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Agency Warns COVID-19 Threatens Access to HIV Medications

  • 1Consulting Editor, JAMA Health Forum and JAMA

A total of 73 countries—more than one-third of the world’s nations—warn that they are at risk of running out of life-saving antiretroviral (ARV) medications because of disruptions to supply lines and other problems stemming from the COVID-19 pandemic.

Moreover, 24 of the 73 countries report already having “critically low stocks” of ARVs or disruptions in the supply of these medicines. These findings, announced earlier this month, are from a survey conducted by the World Health Organization (WHO) following a modeling exercise that the WHO and the Joint United Nations Programme on HIV/AIDS (UNAIDS) convened in May.

The WHO noted that in those 24 countries currently experiencing supply shortages, an estimated 8.3 million people—about one-third of all people receiving HIV treatment worldwide—were receiving ARVs in 2019.

“The findings of this survey are deeply concerning,” said WHO Director-General Tedros Adhanom Ghebreyesus in a statement. “We cannot let the COVID-19 pandemic undo the hard-won gains in the global response to this disease.”

Among the causes for disruptions cited in the survey were failure of suppliers to deliver ARVs on time, difficulties with land and air transport services, and limited access to health services within countries.

A recent analysis from UNAIDS also found that the production of ARVs has been affected by a number of factors stemming from the massive, rippling effects of the COVID-19 pandemic, such as a shortage of precursors to active pharmaceutical ingredients resulting from the shuttering of factories in China during the first quarter of 2020. Although those factories resumed operation, the effects are still being felt, because problems transporting those materials are ongoing. A sharp reduction in air and sea transport is slowing the distribution of the raw materials and products such as packaging materials that drug companies need to manufacture medications.

For example, shipments by sea have been slowed in many countries by a lack of customs personnel, shortages of workers to load and unload ships, and a reduced availability of road transport to move goods to ports, the UNAIDS analysis noted. The cost of air cargo has surged because only a few air cargo companies are operating in some of the key countries that produce HIV/AIDS medications. The pressure on available cargo space has been exacerbated by the large reduction in the number of passenger flights (which also carry freight) during the pandemic.

In addition, physical distancing and lockdowns reduce the number of workers available in manufacturing facilities.

The modeling exercise convened by the WHO and UNAIDS predicted that a 6-month disruption of ARV therapy for people living with HIV/AIDS could result in doubling HIV-related deaths over a 1-year period, causing, for example, more than 500 000 extra deaths from AIDS-related illnesses in sub-Saharan Africa in 2020 and 2021.

In addition to problems with the supply of medications, COVID-19–related disruptions might lead to substantial increases in ARV prices from manufacturers, such as those in India (a major global producer of generic ARVs). According to UNAIDS’s analysis, a 10% to 25% increase in costs due to the pandemic could make the final cost of ARVs exported from India between $100 million and $225 million more expensive per year than in the past.

The agency recently developed guidance for affected countries on how to safely maintain access to essential health services during the pandemic, such as HIV treatment and testing clinics. Among other measures, it advised countries to consider “multi-month dispensing” for AIDS drugs—prescribing medications for up to 6 months—and 129 countries have adopted this policy to date.

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    1 Comment for this article
    Access to HIV Medications Threatened by COVID-19
    Michael McAleer, PhD (Econometrics), Queen's | Asia Universty, Taiwan
    A lack of ARV medications would likely lead to a substantial increase in deaths from HIV.

    For healthcare public policy decision making purposes, it would be useful to calculate the number of HIV patients taking ARVs who have been found to be:

    (1) COVID-19 positive;

    (2) immunized against COVID-19

    Such information would assist in determining the amount of effort that should be directed by the World Health Organization (WHO) and (inter) governmental instrumentalities in improving the supply chain and other factors to improve access to HIV medications that are threatened by COVID-19.