UNAIDS’ ‘‘90-90-90’’ strategy calls for 90% of people with HIV to be diagnosed, 90% of those diagnosed to be on anti-retroviral therapy (ART) and 90% of those on ART to achieve sustained virologic suppression. Additionally, growing numbers of countries are adopting the universal test and treat model, in which all people diagnosed with HIV receive ART regardless of CD4 level. It is widely recognized that these strategies will challenge public health systems in resource-limited settings, including global and local supply chain systems.
For supply chains, each of the ‘‘90s’’ presents complications and challenges in getting to 90-90-90 by the 2020 target date. Ensuring that 90% of people with HIV know their status will require a large increase in access to HIV tests, often in unconventional settings. The number of people living with HIV and on treatment must rise from the current level of around 17 million to close to 30 million by 2020, a near doubling of the demand for anti-retroviral (ARV) drugs. Similarly, monitoring those on treatment means an unprecedented scale-up of viral load testing.
The Partnership for Supply Chain Management (PFSCM) will host a luncheon and panel discussion at the International AIDS Conference in Durban, South Africa to discuss the procurement, supply chain and logistics challenges in reaching each of the 90-90-90 targets (see below for event details). Funding will obviously be key, and innovative solutions and reforms to the supply chain in developing countries will be essential, but we believe it can be done.
It is important that the fight against HIV continues to be led by governments, primarily through the Ministry of Health, but also include Ministries of Finance and Trade or similar institutions, to set policy and goals, although it is not necessary for the response to be solely from the public sector. The private sector and voluntary and community groups also have much to offer. This is especially true for supply chains.
The commercial private sector is already essential to combating HIV, whether by producing drugs, diagnostics and other health commodities or by transporting those products from the manufacturer to the countries heavily affected by the pandemic. But there is much more that the private sector, for-profit, and not-for-profit organizations can do, especially in supporting and extending in-country supply chains to the so called “last mile,” before the drugs get to patients. There are also many lessons we can learn from the commercial sector in creating and sustaining flexible, responsive supply chains that keep essential goods in constant supply. We are confident that the supply chain can respond as needed, but it won’t be easy and will need dedication, planning, daring, and innovation.
The supply chain challenges and opportunities in treating all those living with HIV and reaching the 90-90-90 targets are further discussed in a new paper from PFSCM published in the Journal of the International AIDS Society entitled “The 90 90 90 strategy to end the HIV Pandemic by 2030: Can the supply chain handle it?”
If you are at the International AIDS Conference in Durban, please join us for lunch and the panel discussion on Wednesday, July 20, 12:45-14:00 at the Rainbow Terrace Restaurant of the Hilton Hotel. We look forward to seeing you there!