life. Although first-line treatments costs have declined, treatment-associated expenses are steeper each year. Sustainability is therefore an important variable for the success of treatment programs. A conceptual framework on sustainability of ARV provision was developed, followed by data collection instruments. The pilot study was undertaken in Brazil. Bolivia, Peru and Mozambique, were visited. Key informants were identified and interviewed. Investigation of sustainability related to ARV provision involved implementation and routinization events of provision schemes. Evidence of greater sustainability potential was observed in Peru, where provision is implemented and routinized by the National HIV/AIDS program and expenditures met by the government. In Mozambique, provision is dependent on donations and external aid, but the country displays a great effort to incorporate ARV provision and care in routine healthcare activities. Bolivia, in addition to external dependence on financing and management of drug supply, presents problems regarding implementation and routinization. The conceptual framework was useful in recognizing events that influence sustainable ARV provision in these countries.
Asunto(s)
Síndrome de Inmunodeficiencia Adquirida/tratamiento farmacológico , Fármacos Anti-VIH/provisión & distribución , Infecciones por VIH/tratamiento farmacológico , Calidad de Vida , Bolivia , Brasil , Atención a la Salud/organización & administración , Países en Desarrollo , Humanos , Perú , Proyectos Piloto , Desarrollo de Programa , Evaluación de Programas y Proyectos de SaludRESUMEN
Abstract The provision of ARVs is central to HIV/AIDS programs, because of its impact on the course of the disease and on quality of life. Although first-line treatments costs have declined, treatment-associated expenses are steeper each year. Sustainability is therefore an important variable for the success of treatment programs. A conceptual framework on sustainability of ARV provision was developed, followed by data collection instruments. The pilot study was undertaken in Brazil. Bolivia, Peru and Mozambique, were visited. Key informants were identified and interviewed. Investigation of sustainability related to ARV provision involved implementation and routinization events of provision schemes. Evidence of greater sustainability potential was observed in Peru, where provision is implemented and routinized by the National HIV/AIDS program and expenditures met by the government. In Mozambique, provision is dependent on donations and external aid, but the country displays a great effort to incorporate ARV provision and care in routine healthcare activities. Bolivia, in addition to external dependence on financing and management of drug supply, presents problems regarding implementation and routinization. The conceptual framework was useful in recognizing events that influence sustainable ARV provision in these countries.
Resumo A provisão de medicamentos ARV é central para programas de HIV/Aids, devido a seu impacto no curso da doença e na qualidade de vida. Embora os custos de tratamentos de primeira linha tenham diminuído, os gastos dos programas com os tratamentos tem aumentado a cada ano. A sustentabilidade torna-se fator fundamental para o sucesso dos programas. Um modelo conceitual para avaliação da sustentabilidade da provisão de ARV e instrumentos de coleta de dados foram desenvolvidos. Um estudo piloto foi realizado no Brasil e a pesquisa de campo cobriu Bolívia, Moçambique e Peru. Informantes-chaves foram identificados e entrevistados. Eventos críticos de implementação e rotinização foram investigados na história dos programas. Foi observado maior potencial para sustentabilidade no Peru, onde a provisão está implementada e rotinizada e os gastos são cobertos pelo governo nacional. Em Moçambique, o financiamento da provisão é quase totalmente dependente de ajuda internacional, mas há grandes esforços voltados à expansão da cobertura e rotinização do cuidado a PVH. Na Bolívia, além da dependência externa para o financiamento há problemas de implementação e gerenciamento da provisão. O modelo avaliativo mostrou-se útil na identificação de fatores que influenciam a capacidade para sustentabilidade dos programas nesses países.
Asunto(s)
Humanos , Calidad de Vida , Infecciones por VIH/tratamiento farmacológico , Síndrome de Inmunodeficiencia Adquirida/tratamiento farmacológico , Fármacos Anti-VIH/provisión & distribución , Perú , Bolivia , Brasil , Evaluación de Programas y Proyectos de Salud , Proyectos Piloto , Desarrollo de Programa , Atención a la Salud/organización & administración , Países en DesarrolloRESUMEN
OBJECTIVE: To describe the cascade of care to HIV mother-to-child transmission (PMTCT) in a Rio de Janeiro reference paediatric clinic and evaluate the main factors possibly associated with HIV transmission. METHODS: Data on antenatal care (ANC), perinatal and neonatal assistance to HIV-infected and HIV-exposed but uninfected children assisted in the clinic from 1996 to 2013 were collected. The cascade of care was graphically demonstrated, and possible factors associated with HIV infection were described using regression models for bivariate and multivariate analysis. We imputed missing values of explanatory variables for the final model. RESULTS: A total of 989 children were included in the analysis: 211 were HIV and 778 HEU. Graphically, the HIV PMTCT cascade of care improved from 1996/2000 to the later periods, but not from 2001/2006 to 2007/2013. The main factor independently associated with the HIV infection over time was breastfeeding. In the period 1996/2000, the lack of antiretroviral use during labour was associated HIV transmission. While in 2001/2007, other modes of delivery but elective Caesarean section, and lack of maternal antiretroviral use during ANC were associated with HIV transmission. In the last period, the main factor associated with transmission was the lack of maternal ANC. CONCLUSIONS: The HIV PMTCT cascade improved over time, but HIV vertical transmission remains a problem, and better access to ANC is needed.
Asunto(s)
Fármacos Anti-VIH/uso terapéutico , Lactancia Materna , Infecciones por VIH/psicología , Transmisión Vertical de Enfermedad Infecciosa/prevención & control , Complicaciones Infecciosas del Embarazo/tratamiento farmacológico , Atención Prenatal/métodos , Combinación Trimetoprim y Sulfametoxazol/uso terapéutico , Zidovudina/administración & dosificación , Adulto , Fármacos Anti-VIH/provisión & distribución , Brasil , Lactancia Materna/efectos adversos , Contraindicaciones , Femenino , Infecciones por VIH/tratamiento farmacológico , Infecciones por VIH/transmisión , Humanos , Lactante , Fórmulas Infantiles/provisión & distribución , Recién Nacido , Edad Materna , Embarazo , Atención Prenatal/normas , Carga Viral , Adulto Joven , Zidovudina/provisión & distribución , Zidovudina/uso terapéuticoRESUMEN
Since 1996, when antiretroviral (ARV) treatments started being guaranteed to people living with HIV in Brazil, the government has faced the challenge of ensuring sustainability of this policy within a context of incorporating patented medicines. This article sought to analyze the historical series of the price of lopinavir/ritonavir (LPV/r) in Brazil and in the international market also considering the initiatives to challenge patent barriers between 2001 and 2012. The methods used were mapping initiatives to challenge LPV/r patent barriers and the analysis of historical series of its price in Brazil and in the international market. Results show that, between 2001 and 2003, there were efforts to use compulsory licensing as a threat. From 2005 to 2007, initiatives by different satkeholders were identified: declaration of public interest, pre-grant opposition ("support to examination") and civil action. From 2006 to 2008, compulsory licensing initiatives in other countries resulted in a price reduction in Brazil. Between 2009 and 2012, there was a 30% reduction in the Brazilian purchasing price.
Asunto(s)
Fármacos Anti-VIH/economía , Costos de los Medicamentos/estadística & datos numéricos , Lopinavir/economía , Patentes como Asunto/legislación & jurisprudencia , Ritonavir/economía , Fármacos Anti-VIH/provisión & distribución , Brasil , Costos de los Medicamentos/legislación & jurisprudencia , Programas de Gobierno , Infecciones por VIH/tratamiento farmacológico , Humanos , Estudios Longitudinales , Lopinavir/provisión & distribución , Ritonavir/provisión & distribuciónRESUMEN
During the 1990s, Brazil and Russia diverged in their policy response to AIDS. This is puzzling considering that both nations were globally integrated emerging economies transitioning to democracy. This article examines to what extent international pressures and partnerships with multilateral donors motivated these governments to increase and sustain federal spending and policy reforms. Contrary to this literature, the cases of Brazil and Russia suggest that these external factors were not important in achieving these outcomes. Furthermore, it is argued that Brazil's policy response was eventually stronger than Russia's and that it had more to do with domestic political and social factors: specifically, AIDS officials' efforts to cultivate a strong partnership with NGOs, the absence of officials' moral discriminatory outlook towards the AIDS community, and the government's interest in using policy reform as a means to bolster its international reputation in health.
Asunto(s)
Fármacos Anti-VIH/provisión & distribución , Infecciones por VIH/economía , Política de Salud/economía , Programas Nacionales de Salud/economía , Discriminación Social/economía , Fármacos Anti-VIH/economía , Brasil/epidemiología , Comparación Transcultural , Consumidores de Drogas/estadística & datos numéricos , Femenino , Financiación Gubernamental/normas , Financiación Gubernamental/tendencias , Infecciones por VIH/tratamiento farmacológico , Infecciones por VIH/epidemiología , Infecciones por VIH/prevención & control , Política de Salud/tendencias , Homosexualidad Masculina/estadística & datos numéricos , Humanos , Incidencia , Agencias Internacionales/economía , Agencias Internacionales/tendencias , Cooperación Internacional , Masculino , Programas Nacionales de Salud/organización & administración , Programas Nacionales de Salud/tendencias , Política , Federación de Rusia/epidemiología , Discriminación Social/legislación & jurisprudencia , Discriminación Social/tendenciasRESUMEN
Resumo: Desde 1996, com a consolidação da oferta do tratamento antirretroviral (ARV) às pessoas vivendo com HIV no Brasil, o governo tem como desafio assegurar a sustentabilidade desta oferta num contexto de incorporação de medicamentos patenteados. O artigo teve como objetivo analisar a série histórica do preço do lopinavir/ritonavir (LPV/r) no Brasil e no mercado internacional à luz de iniciativas de enfrentamento da barreira patentária no período de 2001 a 2012. A metodologia consistiu em mapeamento de iniciativas de enfrentamento da barreira patentária para o LPV/r e análise da série histórica do preço no Brasil e no mercado internacional. Os resultados encontrados apontam que, entre 2001 e 2003, identificaram-se esforços de ameaça de licença compulsória. De 2005 a 2007, identificaram-se iniciativas por diferentes atores: declaração de interesse público, subsídios ao exame e ação civil pública. De 2006 e 2008, iniciativas internacionais de licença compulsória resultaram na redução do preço no Brasil. Entre 2009 e 2012, observa-se uma redução do preço de aquisição pelo Brasil de 30%.
Resumen: Desde 1996, con la consolidación de la oferta de tratamiento antirretroviral (ARV) para las personas viviendo con VIH, el Gobierno de Brasil tiene el desafío de asegurar la sostenibilidad de dicha oferta en un contexto de incorporación de medicamentos patentados. El objetivo de este artículo es analizar la serie histórica del precio del lopinavir/ritonavir (LPV/r) en Brasil y en el mercado internacional, a la luz de iniciativas para enfrentar la barrera patentaria durante el período de 2001 a 2012. La metodología consistió en un mapeo de iniciativas para hacer frente a la barrera patentaria del LPV/r y el análisis de la serie histórica de sus precios de adquisición por el SUS y en el mercado internacional. Entre 2001 y 2003 se identificaron esfuerzos por obtener reducciones de precio de LPV/r, mediante la amenaza de expedición de licencia obligatoria. De 2005 a 2007, se identificaron varias iniciativas de diferentes actores, tales como, la expedición de declaración de interés público, preseentación de subsidios para el examen de solicitudes de patente de este medicamento y la interpesición de acción civil pública. Entre 2006 y 2008, la expedición de licencias obligatorias en el marco de iniciativas internacionales, propiciaron reducciones de precio de LPV/r en Brasil. La reducción promedio del precio de adquisición por parte SUS fue de 30% entre 2009 y 2012.
Abstract: Since 1996, when antiretroviral (ARV) treatments started being guaranteed to people living with HIV in Brazil, the government has faced the challenge of ensuring sustainability of this policy within a context of incorporating patented medicines. This article sought to analyze the historical series of the price of lopinavir/ritonavir (LPV/r) in Brazil and in the international market also considering the initiatives to challenge patent barriers between 2001 and 2012. The methods used were mapping initiatives to challenge LPV/r patent barriers and the analysis of historical series of its price in Brazil and in the international market. Results show that, between 2001 and 2003, there were efforts to use compulsory licensing as a threat. From 2005 to 2007, initiatives by different satkeholders were identified: declaration of public interest, pre-grant opposition ("support to examination") and civil action. From 2006 to 2008, compulsory licensing initiatives in other countries resulted in a price reduction in Brazil. Between 2009 and 2012, there was a 30% reduction in the Brazilian purchasing price.
Asunto(s)
Humanos , Patentes como Asunto/legislación & jurisprudencia , Costos de los Medicamentos/estadística & datos numéricos , Ritonavir/economía , Fármacos Anti-VIH/economía , Lopinavir/economía , Brasil , Infecciones por VIH/tratamiento farmacológico , Estudios Longitudinales , Costos de los Medicamentos/legislación & jurisprudencia , Ritonavir/provisión & distribución , Fármacos Anti-VIH/provisión & distribución , Lopinavir/provisión & distribución , Programas de GobiernoRESUMEN
OBJECTIVE: To document the association between supply-side determinants and AIDS mortality in Mexico between 2008 and 2013. MATERIALS AND METHODS: We analyzed the SALVAR database (system for antiretroviral management, logistics and surveillance) as well as data collected through a nationally representative survey in health facilities. We used multivariate logit regression models to estimate the association between supply-side characteristics, namely management, training and experience of health care providers, and AIDS mortality, distinguishing early and non-early mortality and controlling for clinical indicators of the patients. RESULTS: Clinic status of the patients (initial CD4 and viral load) explain 44.4% of the variability of early mortality across clinics and 13.8% of the variability in non-early mortality. Supply-side characteristics increase explanatory power of the models by 16% in the case of early mortality, and 96% in the case of non-early mortality. CONCLUSIONS: Aspects of management and implementation of services contribute significantly to explain AIDS mortality in Mexico. Improving these aspects of the national program, can similarly improve its results.
Asunto(s)
Síndrome de Inmunodeficiencia Adquirida/mortalidad , Accesibilidad a los Servicios de Salud , Administración de los Servicios de Salud , Servicios de Salud/provisión & distribución , Síndrome de Inmunodeficiencia Adquirida/economía , Síndrome de Inmunodeficiencia Adquirida/prevención & control , Adulto , Algoritmos , Instituciones de Atención Ambulatoria/economía , Instituciones de Atención Ambulatoria/provisión & distribución , Fármacos Anti-VIH/provisión & distribución , Fármacos Anti-VIH/uso terapéutico , Recuento de Linfocito CD4 , Continuidad de la Atención al Paciente , Femenino , Infecciones por VIH/tratamiento farmacológico , Infecciones por VIH/economía , Servicios de Salud/economía , Accesibilidad a los Servicios de Salud/economía , Administración de los Servicios de Salud/economía , Necesidades y Demandas de Servicios de Salud , Humanos , Modelos Logísticos , Masculino , México/epidemiología , Modelos Económicos , Mortalidad Prematura , Programas Nacionales de Salud/economía , Programas Nacionales de Salud/organización & administración , Carga ViralRESUMEN
Objetivo. Documentar la asociación entre factores de la oferta de servicios de atención de VIH sobre la mortalidad por sida en México en el periodo 2008-2013. Material y métodos. Se analizaron datos del sistema de administración, logística y vigilancia de antirretrovirales (SALVAR) y de una encuesta aplicada en unidades de atención. Se utilizaron modelos de regresión logit multivariados para estimar la asociación entre características de la oferta de servicios -en particular, de la gerencia de servicios y de la capacitación y experiencia de los prestadores- y la mortalidad por sida, distinguiendo entre mortalidad temprana y no temprana, y controlando por características clínicas de los pacientes. Resultados. Las características clínicas de los pacientes (CD4 inicial y carga viral) explican 44.4% de la variabilidad en la mortalidad temprana entre clínicas y 13.8% de la variabilidad de mortalidad no temprana. Las características de la oferta aumentan 16% del poder explicativo en el caso de la mortalidad temprana y 96% en el de la mortalidad no temprana. Conclusiones. Los aspectos de gerencia e implementación de los servicios de atención de VIH contribuyen significativamente a explicar la mortalidad por sida en México. Mejorar estos aspectos del programa nacional puede mejorar sus resultados.
Objective. To document the association between supply-side determinants and AIDS mortality in Mexico between 2008 and 2013. Materials and methods. We analyzed the SALVAR database (system for antiretroviral management, logistics and surveillance) as well as data collected through a nationally representative survey in health facilities. We used multivariate logit regression models to estimate the association between supply-side characteristics, namely management, training and experience of health care providers, and AIDS mortality, distinguishing early and non-early mortality and controlling for clinical indicators of the patients. Results. Clinic status of the patients (initial CD4 and viral load) explain 44.4% of the variability of early mortality across clinics and 13.8% of the variability in non-early mortality. Supply-side characteristics increase explanatory power of the models by 16% in the case of early mortality, and 96% in the case of non-early mortality. Conclusions. Aspects of management and implementation of services contribute significantly to explain AIDS mortality in Mexico. Improving these aspects of the national program, can similarly improve its results.
Asunto(s)
Humanos , Masculino , Femenino , Adulto , Administración de los Servicios de Salud/economía , Síndrome de Inmunodeficiencia Adquirida/mortalidad , Servicios de Salud/provisión & distribución , Accesibilidad a los Servicios de Salud/economía , Algoritmos , Infecciones por VIH/tratamiento farmacológico , Modelos Logísticos , Síndrome de Inmunodeficiencia Adquirida/economía , Modelos Económicos , Recuento de Linfocito CD4 , Continuidad de la Atención al Paciente , Fármacos Anti-VIH/provisión & distribución , Carga Viral , Mortalidad Prematura , Instituciones de Atención Ambulatoria/economía , México/epidemiología , Programas Nacionales de Salud/economíaRESUMEN
BACKGROUND: Policy makers, health staff and communities recognise that health services in lower- and middle-income countries need to improve people's access to HIV treatment and retention to treatment programmes. One strategy is to move antiretroviral delivery from hospitals to more peripheral health facilities or even beyond health facilities. This could increase the number of people with access to care, improve health outcomes, and enhance retention in treatment programmes. On the other hand, providing care at less sophisticated levels in the health service or at community-level may decrease quality of care and result in worse health outcomes. To address these uncertainties, we summarised the research studies examining the risks and benefits of decentralising antiretroviral therapy service delivery. OBJECTIVES: To assess the effects of various models that decentralised HIV treatment and care to more basic levels in the health system for initiating and maintaining antiretroviral therapy. METHODS: Search methods: We conducted a comprehensive search to identify all relevant studies regardless of language or publication status (published, unpublished, in press, and in progress) from 1 January 1996 to 31 March 2013, and contacted relevant organisations and researchers. The search terms included "decentralisation", "down referral", "delivery of health care", and "health services accessibility". Selection criteria: Our inclusion criteria were controlled trials (randomised and non-randomised), controlled-before and after studies, and cohorts (prospective and retrospective) in which HIV-infected people were either initiated on antiretroviral therapy or maintained on therapy in a decentralised setting in lower- and middle-income countries. We define decentralisation as providing treatment at a more basic level in the health system to the comparator. Data collection and analysis: Two authors applied the inclusion criteria and extracted ...
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Humanos , Fármacos Anti-VIH/provisión & distribución , Países en Desarrollo , Infecciones por VIH/tratamiento farmacológico , Accesibilidad a los Servicios de Salud/organización & administración , Cumplimiento de la Medicación/estadística & datos numéricosRESUMEN
Haiti is the poorest country in the Western Hemisphere and has the highest number of people living with HIV in the Caribbean, the region most impacted by HIV outside of Africa. Despite continuous political, socioeconomic and natural catastrophes, Haiti has mounted a very successful response to the HIV epidemic. Prevention and treatment strategies implemented by the government in collaboration with non-governmental organizations have been instrumental in decreasing the national HIV prevalence from a high of 6.2% in 1993 to 2.2% in 2012. We describe the history and epidemiology of HIV in Haiti and the expansion of antiretroviral therapy (ART) over the past decade, with the achievement of universal access to ART for patients meeting the 2010 World Health Organization guidelines. We also describe effective models of care, successes and challenges of international funding, and current challenges in the provision of ART. We are optimistic that the goal of providing ART for all in need remains in reach.