TLD as first-line treatment for adults will change the market in a big way

by | Feb 12, 2018

The generic antiretroviral (ARV) market will be in a state of transition in 2018 with the introduction of a new fixed-dose combination (FDC) to serve as an alternative first-line treatment for adults. The product, known as “TLD,” is a single pill comprised of tenofovir disoproxil fumarate (TDF), lamivudine (3TC), and dolutegravir (DTG).

Demand for TLD is expected to be significant


The ARV Procurement Working Group (APWG) – in coordination with various procurement agents, donors, and other partners – has compiled key recommendations for procurement of TLD to help country programs prepare adequately for this transition. Read the full announcement here…

Ultimately, the goal is to ensure all patients, both new and existing, have access to a sustainable supply of ARVs before, during, and after the transition to TLD, while attempting to limit the amount of wasted legacy ARV stock.

Speaking during a webinar arranged by the ARV Procurement Working Group on February 8, 2018, Vineet Prabhu, Associate Director of HIV Market Intelligence at of the Clinton Health Access Initiative (CHAI), noted that with the launch of TLD, it will be the first time that a best-in-class treatment is made available to the market at a lower entry price than the current standard of care.

He added that TLD is creating a lot of movement in the market with orders actively being placed.


Supporting the supply chain


PFSCM Global Supply Chain Director and ARV Procurement Consortium (part of the APWG) chairperson Wesley Kreft also presented on the occasion, recapping the history of the working group and the role it will play in supporting stakeholders during this market transition.

Kreft explains that the APWG has always had a firm grip on the general ARV market even when it was just supporting paediatric programs.

“About seven years ago, ARV stakeholders were trying to navigate a small but complex market that had around 65 different paediatric ARV formulations, which made visibility into volumes and capacity extremely challenging for those involved in the supply chain. The APWG provided insight into these challenges and supported the supply chain through stakeholder engagement and pooled procurement initiatives that helped align the sector, stimulating demand and improving service delivery.

In 2016, the then Paediatric ARV Working Group (PAWG), underwent its own transition, becoming the APWG to support the procurement activities of adult formulations as well. With many years of experience under its belt, the APWG is well positioned to now assist even more stakeholders in adapting to this market transition.

“The APWG will be engaging with donors, recipients, and suppliers to ensure that old products are phased out appropriately, that healthy demand for TLD is stimulated, and that supply remains reliable.”

Kreft concluded that the working group and PFSCM strongly encourage initiatives that make new drugs available to patients at affordable prices.


About the ARV Procurement Working Group (APWG)


In early 2016, the Paediatric ARV Procurement Working Group (PAPWG) broadened its mission to include select adult ARVs, a change reflected in the group’s new name: the ARV Procurement Working Group (APWG). The expansion has allowed the working group to continue its support of at-risk paediatric ARVs while also enabling the same coordination and collaboration to be applied to adult products with challenging market conditions.

Under the Supply Chain Management System (SCMS), PFSCM was a founding member of the PAPWG, an effort to pool the requirements for paediatric ARVs to create and manage sufficient demand to keep the market attractive to suppliers. By coordinating the demand of major purchasers — such as PFSCM and the Global Fund to Fight AIDS, Tuberculosis and Malaria — with demand from smaller countries, supply became more consistent and flexible. PAPWG results are described in a paper published on the Global Fund’s website.

The APWG’s Procurement Consortium is chaired by PFSCM’s Director of Global Supply Chain Wesley Kreft.